GPs will be paid to identify patients of black, Asian and minority ethnic (BAME) backgrounds and offer education on Covid-19 risks as well as health reviews, under a new locally commissioned service.
GPs in Sussex will also be incentivised to monitor people of BAME background, as well as other vulnerable patients, who develop Covid-19.
The three CCGs which will be commissioning the LCS – NHS West Sussex CCG, NHS East Sussex CCG and NHS Brighton and Hove CCG – said the initative is in direct response to Public Health England’s report into the health inequalities exposed by Covid-19.
According to the group of CCGs this is the first LCS in England to respond to the unequal impact of Covid-19 on the BAME population.
The Sussex CCGs said GPs are ‘best placed to offer bespoke care for individuals in a way that can promote trusting relationships to support these groups’.
CCG board papers said: ‘This two-part LCS aims to address factors which may put individuals at increased risk, as well as identifying problems early in those at risk who contract Covid-19. The CCGs’ primary care teams will be able to support practices (either individually or in groups) to ensure that all affected populations can benefit from the additional support provided in this LCS.’
GP practices can choose to deliver one or both of the LCS’ two components. The papers specificed that GP practices undertaking part A of the LCS will:
- Communicate Covid risks ‘to all BAME patients using their first language where recorded’;
- Offer ‘holistic reviews’ to ‘BAME people with modifiable risk factors’; and
- ‘Reflect’ on what steps practices can make to ‘improve the experience of the BAME population within their patient population’.
Meanwhile, under part B of the LCS, practices are expected to monitor those who have Covid-19 and who are at greater than average risk – including patients of BAME backgrounds, those who are socially deprived, and patients who have an ‘absolute risk’ based on risk factors such as having underlying health conditions or being male.
The chief medical officer for the Sussex CCGs, Dr Tim Caroe, said: ‘Our commitment to this LCS is underpinned by our desire to make a difference to communities that are disproportionately affected by Covid-19. The LCS promotes a number of new measures to support affected communities at this challenging time.
‘The initial response from practices has been excellent and is a further endorsement of how important they feel this work is to their local communities.’
The CCGs would not say how much GPs will be paid for the LCS.
However, Julius Parker, chief executive of the Surrey and Sussex LMC, said: ‘Surrey and Sussex LMCs have worked in partnership with the Sussex Health and Care Partnership and Sussex Commissioners to co-design the BAME/vulnerable group LCS and ensure that an appropriate remuneration package for general practice was agreed to support what is a very important piece of work amongst our BAME communities in Sussex.’
The Sussex CCGs said the LCS fits in as a ‘critical element’ of its pre-existing cross-Sussex BAME Disparity Programme.
The executive co-lead on the programme, Lola Banjoko, executive managing director of NHS Brighton and Hove CCG, said: ‘The locally commissioned service plays such an important role in the Sussex-wide programme to ensure that all our BAME communities understand the risks and symptoms but also feel supported and cared for at this time.
‘As we consider the advice from the scientists about the virus we remain committed to the population of Sussex, especially those at greater risk, to provide them with the best possible health and care support.’
The Sussex CCGs, local authorities and public health teams further plan to work with community voluntary sector organisations to liaise with ethnic minority communities, collate feedback on their experiences of healthcare during the pandemic, and consider how best to show support in the future. They are planning to do this via a series of webinars this autumn and winter.
In response, the Medical Association of Nigerians Across Great Britain (MANSAG) told Pulse: ‘As it has become evident that some in the BAME communities are disproportionately affected by Covid-19, it is paramount that these communities understand the risks and know that they are supported during these times.
‘We are pleased to hear of the work happening in Sussex where they are working with various services to reach out to BAME communities to listen to their experiences of Covid-19 and provide the appropriate support.
‘This is a fantastic example of how we can use lessons learned from past experiences to provide a safer, more proactive and more supportive service for those at risk. We hope that some of the lessons learned from this pandemic can be woven into other aspects of healthcare provision for all our local communities.’
Dr Kamal Sidhu, GP chair of the British Association of Physicians of Indian Origin (BAPIO), said: ‘It is heartening to see an initiative that focuses on the groups that have borne the brunt of Covid-19. We welcome such initiatives that can help tackle the health inequalities faced by BAME groups and hence, reduce the “modifiable” risk factors.
‘There is a dire need to find evidence based measures through such projects for BAME as well as other deprived sections of the society. Covid-19 has laid bare open the economic disadvantage and deep rooted systemic barriers to progress faced by these groups. Until we all recognise this problem, the inequalities and social justice will only be exacerbated.’
Dr Adwoa Danso, of the Ghanaian Doctors and Dentists Association UK, added: ‘We are now all aware of the pre-existing inequalities that exist within these communities. We must work together to protect those at most risk.
‘It took six weeks for the Government to release [specific recommendations]. This delay caused a lot of speculation, uncertainty and the birth of myths. It will take a lot of work to build relationships up and regain trust. Understanding the unique challenges and hardships faced by these individuals is a necessary first step.
‘A “second wave” has been widely speculated, and we need a systematic way of identifying at risks groups and safeguarding them appropriately. I welcome this new initiative and encourage other CCGs to follow suit.’
Dr Chandra Kanneganti, chair of the British International Doctors Association (BIDA) is also backing it, telling Pulse: ‘BIDA is happy to support this initiative by Sussex CCGs. Any lessons and learning form this should be shared with other CCGs.’
And West Sussex GP Dr Richard Cook said: ‘Anything we can do to identify those at greatest risk, in order to protect them and reduce that risk, has to be a good thing.’
PHE’s rapid review into the disparities in risks and outcomes of Covid-19, carried out in May, concluded that people of Bangladeshi origin were most at risk of dying from Covid-19 in England. But it found that ‘people from black ethnic groups were most likely to be diagnosed’ with the disease.
In June, PHE followed up with a series of recommendations for how to tackle the ‘humbling inequalities’ its review had laid bare, including ‘culturally competent Covid-19 education and prevention campaigns’ and ‘efforts to target culturally competent health promotion and disease prevention programmes’.
Note: This article was updated at 12.56 on 3 September to reflect that only three of the seven Sussex CCGs are commissioning the LCS.
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