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The waiting game

Out-of-hours GP services drafted in to care for non-emergency coronavirus patients

Out-of-hours GP providers are being asked to set up a dedicated service to care for coronavirus patients at home.

NHS England and NHS Improvement’s strategic incident director Professor Keith Willett issued a letter, seen by the BMJ, on 8 March to regional primary care directors throughout England.

He ordered them to establish a 24/7 service for the management of patients who do not require immediate hospitalisation. 

There is a deadline of 10 March for every part of the country to be covered by the new service, with the possibility to 'bring in a provider of digital first primary care to support the response' should 'gaps in provision remain'.

Each branch of this community approach should be provided by a GP team, including a nurse, with all clinical information electronically transferred to the patient’s general practice.

They must provide regular reports, including confirmed numbers of patients cared for under the service, how many deteriorate, and numbers of patients admitted to and discharged from the service.

As well as focusing on those able to self-isolate at home, the provision will allow active monitoring of those at high risk of contracting severe illness, and advise those considered low risk on which action they should take if their condition worsens. 

Dr Fay Wilson, the GP in charge of Birmingham out-of-hours provider Badger, told Pulse that although providers would attempt to meet the new requirements, there was a worry about workforce, safety measures and bureaucracy.

She said: ‘There are questions about whether we have the workforce and resources to recruit, employ and train them; whether there will be protective antivirals and PPE; whether pension tax consequences are going to fall on anyone who takes on extra work; whether current contractual expectations will be temporarily set to one side; and whether the bureaucracy which has increasingly grown since the swine flu of 2009 will be relaxed.

‘Out-of-hours organisations will do their best to rise to this challenge, as we always do.'

Providers could each receive up to £20,000 to meet the costs around mobilisation of capacity, and an indicative tariff of £100 per patient for the service applies, to be reviewed in relation to home visits.

The individuals affected will have their symptoms and possible decline monitored via daily phone calls. 

However, Professor Willett stressed that anyone who requires hospitalisation will receive it. 

The Government is preparing for a worst-case scenario where a fifth of the population could be off work due to the virus, with proposals for retired doctors and medical students to contribute to the NHS in its wake.

Over 300 people have now been diagnosed in the UK, with the fifth related death reported yesterday. 

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Readers' comments (11)

  • I feel like a stuck record but I cannot afford to take on extra work at OOHs because of AA tax trap. Increasing price paid to fill sessions would be a normal commercial technique but AA issue means almost no amount of money works for me. This pandemic only makes the same problem more acute.

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  • Pension Tax= No OOH

    Unless they fix it tomorrow?

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  • A) there is no staff
    B) there is no PPE available unless you count gloves.
    This is mission impossible & I suggest they go back to the drawing board...

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  • if you get infected doing this work whats the compensation payout, is it tax and pension free? will you get fitted with the proper equipment? as a locum we don;t get sick pay, taking 2 weeks off to hibernate is a huge risk for no income. SSP would not cover the expenses of being a locum just to be able to work, let alone live. its a big ask. we also don't get in house pension death benefits if we die when not working, so if we die of covid our families are screwed. don;t think they have thought this one through enough.

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  • Vinci Ho

    The slogan of ‘ The government needs GPs far more than GPs need it.’ , is only more undeniable against the backdrop of this Covid-19 .

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  • We need dedicated, fully trained and appropriately equipped community Covid teams ready to attend multiple cases in nursing home etc. Many such patients will not be for admission, especially given that critical care beds will be rapidly saturated. We will therefore be dealing with a huge number of acute end-of-life care situations, in the most challenging of situations. Nobody is talking about this. It’s all about hospitals (as usual).

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  • The community teams should have been recruited, trained, fitted & equipped from early-mid Feb. Also know locally morphine shortage so if that can’t be sourced it will add to distress in palliative cases. Also who will administer? District nurse teams have been devastated by cuts- there is no army never mind cavalry of clinicians for non hospital patients. Where is the foresight? Community care has been completely overlooked or ignored by planners. Now we are in an emergency, things are about to escalate within days yet primary care is making it up on the hoof.
    Local OOH can’t fully staff a normal service never mind these exceptional stresses & demands.

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  • Well done Doc Anon and Mr Ohms for raising the very real but difficult issue of palliative care in the community with this Corona Virus crisis.

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  • Agree with Mr Ohms /Doc Anon - there isn't the capacity to continue with the current system of assessment if the numbers predicted become reality. Diagnosis will not be the main issue then it will be managing a huge number of patients with respiratory and other complications. A dedicated HV assessment service is urgently needed in all CCG / network areas. They need to be equipped to provide basic hospital at home care e.g. oxygen and sats monitoring.

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  • Told yesterday that if asked to visit a poorly suspected case ( when those taking the swabs have been and gone) to do a check up, thar all my gear...stethoscope, sat monitor, tympanic thermometer etc has to stay in the house till the results come back are are negative. So day one.. say 3 visits...no equipment left......

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