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Most GPs practising ‘outside comfort zone’ during Covid-19 pandemic

Exclusive Almost three-quarters of GPs say they have been managing more patients ‘outside their comfort zone’ due to less support from secondary care during the Covid-19 pandemic.

NHS England told GPs in April that they should continue referring as usual to secondary care on the understanding that hospitals ‘accept and hold clinical responsibility for GP referrals’.

Specialists would be told to advise GPs ‘in a timely fashion’, NHS England added.

But a Pulse survey of over 900 GPs revealed that the majority agree they have been ‘managing more patients outside their comfort zone due to fewer resources/less support in secondary care as a result of Covid-19’. 

Of the 675 GPs who answered the question, 73% said they agreed with the statement, including almost a third (29%) who ‘strongly’ agreed.

Only 11% of respondents disagreed that they were working outside their comfort zone and 14% and 2% said they neither agreed nor disagreed or didn’t know respectively.

Dr Zishan Syed, a GP in Kent and a member of the LMC, said that lots of patients have been ‘dumped’ from secondary care into practices.

He said: ‘Any benefits from the previous fight against secondary care dumping has been undone. We frequently get reports saying  “GP to do bloods, chase [urine tests]”.’

Other examples include a lack of access to walk-in x-rays and scanning forms submitted before the pandemic being returned to the practice ‘with no information as to whether patients have been informed of the cancellation’, he added.

Meanwhile, practices are facing ‘considerable risk’ as a result, Dr Syed said.

He said: ’We have been told that [an] A&E clinician is not allowed to refer directly to the rapid access chest pain clinic and has to approach GP for this to be done, which obviously is a considerable risk.’

And the new electronic referral system ‘appears to create a medico-legal risk onto GPs’ because they cannot monitor the progress of any referrals, he added.  

Respondents to the survey added that they were ‘managing huge risk’ due to ‘less support locally’.

An anonymous GP said: ‘Mental health is a disaster area – provision has disappeared. I spent eight hours trying to get a patient seen [and] I was repeatedly deflected and promised call-backs which didn’t happen.’

Another added: ‘We are trying to manage symptomatic patients who were due to have outpatient investigations or diagnostics which have all been cancelled.’

Meanwhile, others expressed concern over ‘misdiagnosis’ and fitness-to-practice investigations arising from the circumstances.

One GP said: ‘Face-to-face contact can’t be beaten. Fear of litigation for misdiagnosis is a concern.’

Pulse reported last month that NHS Mid and South Essex CCGs told local GPs to continue ‘holding outpatient referrals’, leaving them ‘holding all the risk’ for paused treatment.

And GPs in East London expressed concern that ‘hundreds’ of cancer referrals – including those deemed urgent – are being rejected by their local hospital.

Meanwhile, GP leaders in Birmingham are demanding ‘full investigation’ into ‘hundreds’ of radiology referrals that have been returned to GPs across the city.

Last week, NHS England told GPs to assess where urgent and routine treatment has been delayed, ‘focus’ on resuming chronic disease treatment and prevention and ‘proactively’ address ‘unmet’ health needs.