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GP practices could lose 'significant' income as minor surgery protection ends

GP practices could lose 'significant' income because they cannot restart corticosteroid joint injections when NHS England ends minor surgery income protection that has been in place during the Covid-19 pandemic.

NHS England has said it is time for GPs to restart routine services, however new guidance on corticosteroid joint injections has advised against these during the pandemic.

GPs warned this would leave them taking ‘a significant cut in income’ or resuming delivery of the injections against the guidance.

Earlier this month, NHS England outlined its plan for the ‘second phase’ of the general practice response to coronavirus, including that GPs should resume patient reviews and health checks.

The letter added that local commissioners should stop making monthly payments to practices for the minor surgery DES - which includes joint injections and had been maintained ‘in line with the previous year’s achievements’ since April - from 1 July.

Dr Hugh Reeve, a GP in Grange-over-Sands, Cumbria, told Pulse that ‘the implication is that in order to maintain income we have to restart [the injections]’.

However, recent guidance advised GPs to exercise caution over delivering corticosteroid joint injections during the coronavirus pandemic due to risks of immunosuppression.

The guidance, supported by multiple groups including the British Orthopaedic Association, the British Society of Rheumatology and the RCGP, said GPs should ‘only give steroid injections for severe symptoms and where there are no other options’.

It said: ‘During the coronavirus pandemic, clinicians need to give extra consideration as to whether the benefits outweigh the risks.

‘Giving a steroid injection to an asymptomatic patient who is carrying the virus could potentially put them at increased risk of an adverse outcome from the virus.’

It added that GPs must take ‘great care’ over patients who are ‘clinically extremely vulnerable’ to Covid-19.

It said: ‘Great care will need to be given to assessing and discussing the risks both of any immunosuppression resulting from the injection and also attending a clinical setting where higher levels of Covid-19 may be present.

‘The risks for these patients may outweigh the benefits so clinicians need to exercise great caution and explain the risks to the patients. ‘

Dr Steve Kell, GP partner at Larwood Health Partnership in Worksop, reiterated that stopping income protection implies practices should restart delivering the injections - or face a ‘direct cut in funding’ if they follow the guidance.

He said: ‘[NHS England’s letter] doesn’t say you must start again, what it says is that the support for it stops on the 30 June. 

‘So you either take quite a significant cut in income or you start minor surgery again at your own risk and at the patient’s risk. That’s not good enough.’

He added: ‘It feels like we’re having to make things up as we go along, sometimes despite the guidance.’ 

And Dr Kell told Pulse that he doesn’t ‘know many GPs who would be happy to do minor surgery involving local anaesthetic in full PPE when it can wait, but we need the support financially’.

Dr Reeve took to Twitter to express his frustration at the news.

However, North London GP Dr Richard Ma said he had resumed delivery of the injections in April.

In a Tweet, he said: ‘I think we waited as long as we could but there's only so much painkillers can do.’

In April, NICE warned that GPs should advise patients with chronic obstructive pulmonary disease (COPD) not to self-start a course of corticosteroids or antibiotics if they develop symptoms of coronavirus.

However, last month the low-cost and widely available steroid Dexamethasone was found to cut Covid deaths in an intensive care trial.

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Readers' comments (22)

  • THEN DEMAND NHS ENGLAND EXPLAIN THEMSELVES.

    THEY ARE ONCE AGAIN LOOKING FOR A CONFRONTATION WITH GPs AND THIS IS APPARENT IN THE DAILY NUTTER RESTARTING ATTACKS ON US.
    LET US ALL LEAVE THIS SHIT HOLE OF A JOB AND NHS ENGLAND CAN FIND NEW MUGS TO RUN GP LAND........GIVEN THEY HAVE A MONSTROUS EGO THEY WILL ASSUME SUCCESS THEN CRASH AND BURN

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  • Let's be honest half those skin tags and joint injections are trivial murky practice. And placebo fun. Re-focus. Re-prioritise.

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  • Has anyone produced any evidence of immunosuppression from joint injections or is this just another "Sorry, we can't (insert item here) due to coronavirus" eg mend my boiler, do surgery on suffering non-cancer patients, MOT the car, negotiate on Brexit, take my patients to Xray in a hospital car, open any referral letters, give you a haircut.. Really...?!

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  • There are a lot of desperate patients in pain where the NHS is shut to for over six months, whether there be a element of placebo most of these folks are begging for something to be done, guess where the shitty stick points to ,yes my friends it is us as usual.The establishment has let us down again.

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  • Vinci Ho

    Is this pedantic or is it really evidence-based for joint injections?
    For cry sake , I have given about ten last 3 weeks now . These elderly patients with bad OA knees , for instance , did get some relief . That is my evidence !

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  • Steroids and corona virus. What evidence? Initially high dose methylpred in an ARDS type treatment made them worse. Now they are getting a moderate dose of dexamethasone that makes them better. Thus the systemic effects of low dose joint injection are low dose. Like many early pronouncements on this they have back tracked. Steroids, Nsaids. Not every practice does minor surgery. So you have a choice.

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  • I am discussing pros and cons and all have opted to have injection. There seems to be growing cynicism (not unfounded) that corona is being used as an excuse to cut services.

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  • But if we dont get paid to do them should we?I think not stop the service no pay no service.

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  • What about hyaluronic acid injections for osteoarthritis of the knee. Widely used abroad, shame NICE says ‘Do Not Give’ but might they help out in the short term.

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  • unsurprisingly ortho/rheum doing phone consultations advising patients to see gp for local injections....

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