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Out-of-hours GP services drafted in to care for non-emergency coronavirus patients



Out-of-hours GP providers are being asked to set up a dedicated service to care for coronavirus patients at home.

NHS England and NHS Improvement’s strategic incident director Professor Keith Willett issued a letter, seen by the BMJ, on 8 March to regional primary care directors throughout England.

He ordered them to establish a 24/7 service for the management of patients who do not require immediate hospitalisation. 

There is a deadline of 10 March for every part of the country to be covered by the new service, with the possibility to ‘bring in a provider of digital first primary care to support the response’ should ‘gaps in provision remain’.

Each branch of this community approach should be provided by a GP team, including a nurse, with all clinical information electronically transferred to the patient’s general practice.

They must provide regular reports, including confirmed numbers of patients cared for under the service, how many deteriorate, and numbers of patients admitted to and discharged from the service.

As well as focusing on those able to self-isolate at home, the provision will allow active monitoring of those at high risk of contracting severe illness, and advise those considered low risk on which action they should take if their condition worsens. 

Dr Fay Wilson, the GP in charge of Birmingham out-of-hours provider Badger, told Pulse that although providers would attempt to meet the new requirements, there was a worry about workforce, safety measures and bureaucracy.

She said: ‘There are questions about whether we have the workforce and resources to recruit, employ and train them; whether there will be protective antivirals and PPE; whether pension tax consequences are going to fall on anyone who takes on extra work; whether current contractual expectations will be temporarily set to one side; and whether the bureaucracy which has increasingly grown since the swine flu of 2009 will be relaxed.

‘Out-of-hours organisations will do their best to rise to this challenge, as we always do.’

Providers could each receive up to £20,000 to meet the costs around mobilisation of capacity, and an indicative tariff of £100 per patient for the service applies, to be reviewed in relation to home visits.

The individuals affected will have their symptoms and possible decline monitored via daily phone calls. 

However, Professor Willett stressed that anyone who requires hospitalisation will receive it. 

The Government is preparing for a worst-case scenario where a fifth of the population could be off work due to the virus, with proposals for retired doctors and medical students to contribute to the NHS in its wake.

Over 300 people have now been diagnosed in the UK, with the fifth related death reported yesterday.