Routine GP contract work suspended as BMA warns support for practices must go further

Practices can suspend routine work such as health checks and have been promised QOF pay top-ups for this year under measures set out by NHS England - but GP leaders have warned support must go further.

NHS England has cut back GP contract requirements (Photo: Universal Images/Getty Images)
NHS England has cut back GP contract requirements (Photo: Universal Images/Getty Images)

NHS officials have pledged that practices whose QOF income for 2019/20 drops compared with the previous year 'as a result of COVI9-19 activities' will have their income adjusted. The move comes after NHS chief executive Simon Stevens confirmed earlier this week that QOF pay for 2020/21 would be protected.

Requirements for PCNs under the network DES have been relaxed - with deadlines for structured medication reviews pushed back to October, and a workforce planning deadline under the additional roles reimbursement scheme moved from June to the end of August.

GP practices have also been told they are free to suspend routine health checks, new patient reviews, clinical reviews of frailty, friends and family test and other measures - and that regulations are being changed to prevent practices facing contract remedial action from commissioners.

GP workload

A letter from NHS England primary care director Dr Nikki Kanani and primary care strategy director Ed Waller spelling out the changes also confirms local commissioners have been urged to stop audits, data collection and local enhanced services that could add to pressure on GP practices - and to support practices to procure equipment to shift rapidly to digital appointments.

BMA leaders, however, have warned that the measures are no more than an important 'first step' to support practices coping with 'significant strain' during the coronavirus pandemic.

BMA GP committee chair Dr Richard Vautrey warned that practices will need a long time to recover from the impact of huge changes to the way they work during an outbreak that looks set to stretch NHS resources to the limit over the coming months - and that short-term changes to requirements for practices would not be enough.

Dr Vautrey warned: 'Practices – and the whole NHS – are now facing an incredibly challenging few months, and as the BMA continues to stress, if we are to stand the best chance of minimising the impact of COVID-19, there must be significant changes to the way the system operates.

COVID-19 demand

'GPs and their teams are already feeling the significant strain of increased demand – and in many cases staff absences – which is why it’s vital that all efforts are focused on treating those patients who need them most.

'This means removing bureaucracy and suspending many elements of routine care, such as planned annual reviews and health checks for patients. While we recognise this will be frustrating to some patients, it is vital so that GPs and other practice staff can prioritise those who are most ill. To be clear, urgent cases will still be treated as is clinically necessary.

'Today’s measures from NHS England however can only be the first step. While commitments to guarantee payments to practices in the coming year are important, practices expect bold and clear action, that gives them confidence to focus on the emergency at hand.

'A short-term suspension of QOF and the PCN service specifications is unsustainable – COVID-19 will have a severe and prolonged impact on how general practice operates and in addition practices will need time to recover. The idea that it will be business as usual by October is not in line with the evidence and projections, not least as this could be the very time a second wave of infections starts to circulate. These elements need to be suspended for the full year at least, and until practices are back on sustainable footing.

PPE concerns

'With practices already raising serious concerns about poor access to PPE – which must be addressed as an absolute priority – and managing potentially significant numbers of staff absences, practices need certainty and a clear message from NHS England that they are trusted to make the best decisions for their patients.'

The NHS England letter says GP practices should focus on six key priorities - moving to a 'total triage' system by phone or online, choose which premises locally should deliver urgent face-to-face appointments, consult remotely where possible, prioritise support for high-risk patients, prepare for a rise in home visits to support older patients self-isolating and work together locally to develop primary care resilience.

The letter adds: 'We will seek to do all we can to support practices to manage inevitable increases in workload at this extremely difficult time.'

The letter comes as the number of confirmed coronavirus cases in England rose beyond 100 on 18 March, as the government's chief scientific adviser suggested the true number of cases in the UK may now have passed 50,000.

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