In a letter to NHS organisations on 17 March, NHS chief executive Sir Simon Stevens said that COVID-19 'presents the NHS with arguably the greatest challenge it has faced since its creation'.
The letter, which came as the NHS chief told MPs on the House of Commons health select committee that non-urgent surgery would be suspended from mid-April - or potentially earlier in some hospitals - called for providers to shift away from face-to-face contact with most patients by offering video, telephone, email and text services.
NHS England confirmed a further 14 deaths in patients infected with coronavirus on 17 March - taking the total to 67, with 1,950 cases now confirmed UK-wide.
Patients in high-risk groups, who are expected to be told within days to isolate themselves for a period of 12 weeks or more, will be identified and contacted in the coming week by the health service.
These patients will need 'enhanced support' from their GP practices, the letter says. It adds: 'GP services should agree locally which sites should manage essential face-to-face assessments. Further advice on this is being developed jointly with PHE and will be available this week.'
The letter offers a guarantee that from 1 April, practices' QOF and enhanced services income will be protected as part of a plan to review and 'where appropriate temporarily suspend certain requirements on GP practices'.
It says: 'The key principle is that from 1 April we free up practices to prioritise workload according to what is necessary to prepare for and manage the outbreak, and therefore guarantee that income will be protected if other routine contracted work has to be substituted.
'This does not prevent us from continuing to measure activities (for example those undertaken with QOF) but it ceases to put 2020/21 income at risk for performance.
'We will make sure that funding does not influence clinical decision making by ensuring that all GP practices in 2020/21 continue to be paid at rates that assume they would have continued to perform at the same levels from the beginning of the outbreak as they had done previously, including for the purposes of QOF, DES and LES payments.'
The letter makes clear that CCGs should plan to pay practices on this basis - and that additional costs will be reimbursed by NHS England.
However, the letter does not make clear whether any flexibility is planned for payments relating to the current financial year. Practices face heavy workload in the run-up to 31 March as they update achievement data - and LMCs have called for urgent guidance.
The letter confirms moves such as the decision to suspend CQC inspections on GP practices, to commission out-of-hours providers to offer home-based care for patients with confirmed coronavirus infection.
The NHS People Plan - expected to set out workforce proposals for the health service will be suspended, along with a planned update to the NHS Long-Term Plan, while CCGs would be asked to work with local authorities to commission additional 'step-down' care facilities to allow more patients to be moved out of hospital during the outbreak.
CCGs will also be reimbursed for an 'NHS urgent medicines supply service for patients whose GP practice is closed' and for a medicines delivery service to support patients with confirmed COVID-19 infection or vulnerable patients self-isolating at home.
The letter from Sir Simon says staff and organisations across the service will have to pull together 'in a nationally co-ordinated effort' to deal with a 'fast moving' situation during the coronavirus outbreak.
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