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GPs to decide what workload to postpone, says BMA/RCGP prioritisation guidance


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GPs need to decide for themselves what workload to pause to make time for Covid booster jabs, the BMA and RCGP’s updated workload prioritisation guidance has said.

It also stressed that ‘whatever steps we take to manage workload, we must reassure the public that general practice remains open and that patients will be seen face to face where it is clinically appropriate’.

The new guidance for GPs in England, published today, said that ‘final decisions’ on what to delay or stop should be made locally with LMCs and CCGs but that ‘ultimately it is for practices to determine how they best meet the needs of their patients’.

However, it set out that during the accelerated Covid booster jab campaign, GPs should ‘consider pausing, postponing or deprioritising’:

  • Routine non-urgent screening
  • All non-essential paperwork
  • Data collection requests 
  • Blood monitoring for lower-risk medications and conditions 
  • Vitamin B12 injections
  • Routine care review or care management for those with LTCs, who are not considered ‘high risk’, as outlined above
  • Non-essential procedures
  • Complaints
  • Minor surgery
  • Non-urgent investigations that will not impact on treatment 

The guidance added that ‘current clinical priorities’ include long-term conditions management for those ‘at higher risk’, ‘acutely unwell’ adults and children for urgent care, cancer or suspected cancer, acute home visits to housebound or care home patients and cervical smear tests. 

‘Essential paperwork’ is also a ‘clinical priority’, including blood and test results review and filing, discharge letter review and medication reconciliation, new patient registrations and DVLA requests for medical information for licensing for essential workers, it said.

The guidance said that these ‘key priorities’ should ‘continue wherever possible during the delivery of the accelerated booster campaign’.

It added: ‘Most importantly, whatever steps we take to manage workload, we must reassure the public that general practice remains open and that patients will be seen face to face where it is clinically appropriate.

‘We must continue to encourage patients with potentially serious symptoms to contact their surgery to enable an assessment.’

‘Appropriate’ PPE should be worn in line with current guidance where face-to-face consultations are ‘required’, it said.

The whole NHS is ‘under significant strain and unprecedented pressures’, but there is ‘no single “one size fits all” blueprint’ for managing daily GP workload since Omicron pressures are ‘not being uniformly felt’ and acute and social care provision differ across the country, the BMA and RCGP said.

They added: ‘While we appreciate there have been requests for a definitive list of activities which can be postponed, we recognise that this is not possible. Individual practice population demographics, including availability of workforce and individual patient factors, significantly impact clinical decisions in different areas. This is set against a backdrop of ongoing pandemic pressures. 

‘Final decisions about what to stop or delay should take place locally in consultation with LMCs and in partnership with CCGs, but ultimately it is for practices to determine how they best meet the needs of their patients.’

GPs and practice teams ‘will need to make difficult decisions’ but it is ‘essential that the workforce does not become burnt out and therefore unable to deliver care over the coming months’, they said.

The BMA and RCGP said that the updated guidance is ‘intended as short-term guidance for practices in their planning whilst delivering the accelerated booster vaccination campaign’ and will be ‘reviewed on a regular basis’.

‘It is not intended as a substitute for expert clinical judgement, nor does it take into account individual or local circumstances’, they added.

BMA England GP Committee chair Dr Farah Jameel said that the guidance ‘isn’t an instruction’ or a ‘definitive list of activities practices should or should not do’.

She said: ‘Patients will be understandably concerned that some appointments will need to be postponed in order to ramp up the booster campaign. GPs and their teams will do their best to continue to prioritise the care they offer alongside providing Covid-19 vaccines

‘But with ever-increasing demand on healthcare services and rising staff sickness rates, the unfortunate fact is there are not enough GPs and surgery staff to do everything for everyone all of the time, and we know many members of the public appreciate this.’

Dr Jameel added: ‘We cannot be clearer, however, that general practice is open, as it has always been open, and any patient who has any worrying symptoms should continue to contact their surgery, where they will be advised accordingly, and patients who clinically need to be seen in person will be.’

Last week, NHS England promised that the BMA and RCGP would provide ‘additional prioritisation guidance’ after asking GPs to prioritise the Covid vaccination campaign over routine care until the New Year.

It also announced that GPs will be paid an enhanced fee of £20 per Covid jab between 25 December and 3 January, alongside a range of measures to make time for the Covid booster campaign.

But it comes as GPs have told Pulse they are ‘exhausted’ and ‘don’t have a lot more to give’ as they face a tough Christmas ahead.

BMA/RCGP joint workload prioritisation guidance

Current clinical priorities:

  • Acutely unwell adults and children for urgent care – Patients believing themselves to be unwell if requiring medical attention following initial remote assessment including immediately necessary patients; Investigations for immediately necessary conditions
  • Contraceptive services
  • Childhood immunisations, postnatal checks and new baby checks – Including newborn and infant physical examination (NIPE) and newborn hearing screening (NHSP)
  • Flu vaccinations – Especially where these can be co-administered with Covid-19 vaccinations. 
  • Medication problems that cannot be dealt by community pharmacy or PCN pharmacist
  • Cancer or suspected cancer – Symptoms consistent with new potential cancers or ongoing cancer care that may require referral or treatment; Follow up of 2ww referrals
  • Palliative care including anticipatory care and end of life conversations
  • Wound management/dressings – Whilst encouraging patients to self-care, providing dressing where possible.
  • Acute home visits to housebound/residential or nursing home patients – This should continue and be done following remote triage, with appropriate PPE
  • Long term conditions management for those at higher risk – T2DM with HbA1c>75, recent DKA, disengaged; uncontrolled hypertension; COPD with a hospitalisation in last 12 months and/or 2 or more exacerbations in last 12/12 requiring oral steroids/oral antibiotics, patients on LTOT; Asthma with a hospitalisation in last 12 months, ever been admitted to ICU, 2 or more severe exacerbations in last 12 months (needing oral steroids), on biologics/maintenance oral steroids; Proactive care for frail, housebound and vulnerable patients; Post discharge reviews.
  • Mental health care – Mental health monitoring for patients with long term mental health conditions/ severe mental Illness; Significant mental health with concerns regarding suicide
    or deliberate self-harm risk or currently unstable mental health.
  • Cervical smear tests – Providers should continue to offer cervical screening sample, offering appointments to all women who are eligible and due to be screened (this includes individuals on both the early and normal call/recall intervals)
  • Safeguarding – The role of primary care in safeguarding at this time is to continue to recognise when children/adults/families are struggling or potentially suffering abuse or neglect, signpost to resources which can help, refer to other agencies as available and appropriate, and support vulnerable patients were possible
  • Essential injections – For example, Prostap, aranesp, clopixol etc. when normally given in general practice.
  • Essential paperwork – Blood and test results review and filing; Discharge letter review and medication reconciliation; New patient registrations especially for new residents for care homes and the homeless. DVLA requests for medical information for licensing for essential workers (e.g., bus and lorry drivers) in line with DVLA guidance. 
  • Med3 after a period self-certification – Only after a period of self-certification, in line with DWP guidance.

Activities to consider pausing, postponing or deprioritising:

  • Routine non-urgent screening – For example, NHS health checks.
  • All non-essential paperwork – DVLA medicals for non-essential workers (only prioritise in urgent cases for essential workers e.g., bus and lorry drivers) until 12th January in line with DVLA guidance; Private to NHS prescription changes. These can go straight to a pharmacy;
    Hospital outpatient prescriptions. These should be filled at the hospital or secondary care can provide patients with FP10s to use in community pharmacies; Friends and family test; Insurance reports.
  • Data collection requests – Unless related to Covid-19, DESs/LISs/LESs, audit and
    assurance activities.
  • Blood monitoring for lower risk medications and conditions – Consider increasing the interval of testing if clinically safe to do so referring to national guidance where available
  • Vitamin B12 injections
  • Routine care review or care management for those with LTCs, who are not considered ‘high risk’, as outlined above
  • Non-essential procedures – For example, routine pessary changes and ear syringing
  • Complaints – Consider developing a standard automated response to pause processing or responding to complaints
  • Minor surgery – With the exception of skin cancer excision which should continue.
  • Non urgent investigations that will not impact on treatment – For example: Routine/ annual ECGs; Spirometry: Consider home peak flow monitoring where indicated.

Source: BMA/RCGP

READERS' COMMENTS [7]

Colin Malcomson 21 December, 2021 12:08 pm

Postpone B12 injections ? What degree of nerve damage do they think is acceptable ?

Iain Chalmers 21 December, 2021 12:11 pm

How long did they collectively take to come up with this?

I had fun receiving a hospital pass on the rugby field!

No worries I’ll keep “buggering on!”

Dylan Summers 21 December, 2021 12:22 pm

“Non urgent investigations that will not impact on treatment ”

One might ask why the health service would be offering non-urgent investigations that will not impact on treatment…

Kevlar Cardie 21 December, 2021 1:35 pm

stop checking Folate levels.

What could possibly go wrong, eh ?

Patrufini Duffy 21 December, 2021 2:59 pm

Ah yes contraceptive services. Critical. Well, had an irrate priveleged Generation Z wanting her pill sent ^^*NOW*^^ to the train station pharmacy, before she boards her train to “work” from home at her parents before New Year’s Eve charards. How many of you will soon be consulting patients, sitting miles away from you in another city, in their pyjamas as they’re “working from home” in Diddleydoo Town? And how you never got that recognition for 2 years gone tomfoolery.

Paul Attwood 21 December, 2021 3:38 pm

I’ve a better idea. HMG you’ve had 2 years to set up a National Vaccination Service and allow GPs to get on and be GPs, not some kind of fall back stooge upon whom everything can default to.

This way kinda burns out the very cornerstone of the NHS and, when the pandemic ends, will be too bloody exhausted to take up the reins.

Or is that the plan?

David Turner 21 December, 2021 4:05 pm

All non-essential paperwork…….

How about refusing to do appraisal, revalidation and anything to do with the CQC?
It seems odd that these pointless time consuming tasks which take us away from proper work looking after patients have not been included specifically in the ‘non-essential’ list