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NHS England expanding scope of Covid helpline ‘on the sly’, claim GPs

Exclusive GPs working for the Covid telephone hotline claim that NHS England is expanding its scope beyond coronavirus without increasing their pay.

NHS England has refuted the claims, but GPs told Pulse they think the Covid clinical assessment service (CCAS) is moving towards a more general clinical assessment service, with the shift taking place ‘on the sly’.

They also said new tasks had recently been added to their role, including prescribing and video consultations, with significant liability implications for GPs.

The BMA told Pulse the future of the CCAS is an ‘area of concern’.

A spokesperson for NHS England said the CCAS still only works with patients who have coronavirus symptoms and that the ‘roles and responsibilities of the service have not changed’.

But the latest NHS England board papers, which outlined plans for patients to pre-book A&E appointments by December as part of the new ‘NHS 111 first’ service, also revealed plans for the ‘potential development’ of the CCAS.

The CCAS was set up as an expansion of the NHS 111 service at the start of the pandemic, to offer further triage to Covid-19 patients for whom the 111 algorithm cannot determine whether hospitalisation is required.

But anonymous GPs working for the service have approached Pulse to share concerns that its scope is being quietly expanded.

One locum GP, who spoke on behalf of an online support group of 269 GPs who do sessions for the CCAS, told Pulse that staff are experiencing ‘increasing mission creep’ to their role over the past few weeks, including new requests to do video consultations and prescribing.

They said: ‘They’re optional for the minute, but there is talk that [prescribing and video consultations] are going to become compulsory throughout. 

‘[And] there’s a load of non-Covid cases coming through – initially it just seemed to be a few isolated ones but now most shifts seem to be at least half non-Covid.’

The GP said it appeared NHS England wants to keep CCAS going ‘well into next year’, with GPs working for the service polled on whether they would be interested in continuing shifts for six or 12 months.

They said: ‘I don’t know if they’re morphing it into the new “NHS 111 first” service that’s due to start up in [December]. I have a feeling that this service will be involved in that or they’re going to change some clinicians into that role.’

Another anonymous GP working for the service warned this could destabilise primary care as a whole by ‘devaluing’ the work, as CCAS GPs are paid just £50/hour.

They said: ‘If you can get a cheap primary care service through 111 – 24/7, working digitally and remotely – then primary care will have to shrink dramatically. 

‘No practice or out-of-hours provider can compete with £50 an hour and if GPs are prepared to work at this role for this pay then they’re essentially facilitating the end of primary care.’

The pay rate is another source of concern for CCAS GPs, who feel NHS England is ‘holding GPs to ransom’ while locum work is scarce.

GP and chairman of Urgent Health UK Dr Simon Abrams told Pulse the CCAS pay was ‘very low’ compared with typical basic rates for GPs working for NHS 111, which range from around £60-£65 an hour.

The CCAS GP group representative told Pulse: ‘It’s basically like out-of-hours work, but at a cut price of £50 an hour because they know they’ve got this significant workforce that is pinned [against the wall] because of lack of work availability elsewhere. It’s just cheap labour at the minute.’

‘We just wanted to help and obviously something to live off for the minute while the pandemic was happening.’

They added that the additional responsibilites come with no added pay ‘despite massively increasing risk’ for GPs indemnified only for triage work for the service.

The locum said: ‘They’re not increasing the pay – they’ve pinned everyone to this vague contract that the service would develop and then [are] just adding on extra bits on the sly. It’s not acceptable. 

‘They’re adding more and more [roles] and the majority of us so far have still been accepting that because of the lack of available work, which is risky and dangerous and potentially not safe if you’re not indemnified for it.’

BMA sessional GP Committee chair Dr Ben Molyneux told Pulse that ‘the future of the CCAS is an area of concern’ for the BMA. 

He said: ‘The CCAS is a one-problem system that only deals with Covid cases so it’s very straightforward, whereas a generic national clinical assessment service (CAS) will have to deal with everything so the breadth is hugely different. 

‘Anyone who works for a national CAS will need to have adequate training to manage that and development allocations for that.’

Dr Molyneux added that there would also be a ‘significant reshuffling’ of staff, not least because retired returners may not have ‘the right skills and competences’ for an expanded service.

He added: ‘Some people won’t want to do a general CAS [because] they only came in to help out, [while] others will be very keen to widen their portfolio of work for the CAS.’

The CCAS contract, which locums branded as ‘purposefully vague’, said GPs were to be engaged as ‘Covid-19 response general practitioners’ to ‘assist with the care of patients affected by Covid-19’.

However it added that ‘duties and responsibilities’ would be ‘reviewed from time to time’.

An NHS England spokesperson told Pulse: ‘Only patients who are assessed by NHS 111 as having coronavirus symptoms and requiring a clinical discussion are directed through to the service, and the roles and responsibilities of the service have not changed, so pay rates are standard for the role they are performing. 

‘Most importantly, patients who require additional clinical advice about Covid-19, after using NHS 111, have been able to get the help they need quickly through this service.’

It comes as the CCAS has stopped nurses and allied health professionals – such as paramedics – from handling patient calls after an audit revealed more than half did not pass safety criteria. 

According to the new NHS People Plan published last month, more than 500 retired GPs have returned to work alongside 1,000 locums and other GPs for the CCAS.

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