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Covid-19 antivirals to be rolled out nationwide through GP hubs

GPs to refer ‘modest’ number of newly-eligible Covid antivirals patients

Thousands of vulnerable patients in the UK will now have access to Covid-19 antiviral treatments in the community through GP hubs, the Government has announced.

Treatment is being provided through the PANORAMIC study, run by the University of Oxford, which will recruit 10,000 patients at risk of serious illness from Covid-19 to take the antiviral treatment molnupiravir at home after receiving a positive PCR test.

Eligible patients will include those aged 50 and over or 18 to 49 with an underlying health condition that puts them more at risk of severe Covid-19.

Participants will be randomised to receive either the molnupiravir plus the current standard care, or the current standard of care without the antiviral so researchers can further assess whether it reduced the need for people to be admitted to hospital.

In addition, those most at risk of severe disease including people who are immunocompromised, cancer patients or those with Down’s syndrome will also be able to access either molnupiravir or the novel monoclonal antibody Ronapreve outside of the study from 16 December.

It follows clinical trial data that molnupiravir cuts the risk of hospitalisation or death for at-risk, non-hospitalised adults with mild to moderate Covid-19 by 30% and Ronapreve reduced the risk by 70%.

The MHRA approved its use in November. Ministers had ordered 480,000 doses of the antiviral – which is taken as a twice daily pill.

Patients may be contacted by the study team or their GP to take part but can also sign themselves up through the through the study’s website.

The study is open to anyone in the UK who meets the criteria and will allow for collection of further data on treatment benefits ahead of a wider role out next year, the Government said.

‘If people feel they may be eligible, but haven’t received a letter, they can contact their GP or consultant to discuss whether they should be in the highest risk group,’ the Government added.

‘They will make an assessment of any conditions they may have, and if they should be eligible, they will issue them with a copy of the letter to provide further information on next steps.’

Eligible patients who receive a positive test will be assessed over the phone by an expert clinician from an NHS Covid Medicines Delivery Unit (CMDU), who will review and discuss with the patient what the most appropriate treatment would be for them.

Health secretary Sajid Javid said: ‘This opens up a new era for the treatment of Covid-19, one where we can begin to cover every phase of contracting this deadly disease – whether it be before you catch it, just after you catch it, if you develop symptoms or if you require hospital care.

‘If you’re eligible, please sign up to the study as soon as possible and play your part in history.’

England deputy chief medical officer Professor Jonathan Van-Tam said: ‘Antivirals will be a vital intervention for years to come, helping to protect those that can’t mount the same antibody response to the vaccines.’

Those taking part in the study will be asked to complete a daily diary for 28 days through the PANORAMIC website or receive a phone call from the trial team on days 7, 14 and 28. The first set of results from the trial are anticipated in early 2022.

Professor Chris Butler, professor of primary care at the University of Oxford and co-chief investigator of the study said: ‘Studies in relatively small numbers of people with Covid-19 who have not yet been vaccinated have generated optimism that these new antiviral medicines, if used at scale, could reduce the need for people to be admitted to hospital and help them recover faster.

‘The PANORAMIC trial is a world-first study for generating the evidence we urgently need about large scale, early treatment with novel antiviral medicines of people who are mostly all vaccinated, still well enough to be in the community, and who are at higher risk of complications from Covid-19.’

Covid antivirals – what are GPs expected to do?

For wider rollout:
  • You will not need to prescribe or dispense nMABs or antivirals
  • However, your practice might need to refer highest risk patients to the local COVID-19 Medicine Delivery Unit (CMDU) who can assess eligibility and arrange treatment. 
  • You are encouraged to help recruit to the national study.
Each integrated care system (ICS) has established one or more local CMDU to roll out nMABs or antivirals as a treatment for COVID-19. The majority of CMDUs are based in hospital settings.
 
In the event of a positive PCR test, a local CMDU will contact the majority of patients directly to discuss the treatment and confirm eligibility. The CMDU will arrange treatment. 
 
A small proportion of PCR results cannot be matched to a patient’s health record. We are encouraging patients not contacted directly by the NHS within 24 hours of a positive PCR test result to phone their GP practice (in hours) or 111 (out of hours) for an urgent referral to a CMDU. GP practices will not need to prescribe treatment; only refer.
 
For PANORAMIC study:
 
You are encouraged to help recruitment by reviewing the list you receive each day of patients from your practice who test positive and either signpost those eligible to consider enrolling in the study using the PANORAMIC website or refer to a GP hub you may be linked with. This should be done urgently on the same day to enable eligible patients to enrol in the study as soon as possible.
 
Source: NHS England

READERS' COMMENTS [3]

Vinci Ho 9 December, 2021 12:05 pm

I suppose it is always about the timing between commencing the treatment and first day of symptoms, as always .
Prompt testing availability and time of reporting results are the other essentials

Patrufini Duffy 9 December, 2021 8:23 pm

At least that keeps the bars, clubs and holidays going. Which feeds the elites bank accounts.

Reply moderated
Dave Haddock 10 December, 2021 2:37 pm

Needs to be absolutely minimum workload for GPs. The usual twelve page form, complex criteria and a never-answered helpline number will not cut it.

Reply moderated