The BMA has advised GPs not to agree to prescribing duties for Covid treatments unless as ‘part of an appropriate commissioned service’.
The guidance comes as ICBs are taking on responsibility for delivery from the end of this month from Covid-19 Medicines Delivery Units (CMDUs).
It is not ‘appropriate for every GP to be required to start prescribing these medications’ due to ‘the complexity of the current cohort of eligible patients and the nature of the medications themselves’, the BMA warned.
Those patients eligible for treatments such as antivirals and IV treatment have already been advised to contact their GP practice from the end of June if they test positive for Covid.
However vulnerable patients have already been advised to contact their GP if they contract Covid.
In a letter sent to this patient cohort on 5 June, NHS England said they ‘will no longer be automatically contacted by the NHS about treatments’ after reporting a positive test.
Patients have therefore been told from yesterday (27 June) to ‘instead contact your GP practice, NHS 111 or hospital specialist’.
Earlier this month, NHS England guidance suggested that GPs could take a greater role in the delivery of community Covid treatments for eligible vulnerable patients.
Up until now, GPs have had little to do with the process, which was being led by CMDUs.
But in the recent primary care bulletin, NHSE asked ICBs to work with GP practices and other primary care providers to ‘develop local clinical pathways for oral antivirals and IV treatments’.
In response to the upcoming change, the BMA guidance said the GPCE and wider BMA ‘recommend that GPs do not agree to prescribe’ Covid treatments for clinically vulnerable patients unless these duties are commissioned through an appropriate service.
The guidance added: ‘The first line drug (Paxlovid) is very difficult to prescribe, as it has interactions with many common and specialist medications that many in this patient group will be taking.
‘Current numbers of eligible patients suggest prescribing levels are around 5/100,000 patients per week.
‘This does not enable clinicians prescribing at practice level to develop the required knowledge or skill to safely prescribe this treatment.’
Dr Paul Evans, chairman of Gateshead and South Tyneside LMC, told Pulse that today his local ICB, North East and North Cumbria, confirmed it will maintain the current delivery framework through CMDUs for another three months from the end of June.
However, he expressed concerns about GPs taking on more responsibility for delivery in future, and that the lack of communication from NHS England and the ICB has been ‘dire’.
Dr Evans said: ‘We’ve already advised the ICB we will not be supporting this moving into general practice and that we will be advising our constituent GPs that it is perfectly legitimate for them to have their receptionists signpost patients towards hospitals.
‘This isn’t something that’s been commissioned within general practice, therefore it’s not happening in general practice, unless or until GPs feel that they have the time and expertise to do so, and I don’t know of any who do.’
Chair of North Staffordshire LMC Dr Chandra Kanneganti said the current system in his area, where the GP federation triages patients for the CMDU within the hospital, works well and is properly commissioned.
But he said if patients will begin contacting GP practices directly from 27 June, this is ‘really a concern’, and flagged risks around the lack of training a practice level, since GP colleagues currently working the CMDU through the federation have all received specific training from a hospital consultant.
Dr Kanneganti said: ‘It should be commissioned through some kind of PCN-led service or GP federations, but not by single general practices at all, because I don’t think general practice will cope with that.’
He also told Pulse that the ICB has not discussed the potential pathway with his LMC.
Don’t forget, it remains a compulsorily Notifiable Disease, so if you have contact with a patient, you MUST ensure they report their infection to 111 for onward notification to PHE/PHW, the health Security Agency, or MOEH. If 111 are dealing with the notification, they may as well deal with the medications, and ICBs should be contracting the service direct from CMDUs and the existing staff – under TUPE legislation at least!
If you do NOT ensure the patient reports infection to 111, you MUST report it yourself to the MOEH, which is additional workload burden. And you must also learn all about these drugs of which we have no experience, and how to manage risks and symptoms we have not managed so far, due to them being managed by specialising doctors at CDUs and in Hospitals.