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GPs to monitor more Covid patients at home as NHSE expands remote pulse oximetry


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NHS England is to make 200,000 pulse oximeters available to enable primary care practitioners to monitor high-risk Covid-19 patients remotely at home.

Some of the ‘virtual ward’ services are already in place and Pulse understands CCGs across the country are in talks to agree how patients will be monitored.

Speaking with Pulse, Dr Nigel Watson – chief executive of Wessex Local Medical Committees and clinical lead for the project across Hampshire and the Isle of Wight – said they already have two services up and running and others will follow in the next few weeks.

While the model may look different in different areas – some being nurse led, others being managed by GPs – the pathway and criteria will look the same, he said.

It follows a series of pilot studies during the first wave as well as GP practices who set up pulse-oximetry monitoring schemes for their patients.

Updated guidance published in August had encouraged practices to work together to use pulse oximetry ‘where available locally’ to help manage patients at home.

Dr Watson said research had shown that if oxygen saturation fell to around 94/93% mortality increased to 13% and below that mortality increased to around 28%.

‘Around the country people are working on this but we’re a bit further ahead because we had a couple of sites in the first wave.

NHS England has bought 200,000 pulse oximeters which is about 30 per 8,000 patients.’

He added that it was about identifying those patients most at risk – because of their age or underlying health conditions – and in whom further intervention would be appropriate.

‘We have two service up and running and expect quite a few more in the next couple of weeks.’

Dr Rob Barnett, chair of Liverpool Local Medical Committee said due to hospital pressures in their region they had started to discuss this three weeks ago.

It would expand on work they had already done with telemedicine in care homes, he explained but said it was not an easy thing to implement.

‘There is nothing up and running yet but we have got to find a way of balancing the needs of patients with Covid and the needs of patients who haven’t,’ he said.

‘This is being looked at by integrated community teams and PCNs but the workload is high and people are exhausted and this is yet another bit that adds to the complexity of managing patients. The workforce is not infinite.’

The strategy contrasts with Wales where GPs are advised to do face-to-face pulse oximetry.

Some areas of England already have GP pulse oximetry monitoring schemes in place such as that in Waltham Forest in London where ‘drive-by’ pulse oximetry checks were introduced by practices as part of the initial assessment of patients and the introduction of a community monitoring service

‘This monitoring service involves delivering a pack including pulse oximeter, thermometer and blood press monitor to a patient’s home, via the local GP federation,’ said Dr Elliott Singer, a GP in Chingford and Medical Director of Londonwide LMCs.

‘During the week the patient provides their own GP with daily readings and at the weekend the federation checks in with the patient to get updated readings.’

He said the system was used to monitor patients after discharge from hospitals as well as ensuring they are not deteriorating whilst following the advice to stay at home. 

‘Patients tell us they find the system provides them with significant reassurance. The majority of patients are monitored for 8-10 days, but a small number of patients require monitoring for a longer period.’

READERS' COMMENTS [5]

Azeem Majeed 30 October, 2020 11:27 am

This is only a small part of what is needed. We also need a suitable multi-disciplinary clinical team to carry out this work. Patients need to be trained to use pulse oximeters and monitored regularly. This is not something that primary care teams can do on top of their current very challenging workload. NHS England needs to also invest in community teams to do this work.

Chris GP 30 October, 2020 12:44 pm

“GPs to sweep more floors as NHSE expands broom numbers for them to stick up their ar*e”

John Clements 30 October, 2020 2:58 pm

This is a good idea but who can do it? If a patient needs regularly observations should this not be done in hospital? Do GPs have time to do 2 hourly obs on patients in the community?

Patrufini Duffy 30 October, 2020 2:58 pm

Or, you can add a “what to do” piece of paper in the sweetie box, if you get worse, which does not include see your GP. Will someone let out the elephant secret that we have No cxr, dexamethasone, IV abx, heparin or wall oxygen?…or a resus crash team and ITU. If not, let’s keep people at home, and throw candyfloss on their shortness of breath.

GPs can request ‘daily list’ of Covid patients eligible for remote monitoring – Pulse Today – Welcome to Healthclub 23 December, 2020 1:16 am

[…] October, it was revealed that NHS England would make 200,000 pulse oximeters available to enable primary care practitioners to monitor high-risk Covid-19 patients remotely at […]