GPs have radically reorganised their way of working to cope with the threat of Covid-19, often of their own volition.
At the same time, bureaucracy such as CQC inspections and revalidation has been put on hold. NHS England has said it is beginning a review into GP bureaucracy, saying that any tasks that were ‘not a good use of time’ should not be reinstated. We look at what will become of them.
CQC inspections
What happened before?
Inspections of GP practices in England took place in person and their frequency depended on the practice’s rating. For the vast majority of practices – those rated ‘good’ or ‘outstanding’ – this would be every five years. But for those rated ‘requires improvement’ the next inspection would be within 12 months, and for ‘inadequate’ practices it would be within six months.
What has changed?
Routine inspections were suspended in mid March, but by the middle of May the regulator announced its plans to start checking in with practices by having ‘regular conversations’ over the phone. In June, the regulator announced routine inspections would return from the autumn, with higher-risk practices being inspected over the summer.
Will this continue?
Former RCGP chair Professor Clare Gerada, now medical director of the NHS Practitioner Health service, has written to the CQC calling for inspections to be delayed by at least another 12 months. In practice, phone calls to monitor practices may continue as a way to determine the frequency of inspections, but are unlikely to replace in-person inspections.
QOF data reporting
What happened before?
GP practices were required to submit data showing whether they had hit targets in order to receive points-based payments under the voluntary Quality and Outcomes Framework payment system.
What has changed?
In England, at the beginning of the pandemic, QOF recording was suspended and practices were told they would be paid according to previous performance. In a BMA survey of 2,500 GPs in June, half of respondents wanted the QOF to remain suspended after the pandemic.
Will this continue?
Unlikely – there are rumours that QOF work will be reinstated in England before the end of 2020/21. The BMA said: ‘We are in discussions with NHS England and NHS Improvement over this. Practices should use remote consultations for QOF-related long-term condition management where appropriate, though we recognise this is not always possible.’
Revalidation and appraisals
What happened before?
All UK doctors are usually required to have an annual appraisal, which feeds into their revalidation – proving they are up to date – every five years.
What has changed?
The GMC has said all doctors with a revalidation date between 17 March 2020 and 16 March 2021 can now have their revalidation delayed for ‘up to a year’. But the regulator also said ‘a missed appraisal as a result of the pandemic should not prevent a recommendation being made about a doctor’s revalidation’.
Will this continue?
Unlikely for longer than the year stipulated by the GMC. At the start of the pandemic, however, the regulator said delayed revalidation could apply to those with a date between 17 March and the end of September 2020, before extending this to March 2021 – so a further extension may be possible.
Residential homes
What happened before?
GP practices in primary care neworks in England didn’t expect to be delivering an enhanced care home service – under networks’ new DES contract and including regular ward rounds – until October.
What has changed?
NHS England said at the end of April that GPs and community teams would be expected to carry out a ‘virtual’ weekly care home round from May as part of the health service’s response to the pandemic.
Will this continue?
Yes, but possibly only for practices in PCNs. NHS England has said virtual care home rounds are not part of the DES contract for now, but suggested they soon will be, after describing the move as ‘bringing forward’ the rollout of the PCN DES care home service. It also warned of ‘regulatory provisions’ if care homes did not receive the virtual rounds.
Death certification and cremation forms
What happened before?
In England and Wales, the doctor who attended the deceased patient in their last illness – in person, and usually in the last 14 days of their life – had to sign the medical certificate of cause of death (MCCD). For cremation, both Crem4 and Crem5 forms were required.
What has changed?
Under the Coronavirus Act 2020, any doctor can complete the MCCD without referring to the coroner as long as a medical practitioner has seen the patient within the 28 days before their death – including via video link – or as long as they have seen the patient in person after death. Now there is no requirement for Crem5.
Will this continue?
Possibly for the next two years – the legislation lasts for that period. The act allows the four UK governments to switch on the new powers it contains when they are needed, and to switch them off again once they are no longer necessary.
