GPs in dark over plans to drop care warn move could ‘swamp NHS’

Reducing GP services could ‘overwhelm’ the NHS while mental health trusts fear services won’t be sustainable in the new year

Dropping non-urgent services could risk patients’ health, GPs warn (Getty)

GPs and hospital leaders have been left hanging over plans to drop “non-urgent” care, and warn there’s no way to safely stem demand without impacting patients health or “swamping” the NHS further.

On Monday evening the NHS published guidance for GPs and hospital leaders over expectations to deliver the government’s new deadline for all adults to be offered a booster vaccine by the new year.

The guidance comes as reports surfaced on Tuesday that ministers were warned the NHS should expect a “significant” increase in hospitalisations, as modelling showed Omicron cases may reach 200,000 a day.

NHS England sent letters to all GP practices and Trust chiefs on Monday evening setting out some plans to support the vaccine drive, which included opening community vaccine clinics 12 hours a day every day of the week. However, the guidance was not clear on what work GPs and trusts could specifically drop to support the drive.

Several NHS leaders raised concerns over the “nightmare” of deciding what care can be reduced, in lieu of any detailed guidance from the government or NHS England, with one leader calling for “clear directive”.

Speaking with The Independent, Dr Michelle Drage, chief for the Londonwide Local Medical Committees, which represents almost all GP practices in London said: “Right now just about everything is regarded by patients as urgent."

She added: “Because of the way the GP contract works, you can’t just not see patients, and we know that when the criteria to prioritise was bought in during the last wave there were lots of people that didn’t get seen that should have been seen, who now form part of the backlog.

“I think it shows a complete lack of understanding of what GPs do to suggest that you can somehow separate all parts of a whole person’s condition that you might regard as urgent that they wouldn’t otherwise have sought emergency help for.”

Dr Drage continued: “It’s probably because they [the government] believe that GPs can drop stuff, but they can’t. There’s no way of dampening down the current demand without impacting on people’s physical and mental wellbeing.”

The LMC’s chief said practices in London were “completely perplexed” as to why the government is not doing its bit to stop the spread, such as bringing back social distancing and making mask-wearing in hospitality settings compulsory.

Dr Simon Hodes, a GP in Watford, told The Independent: “It’s very challenging to understand what work can be safely dropped from general practice.

“We have already received guidance from the British Medical Association & NHS England last week about deprioritising non-essential bureaucracy – which is welcome. However, we need to be clear that we are dealing with emergency, unscheduled care and long term conditions – how can we stop either?”

He said if GPs reduce access to minor illness or do not see emergencies, patients “will swamp 111 and emergency departments, which could overwhelm the NHS”.

Dr Hodes added if cases of suspected cancers are not flagged, the NHS risks missing serious diagnoses and delaying referrals, or if patients with long-term conditions are not seen they “may deteriorate”.

Dr Ben Shankland, a partner for a group of GP practices called The Hurley Group, said it would be a “huge challenge” to decipher what is “truly urgent or what is routine”.

He said: “Of those people we might need to cancel to focus on the booster programme, most will still need our help, if not today, then maybe tomorrow or next week or the week after. Their problems just don’t disappear.”

He suggested digital triage may be able to help determine to some degree a patient’s urgency, and without some form of triage, GPs would have to call or see every patient first.

Dr Shankland added that he “fears for what happens next” after the vaccine programme drive as GPs have gone through being “lambasted” widely in the press over face-to-face appointments. He said he feared GPs would get the blame again after the crisis, further down the line.

In guidance on Monday, mental health service leaders were told to continue with providing community services and services for those in crisis. However, it is not clear whether any further services should or can be dropped, leaders told The Independent.

One sector leader said: “A number of organisations have been asked to send resources to the vaccination programme, but the mental health organisations are saying, ‘We’ve got a workforce problem anyway, yes we want to try and help, but we’ve got to provide mental health services.’”

The deputy chief executive of NHS Providers, Saffron Cordery, said: “Mental health trusts are under significant pressures.”

One trust leader told NHS Providers six of their wards were closed due to Covid-19 outbreaks, including wards for the most ill patients, while they were facing vacancy rates of 30 per cent.

Ms Cordery added: “With the rise of omicron, mental health trust leaders’ immediate focus is on how to keep their services running as in previous waves of Covid-19. At times, this might include scaling back or providing services in a different way to free up capacity and deliver services as safely as possible. However, over the past couple of days, they are becoming increasingly concerned about how sustainable services will be by January, given the significant workforce shortages.”

She said there were also concerns over how another wave would impact people’s mental health and add greater demand on mental health services in the months ahead.

The NHS Providers deputy chief said staff were working “flat out” for many months to make sure support is in place and trusts were collaborating to support the new vaccine programme efforts, including redeploying staff to support vaccine hubs.

However, she said given the frontline shortages some trusts were focusing on redeploying corporate staff in order to keep mental health services “running safely”.