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GPs go forth

GPs should only resume routine work if it is ‘safe’ to do so, says NHS England

GP practices should resume routine work only if it can be done ‘safely’, NHS England has said.

They should consider different ways of delivering care, such as through group video consultations across PCNs, NHS England’s medical director for primary care said.

GP leaders welcomed the flexibility but said that assessing the safety of services would be a ‘challenge’.

It comes as last week GPs were told to focus on hand hygiene and other basic infection prevention, following concerns about their safety as they resume routine work.

However, Dr Nikki Kanani told GPs in a webinar on Thursday night that safety should be ‘the priority’.

She said: ‘We encourage you to [bring back in routine work] but only if you can do that safely. 

‘You might need to do that in a different way, so some of your long-term condition management might need to be done remotely [and] you might need to work more through your PCN functions. Some people have done group consultations through video.’

She added: ‘It’s really worth thinking about different ways of delivering care but keeping safety as the priority.’

Dr Kanani added that practices are now seeing increasing demand and will be ‘in a transition phase’ for ‘months’.

She said: ‘We’re all experiencing an increase in business in practice. It’s certainly back to pre-Covid levels, if not slightly higher.‘

East London GP and PCN clinical director Dr Farzana Hussain told Pulse that assessing the safety of routine work is a ‘challenge’ for practices on the ground.

She said: ‘I can’t blame NHS England but it is so deliberately wooly - when deemed ‘safe’ to do so. What does that mean?

‘I don’t think there’s an easy answer but it’s not safe - we don’t have a vaccine.’

Dr Hussain’s practice, the Project Surgery in Newham, has chosen to deliver all proactive routine work remotely unless it clinically requires face-to-face contact, she said.

She added: ‘We know that one in four of us are asymptomatic so we as the staff might be passing an infection on to somebody.

‘I’ve also got majority BAME staff in my practice and as an employer and a human being it’s my duty to protect my staff as much as the patients.’

However, she added that the flexibility to find the ‘best fit’ for the practice and its patients is welcome.

She said: ‘How to design that operationally on the ground is a challenge. So we’re making it up [and] I think it’s really good that we have the permission to do that.

‘I have a responsibility to my patients in the community and to my staff and we’re just doing best-fit workarounds. But there’s nothing uniform or standardised about that.’

And while ‘business as usual’ must continue, for many it ‘didn’t stop’, Dr Hussain added.

She said: ‘It’s going to be tough because Covid hasn’t gone away either.’

Previously, Dr Kanani encouraged GPs to come up with ‘creative’ solutions to keep up with ‘vital’ immunisations during the Covid-19 pandemic.

At the end of last month, GPs were advised to resume the delivery of ‘routine and preventative work’ including screening.

But following concerns over the safety of staff, NHS England said that GPs should continue to follow current PPE guidance - while avoiding an ‘over-reliance’ on protective equipment.

GPs were also told to continue making routine referrals to secondary care, although referrals are still being rejected by secondary care providers in many areas.

Meanwhile, recent data has shown that GP referrals to secondary care were down by nearly a third in March. 

Readers' comments (35)

  • Well that clears that up then....

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  • Take no notice of this nonsense anymore and use your own brains. NHSE consistently 3 weeks behind the curve.

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  • We as individual practices will decide when it is safe for us and our staff to open the doors more than we do now. We shut our doors before NHS England advised it and hence have had lower staff illness and hopefully less COVID in our community.Big brother at the moment is not needed to tell us what we know as intelligent people we should be doing. Listening to the weekly webinar for primary care gives us no confidence that NHSE actually know any more than any of us .

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  • Group consultations in PCNs!!
    Gosh who comes up with these ideas
    So you are either getting a group of people in one room in front of one camera , or going through the nonsensical exercise of making sure everyone has zoom connectivity, with no data protection or NHS encryption sitting behind it
    Get a grip

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  • None of our local hospitals are accepting referrals other than suspected cancer.

    We have already been doing as much as we can "safely" and have used our judgement and common sense using PPE throughout.

    The guidance we have so far received, changes so often and contradicts itself that had we followed it diligently we would have closed down long ago.

    How about some support/ backing from NHSe - we don't need more orders/ directives?

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  • "a dog's breakfast" UK informal.
    something that is very badly done.

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  • National Hopeless Service

    Dear Nikki, When is safe safe and is safe actually safe?

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  • i'm pleased to hear that we are being given discretion to decide how and when we undertake routine work. this cannot be a one size fits all model. GPs have to (as they always should) be able to decide what is appropriate for them, their patients, and their staff - in their local area facing their local challenges. Some areas will have high rates of covid with a vulnerable population, others will have lower rates, and their population may be less at risk. so we need to be given the freedom to decide how we manage our work. less top down control, more autonomy, support structures from NHSE/ CCG when we ask for it. its not that hard. Frankly, nothing can ever be completely safe, and we'd be in total abdication of our responsibilities if we refused to see patients (even routine issues) until it was totally safe. I've not met many GPs who would advocate that. We are very capable of risk assessing our own staff, and working together for the good of patients.

    i'm not even going to begin to discuss group consultations via zoom. is that put in to goad us?!?

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  • Fine, I will apply my "common sense" as advised by our prime minister.
    CQC among others will not cross my thrshold!

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  • Struggling to think of a single useful intervention or piece of advice from Dr Kanani over the last few months (or ever). Her 'blue sky thinking' and flaky and often contradictory suggestions demonstrate a woeful lack of grounding in the realities of organising, running and delivering General Practice. She and NHSE have become sources of irritation to me and many of my colleagues. Might be better if she kept her counsel for a while and let us get on with the day jobs that most of us are exceptionally good at.

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  • Is she actually 13, or just her thought process?

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  • CAREFUL WHAT YOU SAY ABOUT DR. KANANI-----IT MAY UPSET THE MODERATOR AND BE TAKEN DOWN

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  • 'Group video consultations':


    Zoom call to 100 patients:

    'Don't worry it's just a virus, except unless it's The Virus, then do worry, unless you're a child, in which case don't worry yet, although if you get a funny rash and fever in 4 weeks time do worry, and if you are unwell don't attend A/e, unless you do need to attend A/E, in which case only do so if you are very ill or could be very ill but if you turn out not to be very ill we'll tell you your visit was unnecessary, but only after testing you to see if you are indeed very ill.'

    Any questions?

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  • Vinci Ho

    I reiterate the lesson of politics you should learn , Nikki:
    The ‘system’ can only sustain if you can rediscover ‘trust and credibility’ from frontline colleagues. Trust is relatively subjective and credibility originates from track records .
    At the moment , no matter how ‘right’ NHS England appeared to be , our frontline colleagues would only treat you guys with animosity. My advice is you need to be ‘walking a tightrope’ with extreme caution especially on your demands written on PCN DES .
    Feelings are already hurt and I am afraid you must pick up the pieces ...........

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  • Bow deeply and fart silently.

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  • So glad we have Nikita Kanani pointing out what none of us would have thought of..... (sarcasm before you ask)

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  • I actually think the frequency of her daft statements is increasing... is she trying more desperately to demonstrate that she has relevance..... if so, she's failing......

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  • She is not a Partner. You do what you need to do to stay safe. No one will care if you die - they'll just say 'well, why did you do that?!'. And opt-out of the PCN-DES before 31.05.20 before your practice disintegrates to 2024!

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  • David Banner

    “Group video consultations.....”
    How do you explain such a bizarre, barmy, bonkers, brainless suggestion like this??
    1- we’ve been beamed to a parallel universe where such trivia as patient confidentiality and GMC investigations do not exist, patients are happy to discuss all of their problems in a group, and the multi-talented GP can somehow extrapolate individual treatment plans from this obvious fustercluck.
    2- Dr Kanani was put on the spot and had to magic up a suggestion that she instantly wished she had never made (we all do it, don’t worry, just say you “misspoke “ and all is forgiven)
    3- NHSE actually think this is a good idea, in which case they need to scrap Medicine and take up Comedy full time, they’re naturals.
    4- they are extracting the urine out of us (in which case, good one, you got us, well played!)
    5- NHSE is a washed up, brain dead organisation that is like a cork on the ocean during Covid, with no sensible ideas, bankrupt of any credibility , and making up any old rubbish on the spot to fill a policy hole because they are utterly clueless when it comes to getting out of this mess.

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  • just apologise for getting it wrong, give us the GMS money for the year now, cover any lost income for this financial year, whether we are able to do the work safely or not, pay for all the PPE costs and locum cover and then back off and leave us to get on with the job at hand. we will innovate because thats what we do. your just in the way. accept it and move aside.

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  • Group consultations through PCNs! Expensive in time and resources. With rarely much benefit.

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  • NK - when you stood on the podium in front of the nation why did you forget to tell the public you're extracting their data?? SCANDAL.

    https://digital.nhs.uk/coronavirus/gpes-data-for-pandemic-planning-and-research

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  • I seriously doubt Dr Kanani has worked full time in GP for any significant period of time. I am even more doubtful that she has been a partner and run the business with the associated liabilities and pitfalls.
    She is as far as NHSE are concerned therefore, the ideal person to be director of primary care.

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  • Very easy to understand and very helpful guidance.
    Thanks

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  • Discussion among colleagues and support for our primary care staff is mandatory.
    Long live NHS

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  • Through the looking glass.
    Madness.

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  • What PCN functions?

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  • Group video consultations but please keep the consultation tailored to each patients need. I'm really growing tired of this.

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  • Is she for real?

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  • d in vadar | Locum GP19 May 2020 1:57pm

    - I can go 1 better for her: Resign and recommend that NHSE is shut down.

    And Angus, keep giving the state more tax, this is what you get, more regulation, more control, more unjustified and corruptible power. Qsn: do you think we're giving the state too much? Is the state too big? You're clearly sceptical of "NHSE’s medical director for primary care".

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  • ... you are our leader and we respect you....... (No sniggering please)

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  • CENSORSHIP?

    On the one hand... GPs are going to be forced to cover hot Hubs... especially in Northern Island ..
    and then on the other hand practices can decide when it is safe....

    What if GPs decide it is unsafe to work in hot Hubs??

    What assurances can NHS give that hot hubs are safe for all levels of staff and attending patients and their accompanying relatives?

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  • CENSORSHIP?

    Not sure if NHS Ireland and NHS England..are connected in anyway..

    England seems to have the lesser of two evils

    Less stick ..
    More carrot
    Safe carrot
    Thanks

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  • CENSORSHIP?

    I suspect Like Rishi Sunak
    Nikita Kinani
    are both just hand puppets
    The face of the organisation...
    Whilst other more nefarious individuals pull the real strings..

    (Nothing personal)

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  • Don't worry censorship... theres no nefarious individual... they really are just that incompetent.....its just that compared to Donald Trump, who gets so much air time, that they look relatively competent..... but it is a relative as opposed to an actual......

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