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Staffing Covid-19 ‘hot zones’ falls outside of GMS contract, say local GP leaders



Local GP leaders have addressed CCGs to state that a number of Covid-19-related services that GPs are expected to provide are non-contractual.

Berkshire, Buckinghamshire and Oxfordshire LMC has addressed CCGs in their region to urge them to avoid any coercion of GPs to participate.

It said this should include allowing practices to refuse to staff Covid-19 face-to-face ‘hot hubs’.

The letter said: ‘In the context of Covid, core GMS work might include triage of undifferentiated illness (that may or may not be Covid-related) and direction to the appropriate service to meet the reasonable needs of their patients. 

‘The work of hot hubs, home visits, and end of life care, for patients with Covid is not core GMS.’

The letter added: ‘It follows that Covid services must be supported by newly-commissioned arrangements. This includes hot hubs, visiting services, and palliative care services. These need to be available to the whole of the patient population.’

NHS England’s GP preparedness letters and standard operating procedures that outline different options for managing coronavirus patients ‘do not provide a mandate to bypass local negotiation, agreement and resourcing’ with practices, the LMC added. 

It said: ‘No contractor can be forced into doing something outside of their contractual remit or ability.’

It comes as GPs in Northern Ireland have been told by the Government that they will face contractual changes if they refuse to staff hot hubs.  

And, earlier this month, NHS England said that GP practices that do not have a ‘hot hub’ within their PCN should set up ‘hot’ and ‘cold’ zones within the practice.

However, Berkshire, Buckinghamshire and Oxfordshire LMC argued that the hot sites should be ‘physically separate from mainstream general practice’ because of the risks to both patients and staff.

The letter said: ‘Much of the GP workforce is also at raised risk. It is typically an older workforce, it has health problems like any older population and many of our constituents are raised risk of Covid by virtue of being of black, Asian and minority ethnic background over the age of 50.’

The LMC said ‘scenarios which might invite challenge on ethical grounds’ could include ‘mandating individuals to staff Covid services against their will’, for example if their family members are vulnerable or if PPE is lacking; or ‘making patient access to Covid services dependent upon their practice staffing those services’.

LMC co-chief executive Dr Richard Wood told Pulse that GPs ‘need leadership from CCGs to do the right thing for patients and practices’ and ensure that hot hubs are separately commissioned from practices’ core work.

He said this comes as many GPs ‘do not have the capacity to develop an infectious disease service within their practice’.

He said: ‘Clearly it is inappropriate. If a practice only has older GPs, or all of them have good medical reason not to be exposed to Covid, why on earth should they be asked to staff those hubs at their own health risk.’

He added: ’Clearly, practices have a core obligation to meet the reasonable needs of their patients, such as the safe remote assessment of these patients and cooperation with other services.

‘However, the point of the letter is that, in our opinion, the face-to-face hot services must be separately commissioned – as they already are in some areas.’

It comes amid contractual confusion regarding the latest Covid-19-related advice to GP practices, which said they should carry out a weekly virtual ward round with all care homes.

NHS England initially indicated the work was part of the Primary Care Network DES, then later said it was only ‘clinical advice’. However, it most recently said regulation could be introduced if the rounds did not take place.