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GPs go forth

Staffing Covid-19 ‘hot zones’ falls outside of GMS contract, say local GP leaders

Local GP leaders have addressed CCGs to state that a number of Covid-19-related services that GPs are expected to provide are non-contractual.

Berkshire, Buckinghamshire and Oxfordshire LMC has addressed CCGs in their region to urge them to avoid any coercion of GPs to participate.

It said this should include allowing practices to refuse to staff Covid-19 face-to-face ‘hot hubs’.

The letter said: 'In the context of Covid, core GMS work might include triage of undifferentiated illness (that may or may not be Covid-related) and direction to the appropriate service to meet the reasonable needs of their patients. 

‘The work of hot hubs, home visits, and end of life care, for patients with Covid is not core GMS.’

The letter added: ‘It follows that Covid services must be supported by newly-commissioned arrangements. This includes hot hubs, visiting services, and palliative care services. These need to be available to the whole of the patient population.’

NHS England’s GP preparedness letters and standard operating procedures that outline different options for managing coronavirus patients ‘do not provide a mandate to bypass local negotiation, agreement and resourcing’ with practices, the LMC added. 

It said: ‘No contractor can be forced into doing something outside of their contractual remit or ability.’

It comes as GPs in Northern Ireland have been told by the Government that they will face contractual changes if they refuse to staff hot hubs.  

And, earlier this month, NHS England said that GP practices that do not have a ‘hot hub’ within their PCN should set up ‘hot’ and ‘cold’ zones within the practice.

However, Berkshire, Buckinghamshire and Oxfordshire LMC argued that the hot sites should be ‘physically separate from mainstream general practice’ because of the risks to both patients and staff.

The letter said: ‘Much of the GP workforce is also at raised risk. It is typically an older workforce, it has health problems like any older population and many of our constituents are raised risk of Covid by virtue of being of black, Asian and minority ethnic background over the age of 50.’

The LMC said ‘scenarios which might invite challenge on ethical grounds' could include 'mandating individuals to staff Covid services against their will', for example if their family members are vulnerable or if PPE is lacking; or 'making patient access to Covid services dependent upon their practice staffing those services'.

LMC co-chief executive Dr Richard Wood told Pulse that GPs 'need leadership from CCGs to do the right thing for patients and practices' and ensure that hot hubs are separately commissioned from practices' core work.

He said this comes as many GPs ‘do not have the capacity to develop an infectious disease service within their practice’.

He said: ‘Clearly it is inappropriate. If a practice only has older GPs, or all of them have good medical reason not to be exposed to Covid, why on earth should they be asked to staff those hubs at their own health risk.’

He added: ’Clearly, practices have a core obligation to meet the reasonable needs of their patients, such as the safe remote assessment of these patients and cooperation with other services.

'However, the point of the letter is that, in our opinion, the face-to-face hot services must be separately commissioned - as they already are in some areas.’

It comes amid contractual confusion regarding the latest Covid-19-related advice to GP practices, which said they should carry out a weekly virtual ward round with all care homes.

NHS England initially indicated the work was part of the Primary Care Network DES, then later said it was only 'clinical advice'. However, it most recently said regulation could be introduced if the rounds did not take place.

Readers' comments (18)

  • We need a BMA that starts to clarify the lines.

    We have NHSE at every point call everything Core Contract.

    From 72 appointments per 1000 patients

    From Ear Syringing

    From Domiciliary Phlebotomy of Shielding Patients

    From Dressings

    From Home Visiting Covid Positive Patients

    None of these are Core Contractual requirements.

    If NHSE want to make them part of the contract, we have seen that they can do that at the snap of a finger (Bank Holiday free working).

    So let’s not accept non-contractual activity, especially whilst they allow Hospital Specialities to see no patients and see get full pay.

    Next they will be sending Doctors and Nurse in without PPE leading to their deaths...

    Oh wait...

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  • Meanwhile in lalaland ( Northern Ireland), our “Union” has made it compulsory to staff our covid hot hubs, failure to do so will risk severe punishment from the department of health in belfast as per email confirmation from a senior civil servant.....
    It couldn’t really get a lot of worse treatment from our leaders.....

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  • Who appointed the NI "leaders"?

    What will NI GPs do in response?
    Commenting on forums or facebook groups is not action.

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  • Vinci Ho

    Berkshire, Buckinghamshire and Oxfordshire LMC
    The rebels against the autocratic ‘Command and Control’ .
    Welcome into the arena .👍
    Medical politics has not been so interesting and extraordinary for long time 😄

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  • BBOLMC are what all LMCs should be like.

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  • to all those complaining about the action of the BMA in NI, if you are still a member of this organisation you only have yourselves to blame.

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  • We are our own worse enemies. At the start of the outbreak, GPs set up so called Red zones to see patients with COVID19 symptoms and trumpeted their great achievement. No wonder it was assumed nationally that every surgery should set up COVID19 services.
    But we need the BMA to protect the profession.

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  • What I find really sad is that no one seems to care about patients anymore.

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  • @travel_doctor
    Couldn't agree more!
    We need more walking and less talking.....
    Walk away form the contract
    Walk away from the job
    Walk away from the country

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  • @curious.
    If GPs in NI cant even walk away from the BMA they will never do any other walking you suggest

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