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GPs to manage long Covid patients as specialist clinics suspended


Long Covid burnout


GPs in Essex are set to manage patients with long-term symptoms of Covid-19 as clinics have been temporarily suspended across the area.

It comes as Essex is facing an ‘ongoing critical incident’, with severe pressures across the NHS leading to rationing of home oxygen supplies for patients.

GP leaders warned that the workforce is being stretched ‘too thinly’ and will burn out ‘sooner or later’.

Last month, new NICE guidance recommended that GPs should consider referring long Covid patients to specialist clinics as soon as four weeks after acute infection, after ruling out other diagnoses.

But Mid and South Essex CCGs told GPs earlier this month that local long Covid clinics have been suspended for six weeks due to ‘system pressures’.

An email briefing said: ‘In direct response to the growing levels of Covid infection and subsequent increase of admissions into our acute and community services, we are unfortunately having to suspend the provision of Long Covid Clinics for a period of six weeks. 

‘While the suspension is disappointing, it is in line with guidance from NHS England and NHS Improvement.’

It added that ‘complex’ referral numbers have so far been ‘low’ but that GPs should use ‘existing secondary care pathways to gain support’ if they have ‘significant concerns’ about their patients and believe they cannot wait to be seen.

Meanwhile, home oxygen services are rationing supplies in Essex as hospitals in the area struggle with high oxygen demand, forcing some patients to be transferred to alternative sites.

The email briefing said: ‘In response to the material growth in oxygen usage within hospitals, at vaccination centres and by ambulance services, BOC, as a provider of oxygen cylinders to the whole NHS as well as in patients’ homes, is being asked to meet an unprecedented demand for cylinders for acute/Covid need.’

While demand is ‘currently under control’, BOC will ask patients for permission to reduce their home oxygen supply on a ‘temporary basis’ to ‘mitigate risks’ of a ‘further increase’, it added.

This will apply to patients who have not replenished their oxygen supply ‘for some time’ and who are due a service or risk assessment, as well as those calling for a top-up who are ‘not a high-user requiring frequent replenishment’.

Patients ‘will be able to keep’ both current or newly-prescribed home oxygen supplies if they express any ‘anxiety or concerns’, it said.

The email briefing added that Southend hospital is facing ‘rising numbers’ of Covid patients and those requiring high levels of oxygen are being transferred to other hospitals with higher capacity.

High rates of Covid in the area are causing an ‘ongoing critical incident’ with ‘severe pressures within the whole health and care system across Essex’, the CCGs added.

Essex LMC chief executive Dr Brian Balmer told Pulse that GPs are ‘already up to their eyes’ but warned that there is ‘only so much people can do’.

He said: ‘The thing I’m most worried about is stretching our staff too thinly. It is quite extraordinary the amount of extra work that people have taken on. 

‘But it does worry me that sooner or later they will fall sick. We’re just going to wear them out.’

The LMC is working on a local clinical agreement across the system to ‘cover GPs as much as possible’ while they are having to look after patients in the community who would normally be in the hospital, he added.

It comes as Pulse revealed that GPs in Essex have been asked to go into hospitals and help discharge patients to free up capacity.

Last month, NHS England announced that 69 long Covid clinics were in place around the country, with more sites expected to open in January.

But GPs warned that access to the clinics is patchy, with only one fifth (21%) of GPs saying they currently had access to a clinic in their local area.

READERS' COMMENTS [6]

John Glasspool 29 January, 2021 10:45 am

Strange how, over the years, hospitals have been allowed to refuse work as and when they feel the need to. Years ago in my patch the psychiatric services decided, unilaterally, that they would only see “severe, enduring, mental illness”. When I asked which of the commissioners had sanctioned such a stupid idea, answer came there none. Utterly barmy, I mean, strictly interpreted, if someone presented acutely with a first episode of psychosis, they could theoretically refuse a referral on the grounds that one hadn’t shown it was “enduring” yet.

John Ashcroft 29 January, 2021 11:11 am

Long Covid being a new disease means that there are not an real “specialists” anyway. GPs often end up managing these sort of conditions. Maybe the way forwards would to upskill some GPs to take on these roles for their patients and even others. But they would need access to appropriate investigations and therapists.

Cameron Wilson 29 January, 2021 11:22 am

It feels like every element of hospital provision, community support and basic referrals is being deliberately obstructive with the resulting impossible situation dumped on General Practice. The cumulative degree of this needs addressing or at least acknowledged by the Powers that Be, but that’s not going to happen is it! Rapidly having enough of this nonsense! All those who support the status quo are, I am afraid, deluded !

Turn out The lights 29 January, 2021 3:41 pm

Quite right Cameron

David Church 30 January, 2021 9:10 am

@ John Glasspool – Don’t give them ideas!!

How unfair it is that Essex even had a Long Covid clinics to cancel – our pateitns ahve been denied this service all along so far. is this Discrimijnation??

Mark Carri 31 January, 2021 10:58 pm

Forgive my ignorance, which may be significant, but isn’t “long Covid” just another form of CFS (apart from patients with proven physical damage secondary to Covid – obviously) ?
Read an article on the net somewhere which reckons “long Covid” is the first illness put forward by patients via social media to the medical profession, rather than the long established route of medics discovering illnesses and passing on knowledge to patient!
Unless there is a clearly defined diagnosis backed up hopefully with some tests and a proven treatment, I don’t think we should be bouncing to secondary care. The “diagnosis” of “medically unexplainable symptoms” is a respectable one in my opinion and can be monitored and revised over time if necessary.
“I don’t have a diagnosis for you – but I will continue to monitor you and you might just get better” I think is better than giving someone a “diagnosis” with no treatment, no tests and by definition is chronic and possibly incurable.