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The waiting game

GPs could face contractual imposition if they refuse to staff Covid centres

GPs in Northern Ireland have been warned that they may be forced to staff Covid-19 'hot hubs' via imposed contractual changes, unless they volunteer their services.

A letter to GPs, from the Northern Irish Department of Health, said this comes as a 'small number of practices' have 'declined to participate in the operation of the centres', which have been set up to assess symptomatic patients.

But GPs said the reasons they declined were related to staff pressures and health concerns, with some taking legal advice in response.

The letter, from the NI Department of Health permanent secretary and chief executive of health and social care Richard Pengelly, said: ‘A small number of practices, including your own, have... declined to participate in the operation of the centres. I would encourage you to urgently reconsider this decision.'

He said this comes as GPs' 'skills and experience are vital to tackling this pandemic and it is essential that all of general practice engages with, and commits to, the primary care Covid-19 centres, to enable us to maximise our effectiveness in tackling this pandemic'.

The letter, sent last Friday, said: ‘We judge that the primary care Covid-19 centres are an essential tool in fighting this pandemic. In the absence of your participation in this project, you will need to provide us with written assurance as to the care of your patients.

'Should this assurance not be forthcoming and sufficiently comprehensive, I will give further consideration to the imposition of a contract variation.'

According to Mr Pengelly, contractual imposition would be 'in line with my duty to take all necessary steps during this pandemic to protect the public'.

But he added: ‘I hope, however, that you will choose to commit to supporting the operation of the primary care Covid-19 centres, thereby standing alongside your colleagues to ensure that we are doing everything we can to reduce the impact that Covid-19 has on the people of Northern Ireland.’

A local GP, who asked to remain anonymous, told Pulse: ‘Despite saying they were voluntary to GP partners, 100% sign-up was expected, and the letter went to those unable to fulfil this - some because they’re single-handed GPs, some as they had underlying medical conditions.'

The GP added that there was 'anger felt by GPs here' who feel the Covid centres were 'non-evidence based' and drawn up without consultation with grassroots GPs - despite input from BMA Northern Ireland and the RCGP.

They said: ‘The centres have been very overstaffed and underused, meaning surgeries have fewer GPs. Lots of GPs have concerns about centres potentially being a source of Covid spread, and a home visiting-style service would be far preferable.

‘It’s the unilateral attempted rip-up of the GMS contract and altering times - centres opened til 10pm - that means a cohort of GPs are seeking legal advice.’

An NI Department of Health spokesperson said: ‘The letters to GPs are self-explanatory. A large majority of GPs are contributing to the vital work of the Covid-19 primary centres and our thanks go to each of them for their important contribution.’

The BMA Northern Ireland GP Committee said it collaborated with the Northern Ireland Department of Health, Health and Social Care Board and RCGP to design the centres because they are 'a very important part of the Northern Ireland response to Covid-19.’

NI GPC chair Dr Alan Stout said: ‘With regard to the opening of the Covid centres in Northern Ireland, the response within general practice has been quite remarkable, with 99% of practices engaged and fully participating in the Covid centres as part of the response to the challenge that faces us with the pandemic.

‘Our two main aims in setting them up were first to protect practices and their staff, and ensure that they were sustained and in a position to very importantly deliver the ongoing medical need that still exists in a pandemic without the risk of staff exposure and contamination.

‘The second aim was to ensure a safe and effective service for those patients with suspected or worsening Covid symptoms, and by doing this in a safe and controlled environment we have been able to minimise the risk to GP’s and all other health care workers.'

In England, GP practices that do not have a ‘hot hub’ within their PCN have been told that they should set up ‘hot’ and ‘cold’ zones within the practice, to separate symptomatic and non-symptomatic patients.

Readers' comments (49)

  • There is no evidence that hot hubs save lives.

    COVID19 patients can die of 'silent hypoxia' i.e. low sats in the absence of breathlessness which typically occurs in week 2 of the illness. These means that continuous remote oximetry is more likely to be a successful strategy.

    What we do know is that coronavirus spreads indoors and that a recent HSJ analysis on who is dying shows that front line anesthetists were protected by wearing PPE whereas workers in other environments seem to be at greater risk of death.

    What is needed here is criminal prosecution of those who are forcing staff to put themselves at risk without adequate protection. This is a national scandal of epic proportions.

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  • I see an officer with a loaded pistol aimed at a conscientious objectors head as he’s about to enter no mans land.

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  • Well as an NI GP what Alan stout has said is wrong
    Most GPs are not happy with these centres but are too afraid to speak out and rightly so as we are being threatened with contractual change if we don’t cooperate
    We can’t enlist the help of the BMA and the BMA rep was one of the four people who came up with the covid centre design
    Letters and contact to head BMA office have been unsuccessful in getting any meaningful response

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  • Just say no

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  • We do our covid sessions in (NI) not because we want to but because we have been mandated to comply, it is wrong and poorly thought out project, but if we didn’t agree to working in them then we risked severe sanctions from (NI) department of health
    Dr Stout is proud that 99% of practices complied, we had no option other that to agree, shame on you bma, rcgp and hscni
    Forced into centres against our will with poor PPE and little evidence base.....
    This is not good!

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  • This is truly shocking , shameful and reckless behaviour being demonstrated by BMA, RCGPNI and federations and may lead to the destruction of GP partnership in NI

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  • Hothubs done the wrong way may well turn out to be incubators of infection , expose people to very high viral loads and cause vector enhancement in the well established ‘cluster’ pattern of local community outbreaks

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  • One may feel a professional or moral obligation but a contractual obligation is several steps too far.
    This diktat is going to have very profound repercussions in the fullness of time.
    There may well be legal avenues open to relatives.
    Look at what is happening Italy - class actions begin to emerge.

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  • When did the BMA and GPC become an arm of Government?

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  • An appalling abuse of power by 'our' self elected leaders in BMA/RCGP/Federations here in NI; this flawed project has very little support on the ground; NI GP will now suffer confidence issues for many years to come; cue early retirements etc

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