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Covid-19 recovery principles for General Practice

Date published: 03/08/2020

As services resume from Covid-19 GP practices are facing unprecedented pressure from unmet patient needs and ongoing disruption in services in other parts of the NHS. This is on the background of General Practice being in a very challenging position even before the Covid-19 pandemic started.

Kent LMC, in discussion with PCN Clinical Directors and other stakeholders, has developed a set of principles that should be applied to any NHS recovery processes. This includes any changes to patient services and pathways that have an impact on General Practice.                                                           

Service Changes: An impact assessment on General Practice should be undertaken before any change is made to clinical services and pathways. Any service change that has an impact on General Practice ​must only be made in consultation and explicit agreement with the LMC.

Workload shift: Any shift of workload to General Practice needs to be adequately and safely resourced and funded. This should only be done in consultation and agreement with the LMC.

Remote consultations: in any part of the NHS system, must lead to similar or better outcomes for the patient than face to face consultations. This means that all actions originating from remote consultations should be completed by the care provider without transfer of care to General Practice, unless it is done with explicit agreement with LMC as per points 1 and 2 above.

Clinical pathways: Any pathway change must make the patient journey better or quicker. It must not make the pathway longer or more difficult. For example, any triage process should only move patient care further forward and not add additional steps to patient care.

Patient communication: Patients must be kept informed by the managing clinician of all decisions and actions taken by their teams. All service providers should respond to patient queries and manage patient expectations directly.

Referral management: Referrals should not be rejected but managed safely by the receiving organisation. Any redirection of referral should only take place by a clinician to clinician agreement and should be directly communicated to the patient by the secondary care clinician.

Self-referrals: Where possible patients should be able to self-refer to services to reduce risks for themselves and General Practice staff.

GP workload: GPs and practice staff should aim to adhere to safe workload limits as per BMA guidance once services resume to business as usual. While services are restricted due to Covid practices should only provide care in a safe and sustainable way.  These activity levels are likely to be lower than the safe limits during normal circumstances.

GP IT: including digitalisation of notes, should be a key priority on an ongoing basis. Locum GPs should be provided with IT hardware and ongoing technical support to enable them to safely work remotely.

GP premises: Urgent investment should be made into GP premises to make sure staff and patients have access to safe working environment now and in the future.

GP Workforce: Risk assessments and Occupational Health support should be provided by the CCG or NHS England for all GPs, including locum GPs, and practice staff.

PPE: Adequate and sufficient Personal Protective Equipment and other IPC requirements should be supplied centrally or, if that is not possible, funded upfront by the CCG.

Equitable access: Patients and practices across Kent and Medway should have equitable access to services. Mental health should be treated on par with physical health and patients should have easy and timely access to specialist mental health services.

Flexible and innovative approach: Commissioners should be flexible in contractual arrangements to allow for an innovative approach to service delivery. For example, extended access and community services can be delivered more flexibly to utilise resources efficiently and safely.

Collaboration: NHS organisations and stakeholders should continue to develop system wide partnerships and collaboration to help improve patient care and sustain general practice.