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Implementing the long Covid enhanced service



GP partner and trainer Dr Pipin Singh explains what practices need to know about the new long Covid enhanced service requirements 

NHS England has set up a £30m enhanced service for practices to improve their training and infrastructure to support patients with long Covid.1

It requires practices to demonstrate through self-assessment that they have established the following:

• Education and training on identifying, assessing and managing the condition for all team members involved – for example, doctors, nurses, pharmacists, social prescribers and care navigators.

• Knowledge of local referral pathways.

• Accurate coding (using SNOMED CT).

• Equity of access.

Background

NHS England’s specification says long Covid encompasses both ongoing symptomatic Covid-19 and post-Covid-19 syndrome, in line with these NICE definitions:

• Acute Covid-19 – signs and symptoms of Covid-19 for up to four weeks.

• Ongoing symptomatic Covid-19 – signs and symptoms from four to 12 weeks after the start of acute Covid‑19.

• Post-Covid-19 syndrome – signs and symptoms that develop during or after an infection consistent with Covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.2

The NICE guidance details a range of symptoms that should prompt consideration of long Covid. These include breathlessness, cough, chest tightness, fatigue, fever, symptoms of depression or anxiety, loss of taste or smell. 

If ongoing symptomatic Covid-19 is diagnosed (from four weeks after infection) patients can be offered signposting to self-management, and referral to post-Covid assessment clinics.

Education

The specification states the requirement is for practices to demonstrate they have ‘workforce education and training on how to identify, assess and manage long Covid; this learning may differ depending on the role and learning need of each professional’.1

It does not specify how training should be undertaken. Practices and PCNs will need to decide what is appropriate – for example, an online module or a CCG education event.

Training modules on the Health Education England e-Learning for Healthcare portal3 and the RCGP’s online course4 can be used. 

Staff can do this training in their own time, although practices could appoint a lead clinician to set up a learning event.

The difficulty will be in providing education for non-clinical staff. Care navigators will need to know where to signpost people diagnosed with long Covid, so will have to increase their knowledge of local services. I expect practices will need to allow staff one to three hours of training time.

Promoting knowledge of local referral pathways

Practices signing up must have access to long Covid clinics in their area and be familiar with the NHS England document on setting up post-Covid assessment clinics from April 2021.5

Ensure all GPs have read the specification, had the training and understand how to refer to the clinics. Secretarial teams will need to know the administrative process of referring to clinics. GPs will need to work with the clinics to facilitate tests if possible – although current primary care workloads may make this difficult – and ensure coding is accurate from letters.

The specification emphasises that long Covid management requires a multidisciplinary approach involving doctors, nurses, physiotherapists, occupational therapists and psychological input. It’s likely that cardiologists or respiratory physicians will be required if major systems are involved, and neurologists or infectious-disease teams may also be needed. 

Ensuring accurate coding

This requires use of the correct SNOMED CT codes for:

• Diagnosis.

• Signposting.

• Resolution.

Practices must also demonstrate they are using appropriate coding for key clinical information in letters from clinics or specialist services.

This will be both a clinical and an administrative task, with the clinical team ensuring the diagnostic and signposting codes are completed, while admin staff may be required to complete referral codes and resolution codes with appropriate guidance from clinical colleagues.

Ensuring staff are aware of the codes is important. It might be worth having a clinical lead for the enhanced service who makes sure staff on the coding team are trained and coding is accurate.

Payment

Practices will be entitled to £0.371 per registered patient (75% of payment) on signing up to the enhanced service, paid in monthly instalments. The remaining £0.124 per registered patient (25%) is paid when a self-assessment is completed at the year end. For a practice list of 10,000 patients this will equate to around £4,900.

The work may feature in the GMS contract within the next couple of years as Covid continues to circulate and the prevalence of long Covid increases, so it makes sense for practices to use the funding available now to embed the training and infrastructure.

Long Covid SNOMED CT codes

SNOMED CT diagnosis codes:

Ongoing symptomatic Covid-19 (4-12 weeks after infection) – 1325181000000106

Post-Covid-19 syndrome (12 weeks plus) – 1325161000000102 

CT signposting and referral codes:

Signposting to Your Covid Recovery – 1325021000000106

Referral to post-Covid assessment clinic – 1325031000000108

SNOMED CT resolution code:

Post-Covid-19 syndrome resolved – 1326351000000108

A list of other relevant codes is detailed in Appendix B of the national commissioning guidance.5

Dr Pipin Singh is a GP partner in Wallsend, Tyne and Wear

For further advice on the GP contract and practice finance go to pulse-intelligence.co.uk

References

  1. NHS England. Enhanced service specification – Long Covid 2021/22. London: NHSE, 2021
  2. NICE. Covid-19 rapid guideline: managing the long-term effects of Covid-19. London: NICE, 2020
  3. Health Education England. e-Learning for Healthcare portal
  4. RCGP.Online eLearning course Long term effects of Covid-19 and Post-Covid-19 syndrome
  5. NHS England. National guidance for post-Covid syndrome assessment clinics. London: NHSE, 2021