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More than one in ten GP referrals to long Covid clinics rejected

More than one in ten GP referrals to long Covid clinics rejected

More than one in ten referrals from a GP to a long Covid clinic is rejected for being clinically inappropriate, figures have revealed.

In England, there were 55,687 referrals to an NHS post-Covid assessment centre between 5 July 2021 and 10 April 2022, of which 49,159 were accepted, a Department of Health and Social Care analysis reported.

It means 12% of referrals nationally have been rejected as ‘clinically inappropriate’.

This pattern has been consistent throughout with more up-to-date figures from June showing 13% of referrals – 581 of the 4,837 made that month – were rejected.  

In an assessment of the impact of the Omicron variant on health and the NHS, the DHSC said there are now an estimated two million people who have self-reported long-Covid.

The prevalence has increased due to the high numbers of people infected since the emergence of Omicron, the analysis said, as there is some evidence vaccination reduces the risk of developing long Covid symptoms.

GPs said they were not surprised  by the data and complained that the current process was too onerous.

Dr Irfan Malik, a GP in Nottingham, said he thought 88% was high as ‘very few of our referrals actually make it through’.

‘Our rejection rate seems a lot higher than 12%. They usually bounce back the referral saying refer to x,y or z speciality,’ he said.

‘I feel patients with symptoms of long Covid need better access to long Covid clinics.’

Professor Azeem Majeed, professor of primary care and public health at Imperial College London said the experience in his own practice was that it is a lengthy process for GPs to refer patients to long Covid clinics.

‘In South London, there is a form that needs to be completed. The pre-referral information on the form includes a long list of blood tests and other investigations, such as chest x-ray, along with a physical examination.

‘We are required to do all the tests even when we don’t think some will add much information, for example, chest x-rays in people with no respiratory symptoms. Referrals are often returned because an item of information is missing.’

He added that the process of referral needed to be simplified with a much shorter referral form.

‘Most investigations should be organised by the long Covid clinics. The current system is creating a lot of work for primary care teams and delaying referrals.

‘Finally, when patients are seen in the clinics, the treatment options are usually very limited, which leaves patients very frustrated,’ he said.

Data from the Office for National Statistics shows the prevalence of self-reported long Covid is greatest among people aged 35 to 69 years, females, people living in more deprived areas, those working in social care, teaching and education or healthcare, and those with another activity-limiting health condition or disability.

Last month, NHS England said it would be up to ICSs to decide how support general practice in dealing with the growing problem of long Covid.

NHS England’s long Covid action plan announced that GP workload related to long Covid will be reduced by the introduction of local one-stop-shops and mobile clinics, intended to prevent people having to go back to their GP practice for multiple different tests. 

However the plan stressed that ‘primary care will continue to be a core element of the patient pathway, often being the patient’s point of entry into long Covid care.’


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Please note, only GPs are permitted to add comments to articles

Paul Frisby 15 August, 2022 10:20 am

Sure my experience will be similar to many. I stopped bothering referring to LC clinic months ago, not sure they really even exist. Patients either ‘too well’ and directed to self-management (website), or too ill and directed to refer to respiratory or cardiology. Haven’t managed to find many in the ‘sweet spot’. For the one or two that have made it through all the barriers, never had any communication back

John Charlton 15 August, 2022 11:48 am

I triage dermatology, for referrals ( community) and am a GP. I bounce the worst referrals and usually nearer 15%! Many have not actually seen a clinician.

Dave Haddock 15 August, 2022 1:34 pm

And the treatment for “Long Covid” is what?
Exclude treatable illness and then . . . ?

Patrufini Duffy 15 August, 2022 2:22 pm

Long covid
Long referral
Long nice private procurement

Noticed the clinics aren’t full of the people who were supposed to get covid “bad”.
Nanny state.

Sam Tapsell 15 August, 2022 2:31 pm

The whole game of referral management and triage is increasingly wasteful and demoralizing for all.
Same for GP triage / econsults / remote working.
I cant think of any busy service, which has then introduced triage and now has a better long term experience for staff or patients.
But short term, the reduction in work is impressive for a few weeks or months.
Another “quick win” fail.

Samir Shah 16 August, 2022 6:21 pm

New Service – > advertise all singing /all dancing new service for patients, advertise how they support patients who really need it and how wonderful they are, award a contract that doesn’t make any sense, then the service sets impossible parameters / referral criteria. Majority of referrals get rejected. Advertise modified all-singing/all dancing ‘new’ service. Cycle continues.

David Banner 17 August, 2022 10:16 am

As stated previously, just what magic treatments do LCov Clinics have up their sleeve? Better diet? Graded exercise? Vit D?!!? (Vit D, the last refuge of the clinically bereft scoundrel).

Cynics know the real magic……build huge delays into the referral process, burden GPs with the heavy lifting re investigations, bounce anyone with serious proven complications to another specialty, furrow a concerned brow at the low Vit D/folate levels (and treat as (in)appropriate), await Time The Great Healer to improve the patient, then publish your impressive looking data to justify your expensive existence.

Alternatively the country could save a packet by GPs reassuring anxious patients (who they have already investigated) that, “hey, I know you’re knackered right now, but cheer up, it’ll improve over the next year or so”, Y’know, like we’ve done for post viral syndromes for decades already..

And if the punters want to swallow some OTC Vit D/folate placebos and give them the credit, no problem.

Patrufini Duffy 17 August, 2022 2:07 pm

It’s the art of doing something that means nothing. UK medicine at its best.