Covid-19: GPs can limit routine work to focus on vaccination, says NHS England

Abstract

In a letter to general practitioners and local commissioners sent on 7 January, NHS England set out measures designed to reduce practices’ workloads while protecting their income to help them deliver covid-19 vaccinations.1 The letter urged local commissioners to “take a supportive and pragmatic approach to minimise local contract enforcement across routine care, with attention and support focused on the core areas.” The measures come after NHS England promised to remove “‘unnecessary contractual burdens” to help practices prioritise covid vaccinations.2 Alongside the vaccination programme, priority areas for practices should be supporting the rollout of covid oximetry at home, supporting patients with long covid, supporting clinically extremely vulnerable patients, tackling the backlog of appointments, and making substantial progress on learning disability health checks and ethnicity recording. [...]a letter from the NHS North Central London clinical commissioning group to GPs sent this week, also seen by The BMJ, asked practices to “stand down non-essential work” until at least 15 January to “focus on urgent care including care home support, serious acute illness, and deterioration in long term conditions.” Freeing up practices to support COVID vaccination. 7 Jan 2021. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C1026_Freeing-up-GP-practices-letter_070121.pdf 2 NHS England.

General practices can suspend some non-essential work to allow them to focus on delivering covid-19 vaccinations, NHS England has said.

In a letter to general practitioners and local commissioners sent on 7 January, NHS England set out measures designed to reduce practices’ workloads while protecting their income to help them deliver covid-19 vaccinations.¹ The letter urged local commissioners to “take a supportive and pragmatic approach to minimise local contract enforcement across routine care, with attention and support focused on the core areas.” But it stressed that GPs should ensure that “general practice remains fully and safely open for patients, including maintenance of appointments.”

Most locally commissioned enhanced services should be suspended, except when these are specifically in support of vaccination or other covid-19 related support such as reducing hospital admissions, the letter said. Payment for all enhanced services “should be protected to allow capacity to be redeployed,” it added.

Income from the Quality and Outcomes Framework will also be protected, and appraisals need not take place during the vaccination programme. Funding allocated to primary care networks to pay their clinical directors will increase from 0.25 to 1 whole time equivalents) between January and March “in recognition of the additional demands on the role in managing the covid response,” NHS England said.

The measures come after NHS England promised to remove “‘unnecessary contractual burdens” to help practices prioritise covid vaccinations.² Alongside the vaccination programme, priority areas for practices should be supporting the rollout of covid oximetry at home, supporting patients with long covid, supporting clinically extremely vulnerable patients, tackling the backlog of appointments, and making substantial progress on learning disability health checks and ethnicity recording.

Richard Vautrey, chair of the BMA’s GP committee, said, “GPs and their teams want to get vaccines into the arms of as many people as possible as quickly as they can. This will ultimately depend on supplies but also being given the flexibility to let them focus on the vaccination campaign as a priority.”

The letter came after practices across London had already been told by commissioners to stop non-essential work. A letter from the North West London collaboration of clinical commissioning groups to practices on 29 December, seen by The BMJ, said, “Based on the [Royal College of General Practitioners’] guidance, primary care is now at level 5 response. We are therefore now communicating to all practices to stand down non-essential work.”

And a letter from the NHS North Central London clinical commissioning group to GPs sent this week, also seen by The BMJ, asked practices to “stand down non-essential work” until at least 15 January to “focus on urgent care including care home support, serious acute illness, and deterioration in long term conditions.”

Lisa Harrod-Rothwell, deputy chief executive officer of Londonwide local medical committees, said, “London’s GPs and practice teams are working flat out to keep services as safe and accessible as possible during the covid-19 pandemic. As with the first peak in cases, they will be switching to focusing on essential services due to the unprecedented volume of patients seeking care, stringent infection control measures and the impact of illness and isolation requirements on workforce availability.”

¹ NHS England. To: GPs in England, regional directors of primary care and public health and CCGs. Freeing up practices to support COVID vaccination. 7 Jan 2021. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C1026_Freeing-up-GP-practices-letter_070121.pdf

² NHS England. Primary care bulletin—today’s special edition. 30 Dec 2020. http://createsend.com/t/d-D77E837149CA59B22540EF23F30FEDED