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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.

Related images

  • coronavirus quarantine getty rf cms

Readers' comments (49)

  • The question I have is: are the GPs paid for their services, and why shouldn’t the staffing be on a voluntary basis? I believed our work was not that of indentured servitude?

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  • David Banner

    Outrageous, if not surprising.
    - hot hubs bear all the hallmarks of the back of the envelope thinking that has engulfed desk jockeys desperately trying to justify their existence during Covid
    - patients were told to “stay home” and avoid surgeries, sensible advice
    - telephone triage can easily divide patients into 3 groups....
    a- stay home
    b- go to A&E
    c- we’ll send out a car to assess you
    - group C is very small, and the up-skilled, PPE possessing medical staff manning the cars are doing a terrific job assessing these patients whilst keeping everyone else safe
    - dragging a suspected Covid to a hub is an obvious danger to the public and medical staff, not least the poor relative in the car driving them there.
    - most hubs are seeing literally 1-2 patients a day, an obvious waste of valuable resources
    - practices losing a GP for a week at the hub can then lose them for a second week of isolation, doubling the pressure on remaining partners
    - God help the single handers!
    - how can this possibly be compulsory? Surely conscripts have to sign a medico-legal waiver? Without a waiver there could be massive implications if a conscripted nurse contracts Covid at a hub and (rightly) sues. And no reluctant conscript will sign a waiver....
    - since we are already past the peak, and hubs have pitifully few patients, why on Earth are they being extended and made compulsory?

    Leave individual practices to make there own arrangements. We can handle this just fine on our own, thanks, as we have done for decades, without useless, dangerous, ignorant and authoritarian interference from people who have no idea what goes on in the trenches.

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  • David Banner

    “their own”, sorry

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  • Yet your covid 19 red zone patients are being seen for you. I am not a member of BMA RCGP and can be as defensive as the next GP but I think we need to come out of our trenches for this one. These patients need seen and should someone else take the risks on your behalf? By the way I am at hot hub right now. It is not that busy

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  • Bullying into COVID incubation hubs offers no benefit to anyone. We know our own patients and more importantly our patients trust our advice. These hubs offer no treatment and add nothing only anxiety and risk for all concerned. GPs in NI will not be cajoled or bullied and if necessary will talk with their feet.

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  • If you buy into the idea that the lockdown was implemented to buy the UK time to increase NHS testing capacity and to increase Hospital beds whilst pursuing herd immunity then the idea that GPs will be assessing patients in the community when the 2nd wave comes makes sense as it may be bigger and last for longer.

    Getting GPs in place, forming a rota between local surgeries is something that might be necessary if there is likely to be a surge in demand in the next few months.

    I never felt comfortable with the abdication of responsibility to non medical call handlers via 111 during the first few weeks of the crisis. It was confusing for the patients and often left them in no mans land.

    Whilst I don’t think you should be contractually forced to assess COVID patients - refusing to do so when you’re not on any of the medically vulnerable lists is difficult to understand. I would extend this to vulnerable contacts at home.

    The job needs to be done and due to the “silent hypoxia” group there is a need to perform an assessment face to face. If you REFUSE to do it. Then fine. Good for you. You have successfully reduced your risk knowing that someone else must step into your place.

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  • GP Wales I note no name
    We either do the shifts or are obliged to pay locums to gdo them
    We wanted to see the pts in our own surgeries but were told we wouldn’t know how to clean the rooms etc and were threatened with “sanctions”
    Btw we have much better ppe in our surgeries that we have bought and obtained ourselves

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  • a lot of the upset was to do with the imposition of evening and weekend working as well as complicated arrangements for renumeration of locums through practices- it wasnt clear why the evening and weekend shifts (paid at £100/hr) couldn't have been offered out to all GPs- in the same way as OOH shifts

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  • barely any patients at all attending our HUB at present.

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  • As a semi-rural GP in Northern Ireland , these Covid Centres risk spreading the virus from high incidence to low incidence communities. GPs working in these centres will be vectors for the virus passing it on to their practice colleagues, staff and patients. This public health madness , and potentially disastrous. Look what is happening in nursing homes.

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