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The waiting game

Staffing Covid hot hubs falls under GMS contract, says NHS England

GP practices are contractually required to staff Covid-19 ‘hot hubs’ and should do so with existing resources ‘in the first instance’, NHS England has said.

NHS England director for primary care strategy and contracts Ed Waller was responding to a GP question in a live webinar last Thursday when he provided the clarification.

This follows Pulse reporting on one LMC which has taken issue with their local CCGs to demand hot hubs are commissioned separately from core contractual work.

In Thursday’s webinar, an anonymous GP asked NHS England for guidance after their CCG had 'deemed hot sites as GMS so expect practices to provide the staff without any additional resource'.

To which Mr Waller responded: 'Meeting the Covid-19 needs of your patient list is as much a part of GMS as any other type of illness and so we’d expect in the first instance that resources from practices would be redeployed into any new services that are set up.'

The redeployment of both clinical and managerial staff into ‘new arrangements’ is expected as part of the ‘quid pro quo of guaranteeing income into practices’, he added.

Practices can be reimbursed for extra staff required due to the pandemic from the Covid support fund, Mr Waller said, but only in relation to 'additional capacity' needed ‘above and beyond’ current net capacity.

Kent LMC medical secretary Dr John Allingham told Pulse that existing GMS funding is not enough to cover the running of hot hubs.

He said: ‘As we return to normal activity, running Covid hot hubs and running normal general practice activity is not reasonable out of the existing GMS envelope.’

He added that a ‘lag’ with secondary care is currently putting ‘additional workload and stress on the system’, as rejected referrals leave practices ‘struggling to hold the risk’.

Meanwhile, even if in some cases clinical staff have some capacity, practices lack the resources to redeploy non-clinical staff to hot sites, he added.

He said: ‘Having to run two sites means doubling receptionists and admin teams, that’s not GMS. That’s overtime and needs to be funded separately out of Covid money.’

And promises of additional funding inspire little confidence because they rest on NHS England’s ‘definition of net capacity, not ours’, he added.

Berkshire, Buckinghamshire and Oxfordshire LMCs previously wrote to local CCGs to say that face-to-face hot hubs work was non-contractual and therefore GPs should be able to refuse to staff them - especially if they are at raised risk from coronavirus.

LMC co-chief executive Dr Richard Wood said: ‘This is a question about whether hot hub services should be delegated down to practice level. 

‘What we should be asking is: Is this safe for our vulnerable patients? Is this safe for GPs and their staff? Is this feasible?

‘If the answer to any of these questions is ‘no’, we think hot hubs should have their dedicated commissioned service.’

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

Readers' comments (40)

  • Let me put it as sensitively as I can - NO

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  • So why have hospitals had their debt wiped off? Nothing to do with covid? I'd love to know how much money poured in to secondary care for additional staffing needs...

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  • I'm currently redeploying my right middle finger from a 6 figure grid reference to the extended vertical position on a bearing adjusted for the grid magnetic angle precisely aligned with NHSE HQ.

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  • Ah yes meeting reasonablke needs can be sending to a/e - if they insist we see and that is a separate hub it cannot be contractual. I think NHSE also need remember that they are not the judge on the contract...that is for judges

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  • We are providing HCA/Nurses/Paramedic & a GP to support our Hot Hub, along with other practices in the area. Not equitably, but then some are under more pressure than others. We tend to cover about 4/5 shifts per week and it has very little impact on our practice.

    We see it as worthwhile, if it means symptomatic patients don't end up at our door.

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  • Yep pilling up the +ve for employer of the year. Our hospital trust along with others have attempted to reduced BAME exposure risk.

    One assumes since it’s under GMS contract refusal gets you to the GMC and risk of death doesn’t need consideration?

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  • National Hopeless Service

    Independent contractors...hahahahahahahaha

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  • We are contractually obliged to provide services from our registered premises. THIS DOES NOT INCLUDE HOT HUBS:

    7.1 Provision of Services 21 7.2. Premises 7.2.1. The address of each of the premises to be used by the Contractor or any sub-contractor for the provision of services under the Contract is as follows: insert premises address

    Further, we are not contractually obliged to visit anybody/see any body off site, and are able to transfer straight to secondary care WITHOUT seeing a patient if our clinical judgement suggests this is appropriate:

    7.6.2. Nothing in this clause or clause 7.6.1 prevents the Contractor from: (a) arranging for the referral of the patient without first seeing the patient, in any case where the patient’s medical condition makes that course of action appropriate (low Sats on home monitoring as a clear example).

    Unfortunately not surprising that the Mr Waller is not up to speed on NHSE contract details because he like most of his ilk in NHSE Ivory Towers are good at spouting but inept when it comes to action. The disconnect between NHSE and us widens with each idiotic missive.

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  • For once in agreement - oh dear! | GP Partner/Principal14 May 2020 10:04am

    - Do it if you want, but as per Iain Chalmers said, you going to remove choice of refusal for others and stick a gun to their heads?

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