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GPs 'not expected' to see Covid-19 patients booked in by CCAS face to face

There is no expectation that patients being booked in for appointments with their GP by NHS 111's Covid clinical assessment service (CCAS) will 'turn up' at practices, NHS England has clarified.

Earlier this week, NHS England announced temporary contractual changes stipulating that GP practices must free up one appointment per 500 patients every day for direct booking by NHS 111/CCAS.

However, in a live webinar for GPs last night, NHS England made clear this did not mean patients with Covid-19 symptoms would present at GP surgeries.

Director for primary care strategy and contracts Ed Waller said: 'These are not the same appointments in form and feel as the ones that you're used to allowing NHS 111 to book into. These are simply a way of transferring patients who need contact from their GP into the workflow of GPs in their practice.

'They are not booking people into specific time slots with any expectation that they will turn up in the surgery, for example.'

The CCAS, which is staffed by clinicians, has been set up as an extension to NHS 111 during the Covid-19 outbreak to triage patients when the algorithm used by call handlers has been unable to determine whether or not they need hospital admission.

Also speaking in last night's webinar, NHS England digital lead Dr Masood Nazir said GPs should be able to manage this 'small number' of patients by telephone or video consultation.

He said: 'The practice will look at the patient's details to make contact with them by telephone, by video consultation or in some cases be able to offer them advice on something they need.'

Dr Nazir added that NHS England is hoping to publish a standard operating procedure on the CCAS direct booking system 'in the next couple of days'.

The temporary amendment to the GP contract, which also says NHS England and the health secretary can take control of practices' 'whole appointments book' for Covid-19 patient referrals, is effective until 30 June.

NHS 111 uses use an algorithm to sort patients with Covid-19 symptoms into cohorts, including those with severe symptoms who require an ambulance, those with mild symptoms, and those who require further clinical assessment by CCAS.

GPs have been asked to 'proactively manage' patients referred to them by the CCAS, and also to offer up their spare time to staff the telephone service.

Patients with Covid-19 symptoms are being directed to NHS 111 as a first port of call, but in instances where patients have been unable to get through to 111 - which is experiencing record call volumes - GPs have been asked to avoid 'looping' them back.

NHS England's stages of assessment of patients with coronavirus symptoms 

NHS 111 has been commissioned nationally to provide a dedicated Covid-19 response service to free practices to focus on managing those most at risk of complications from Covid-19. A consistent algorithm will be used to stream patients into the following cohorts:

• Cohort 1 – patient demonstrating severe symptoms, requires treatment in hospital and will likely require an ambulance response

• Cohort 2a – symptomatic patients requiring further clinical assessment before final disposition is decided (these are referred to the Covid Clinical Assessment Service or CCAS)

• Cohort 2b – patient exhibiting mild symptoms but has self-declared high at risk status, having received a letter from the NHS – a post-event message recording this contact will be sent to registered GP for information

• Cohort 3 – patient is showing mild symptoms and advised to self-isolate at home and to reassess via NHS 111 (online whenever possible) if symptoms deteriorate (GP informed via a post event message).

Where CCAS assessment is required, this will result in one of the following outcomes:

• reclassification as cohort 1 – patient demonstrating severe symptoms, requires treatment in hospital and will likely require an ambulance response

• reclassified as cohort 3 – patient is showing mild symptoms and advised to self-isolate at home and to reassess via NHS 111 (online whenever possible) if symptoms deteriorate (GP informed via a post-event message and call closed)

• requires proactive action from practice – eg telephone monitoring

• requires face-to-face assessment in primary care; message sent to appropriate service to arrange.

 Source: NHS England's Preparedness update letter for general practice: 27 March 2020 

Readers' comments (10)

  • So, 111 go through the signs and symptoms and then transfer them to us to.................go through the signs and symptoms?

    Sounds like a great use of time.

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  • John Sanfey

    The challenge for any GP, including those in CCAS is being able to identify patients with viral pneumonia, esp between day 6-12, that do not obviously need hospital admission. Some of them feel deceptively well, even with O2 sats

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  • Listening to the World at One today, I'm hearing that to get mass community testing of COVID, the responsibility will fall upon GPs and the care sector. Surprise and indignation have now become a numb feelings.

    So, I am expecting much more.

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  • More work? What's new?

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  • As an older GP locum I've been approved for telephone assessment for the CCAS limb of 111. Lots of stuff to take on board online; Adastra and "Senior Clinician" mode as well as other training modules and verification of ID, DBS, registration etc. I'm still a bit perplexed as to how much this extra triage layer will help but this article would indicate we can't refer Category 2a patients for GP F2F consults , just round 3 of triage. If we can't do this there's no point in the CCAS.

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  • John Cahill, there is no point in the CCAS except where it directs patients to self care. Even though you personally are probably excellent, I am not going to put myself or my colleagues at risk unless I have confirmed that it's an appropriate level of risk. I cannot rely on someone else to make that decision for me.

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  • I'm also a national-pension-drawing GP who is working for the COVID 111 service. In normal times I still see patients. On the COVID 111 system I have only referred people to their GP whom I don't feel have Covid. Even then, I do not expect their GP to see them (so far). I'm tolerating quite a high-sounding level of breathlessness with careful, I hope, safety netting. My overwhelming impression (as it always has been) is that 111 is a system that attracts people who should be phoning me at the surgery direct. It encourages more people to phone and deals inefficiently with the consequences. The genie is well and truly out of the bottle.

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  • DrDoTooMuch thanks for your comment - I agree it's always safer and more effective to do triage for one's self. Unfortunately NHSE don't allow locums to do triage work within a practice unless you have a pre-existing contract so CCAS is the only way we can help the COVID campaign . If this is the general feeling of GPs I'll have to reconsider .

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  • This sounds like a typical government response which adds in more complex control loop and new systems when existing ones are in place. CCAS seems to have been put in as another tier, rather than integrated into 111 or General Practice.

    1) Patients ringing 111 inappropriately with other stuff in hours just should be told to ring GP. No complex referral needed.
    2) Patients with likely covid who are mild need to stay at home - 111 can cope with these.
    3) Patients deteriorating day 8-12 need to be in hospital- 111 with CCAS should be able to make decisions on this.
    4) Anything that 111/ CCAS needs our help on - PICK UP THE PHONE to us. We can help

    Making us read through an incoherent 3 page reports won't help patient care, nor will spending hours on IT appoointment release, and checking if these are filled.

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  • You really couldn’t make it up. Gp practices and hospitals in many areas are doing a fraction of their normal work, unless you count reading constantly changing policies as work that is.
    And patients are being handled by phone I think ( not video is that correct ? ) by retired doctors who don’t have access to their gp records rather than by their own GPs.
    When they do get passed on to us from 111 it makes it more difficult to deal with them not easier.
    Dear 111 doctors, surely you are only needed in the areas where GPs are off sick or overloaded. You need to tell your bosses that and perhaps resign as you may not be helping

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