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NHS England tells GPs to prepare for ‘significant increase in home visiting’



NHS England has told GPs to prepare to do significantly more home visits to patients as a result of the Government’s strategy to deal with coronavirus (Covid-19).

Earlier this week, NHS England told hospitals that discharge thresholds for patients should be lowered, while people across the UK were advised to avoid all non-essential contact with others and whole households were told to isolate for two weeks if anyone develops a cough or fever.

Anyone over 70 or with underlying health conditions should enter a 12-week isolation, and a group of particularly vulnerable patients should completely shield themselves from potential exposure.

In a letter, sent today, advising GPs on the consequences for general practice, NHS England said:  ‘Prepare for the significant increase in home visiting as a result of social distancing, home isolation and the need to discharge all patients who do not need to be in hospital.’

But, reiterating advice for GPs to carry out all initial patient consultations via telephone or online, NHS England stressed this must not mean patients do not get treatment for health matters unrelated to coronavirus.

The letter said: ‘This does not mean not advising/treating patients for other health issues, where there is clinical need, or unilateral closing of practices doors, rather ensuring that patients are appropriately triaged to the right health professional setting.’

NHS England said GPs should ‘prioritise support for particular groups of patients at high risk’ – who will also be contacted directly via letter by the NHS during next week advising them on what steps they must take to shield themselves.

It also summarised the latest advice on how to deal with potential cases, and linked to new guidance published by PHE yesterday.

Referring to the cancellation of routine CQC inspections and GMC revalidation, NHS England added that it would ‘seek to do all we can to support practices to manage inevitable increases in workload at this extremely difficult time’.

This will also include issuing advice to suspend appraisals, NHS England clarified.

Meanwhile, practices were urged to ‘consider stopping any private work they are doing to help free up capacity’.

NHS England also told GPs in the letter that they will top up QOF payments; defer parts of the PCN DES; allow delays to medication reviews; and urge responsible officers to defer GP appraisals – all in the effort to free up practices to deal with the coronavirus crisis.

NHS England’s six priorities for GP practices and commissioners

  1. Move to a total triage system (whether by phone or online). This does not mean not advising/treating patients for other health issues, where there is clinical need, or unilateral closing of practices doors, rather ensuring that patients are appropriately triaged to the right health professional setting. The upsurge in telephone calls to general practice means that providing a reliable and timely response for patients has already become a vital operational priority.
  2. Agree locally with your CCG which practice premises and teams should be used to manage essential face-to-face services.
  3. Undertake all care that can be done remotely via appropriate channels, guided by your clinical judgement. We ask you to read the guidance note at annex A.
  4. Prepare for the significant increase in home visiting as a result of social distancing, home isolation and the need to discharge all patients who do not need to be in hospital
  5. Prioritise support for particular groups of patients at high risk. Next week the NHS will be writing directly to all patients in this category, and you will receive further advice shortly
  6. Help staff to stay safe and at work, building cross-practice resilience across primary care networks, and confirming business continuity plans.  

Source: NHS England’s letter to GP practices 19 March