Exclusive London primary care networks (PCNs) have predicted that the restoration of GP services after the pandemic will raise the cost of care to each patient by up to 20%.
Analysing future costs, the Tri-PCN Alliance, a collaboration between Waltham Forest PCNs Walthamstow West, Walthamstow Central and Forest 8, has concluded that in order to deal with post-Covid demand, the average practice in the area will require:
- 1.5 GP locums (or three sessions per day);
- a practice nurse and healthcare assistant each working 20 hours per week; admin staff at 25 hours per week;
- and an additional-time practice manager at 15 hours per week.
This would result in an estimated additional weekly cost of £5,875, and they anticipate the need for this further support for a minimum of three months, most likely longer.
In total, this would cost at least £76,375, they believe. In the short-term, they predict that the additional requirement could amount to more than £15 per patient.
The alliance of GPs has written to leaders including the health secretary with its analysis of how the future of the profession in the borough can be more effectively brought about.
The GPs ‘strongly advocate’ that all the DES and LES implementation is deferred until April 2021 at least.
The document also considers short and longer term aspects such as additional referral workload; the impact of extended waiting times; and the recommendation that CQC inspections do not recommence without a year’s notice after the Covid-19 crisis. It classes protection of BAME staff; immunisation and testing, including for antibodies; and the anticipation of Covid-19 exposure systemic monitoring as among additional pressures.
Dr Abdul Q Sheikh, chair of Tri-PCN Alliance, told Pulse: ‘In view of huge surge of patient demand, a tsunami of practice workload and enormous backlog, without applying sufficient resources to support general practice to fully restore the core services, which requires deferment of extraneous work like the PCN DES until at least April 2021, there is a real possibility that primary care service could destabilise or collapse.
‘This would put already-vulnerable patients at further, unnecessary risk. The funding potentially available for existing schemes should instead be utilised as part of the support funding package necessary to restore those core primary care services safely and effectively. The financial impact on general practice in the report is a genuine analysis, requiring £15 per patient of additional resources to accommodate immediate and short term challenges.’
Vice chair Dr Sanjoy Kumar added: ‘An “open the next day” service is just not safe or feasible.’
In response, Londonwide LMCs medical director Dr Elliott Singer said: ‘Throughout the pandemic, Waltham Forest LMC has been highlighting the need to recognise that remote consulting rather than remote triage actually takes longer than a normal consultation and as such providing safe care reduces GP capacity.
‘In view of this, it is key that the NHS enables GPs to focus on providing proactive care for those most in need, including patients with long-term conditions, cancer, frailty and undergoing end of life care. It is positive to see Waltham Forest Tri-PCN Alliance raising very similar concerns in their recent letter.’
BMA GP committee chair Dr Richard Vautrey told Pulse: ‘These proposals highlight the significant clinical and organisational challenges in primary care, as patient demand grows and routine services increase, echoing the concerns of GPs, practices and PCNs across the country.
‘It is important that CCGs, NHSE/I and the Government take notice of what GPs are saying and make the appropriate changes to ensure that we effectively reduce the burden on general practice to practically cope with the impact of Covid-19 alongside routine care.’
The news comes as GPs don’t know if they will be reimbursed for Covid costs incurred to date, as the Treasury has not yet approved the General Practice Covid Support Fund. It has requested proof of additional GP costs from NHS England before releasing funding.
The full document can be viewed here.