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GPs in Wales urged to see Covid patients face to face after seven days

The Welsh Government has urged GPs to use pulse oximetry to assess patients with Covid-19 face to face, if their symptoms have not improved within seven days of self caring at home.

The Welsh chief medical officer said the change to guidance comes as he is ‘concerned that there is potential for people to wait too long to seek medical support and this could potentially result in people being admitted to hospital at an advanced state of deterioration’.

In response, the Welsh Government has updated advice to the public to ask anyone whose Covid-19 symptoms have not improved within seven days to contact their GP or NHS 111.

The updated public advice for people who are isolating with symptoms or confirmed Covid-19 states:

  • If your symptoms do not improve after 7 days;
  • Or if you experience vomiting;
  • Or if you experience breathlessness;
  • Or if you are fatigued and can no longer perform your normal daily activities;
  • Then don’t leave it too late, contact 111 or your GP.

A letter to GPs from CMO Dr Frank Atherton regarding the management of confirmed Covid-19 patients said: ‘I would like to ask for your support to ensure that people who do get in touch with primary and community care services are appropriately assessed on the basis of their clinical risk… I am asking you to place a greater emphasis on measuring pulse oximetry as part of your clinical assessment.’

He said he is ‘not advocating the remote monitoring of pulse oximetry at the present time’ due to evidence of its ‘limited’ clinical value.

The CMO said he recognised ‘the need for proper infection prevention and control in delivering more pulse oximetry assessments’, advising GPs to use ‘drive through’ models of delivery where appropriate.

However, he added: ‘For some patients who are not able to travel, then a home visit may be necessary.’

GP practices which do not have access to pulse oximeters will receive these distributed for free, the letter said.

Dr Atherton said the new guidance comes as there ‘is emerging evidence that a large proportion of Covid-19 cases are avoiding contact with primary care and the vast majority of Covid-19 admissions are likely to be emergencies’.

‘I am concerned that the public message to isolate at home with mild symptoms may have encouraged people to attempt to cope alone for too long without contacting 111 or their GP. 

‘I am also concerned that the emphasis on remote consultation in primary care, given understandable concerns about infection prevention, may make it more difficult for GPs to assess the severity of Covid-19 illness.

‘In particular, it has emerged that breathlessness is not a good indicator of disease severity. Oxygen saturation appears to be the key indicator and this requires the measurement of pulse oximetry,’ the letter said.

Dr Dave Wilson, a GP at Hywel Dda University Health Board, said that ‘the evidence for the seven-day dip is strong – there are a cohort of patients who “go off” and you really want to encourage them to speak to someone’.

But North Wales LMC chair Dr Sara Bodey said: ‘The fact that the CMO has, rather than securing support for general practice and our patients, chosen to exhort us to go “over the top” once more shows a profound lack of respect for the clinical teams who have worked so hard in responding to this crisis.’

And Dr Bodey said the CMO’s letter was ‘badly timed communication, which has the potential to put GPs and their teams at unnecessary risk’.

She added: ‘The fact that pulse oximetry is a key part of assessment of patients with more severe Covid will not be news to any GP who has been working on the frontline, either in practice or in hubs, over the last few months. Some of my colleagues have had first-hand experience of this as patients themselves. A supply of pulse oximeters, whilst welcome, would have been more useful in March.’

Dr Charlotte Jones, a partner in Swansea whose practice has been assessing patients face to face, commented on the CMO’s suggestion that clusters of GP practices should collaborate in assessing Covid patients.

She said: ‘My feeling is that one solution does not fit all, and that options and support for practices should be readily available for them to deliver a safe, effective quality service for patients. I feel the CMO and Welsh Government guidance should support the practices in delivering the right solution for them.’

And Dr Eamonn Jessup, a GP from North Wales, said: ‘I fear this document is too blunt an instrument, failing to reflect the different situations across Wales and runs a significant increased risk to GPs themselves and to other patients using GP facilities.’

Dr Phil White, chair of the BMA’s Welsh GP Committee, said GPs across Wales ‘have responded well to the challenges posed by Covid-19 and have adapted their surgeries appropriately to deliver excellent care for patients’, often at their own expense.

‘To offer practices additional oximeters at this stage is in our view far too late,’ he added.

The Department of Health and Social Care said advice for England regarding Covid-19 self care and assessment has not changed.

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