Exclusive GPs in Northern Ireland have taken offence to their Government’s heavy-handed approach to the pandemic response, with a number feeling ‘bullied’ to staff Covid centres.
This comes after GPs were threatened with contractual imposition if they refused to voluntarily staff the new hubs.
GPs said the reasons they declined were related to staff pressures and health concerns, with some taking legal advice in response.
Recently, GPs who have not participated have received letters from the Department of Health urging them to ‘reconsider the decision’.
Director of primary care Chris Matthews, writing on behalf of DH permanent secretary and HSCNI chief executive Richard Pengelly, told practices: ‘I would urge you and your colleagues to reconsider the decision to not participate in the Covid-19 Centre rota.’
He continued: ‘If your practice continues to fall outside the agreed regional arrangements we may need to review your individual arrangements in order to ensure your patients have access to the same quality services as patients from participating practices.’
GPs also pointed out that the letter requested services that are not covered under the GP contract, including out of hours.
The letter said: ‘Also I am sure you are aware, for those practices who are participating in the Covid-19 centres that their respective patients can also be seen, when required, at the Covid-19 centres both in the evening and during the weekend.
‘I would be grateful therefore if you would provide me with your practice proposal for dealing with your patients who contact OOH and need to be seen outside of your contracted hours. I am assuming that the local OOH centres has been provided with a contact in your practice should one of your patients need to be seen, and would otherwise have been able to be sent to the Covid-19 Centre.’
The letter concluded: ‘Please confirm to me your decision within five working days of this correspondence.’
A GP in the west, who wished to remain anonymous, told Pulse: ‘Our main concerns relate to the bullying nature of the letter. The contents are at odds with the 2004 GP contract. GPs have no responsibility for their patients out of hours. It’s discriminatory to suggest that our patients won’t have access to an out-of-hours service, even though we pay for this service at source from our global sum.’
The GP also criticised the handling of the situation by the BMA and RCGP, which have supported the rollout of Covid centres.
The GP said: ‘We have no confidence that any one of our unions are acting in our best interests, there’s no support. Some GPs were guilted into covering [Covid centre rotas] because if they didn’t, it wouldn’t be fair as other GP colleagues would have to cover their patients.
‘Communication about Covid rotas was often by federation reps who were wearing other hats, such as for LMCs, RCGPNI, or the BMA, so there was conflict of interest as well as fear and confusion by GPs. It was often unofficial, and the emphasis was on urgency to comply to cover the Covid rota.’
Another anonymous GP, from County Antrim, said the frustration was compounded by ‘nebulous language’ that made GPs ‘think’ that staffing Covid centres was a contractual requirement, even though it is not.
They said: ‘It’s the duplicity of the DoH/Health and Social Care Board and the BMA in this whole sorry affair. All of them collectively have made, through the use of nebulous language, GPs think that it is a contractual requirement to staff Covid centres.
‘The language used has been: “GPs are required to engage” and “GPs must commit to staffing Covid centres”. Not only that, but GPs who have chosen not to work in Covid centres and care for all their own patients have been sent a threatening email in recent weeks from the DoH which actually showed a lot of ignorance of the GP contract as it asked how would the GP cover their own patients in the OOH period – which, of course, is not our responsibility.’
According to the Department of Health, the ‘GP-led’ Covid centres have ‘quickly and safely’ assessed some 10,000 Covid-symptomatic patients, ensuring GP practices could continue delivering ‘vital’ services to patients during the pandemic. It also said demand has lessened in the centres, meaning less GP time is required to staff them.
A spokesperson added: ‘There is, however, still a need for GPs to support the Covid centres in order to ensure that those patients who are Covid symptomatic can be quickly and safely assessed. GPs have therefore been asked to work with their GP Federation to ensure that the Covid centres continue to have the vital GP cover they need, albeit at a much reduced time commitment from the GPs.
‘It is important to note that the Department of Health has not made changes to the core GMS contract. Instead, the Department reached an agreement that practices would engage and commit to populating their share of Covid-19 centre rotas, after negotiations with GP representatives.’
Meanwhile, responding to the accusations of bullying, the DH spokesperson said: ‘The Department is disappointed that anyone would say that they feel bullied to continue working in Covid centres given the efforts it has made to work closely with GP leaders and support practices throughout the pandemic. All GPs are strongly encouraged to support Covid centre rotas on an ongoing basis as the overwhelming majority of practices have done to date.’
BMA NI GP Committee chair Dr Alan Stout told Pulse that the ‘general practice response to Covid in Northern Ireland has been rapid and immense’, with the BMA having worked ‘very quickly’ with the Government ‘to make sure that practices remained open, clean and safe for GPs, staff and most of all our patients’.
Dr Stout said: ‘We were the first of the four UK nations to freeze our contract and also to establish a separate workstream for symptomatic Covid patients. This has been successful in managing the peak and has resulted in no practice closures and no significant morbidity or mortality amongst our GPs or our staff.’
He added that maintaining the health of GPs remained a top priority for the BMA.
He said: ‘There is still great concern about a second wave and how we manage this into the autumn and the overwhelming feedback from our LMCs is that we need to maintain these separate workstreams.
‘Finding the balance in maintaining these work streams, one that both avoids workforce burnout and continues to allow us to provide the highest-level of care for the most sick and vulnerable in our communities, is high on our list of priorities and we are in constant communication with HSCB and Department of Health to make sure they are addressed.’
A spokesperson for RCGPNI said: ‘During the pandemic, GPs needed to work differently to keep staff and patients safe. This is under review and changes will be made as and when guidance for practices is updated by HSCB.
‘We understand that GP Federations are trying to be as flexible as possible with the rotas, which are operating at a reduced level currently, and we hope that the backfill options are helping to support GP practices even further.’
They added that RCGPNI ‘continues to highlight GP workload pressures to Government’.
‘The need to support GPs and wider surgery teams is critical and even more so as we move out of the first wave of the pandemic and into the winter months.’