This blog looks at the standard of care patients can expect from their primary care providers as England and Wales opens up after the Covid-19 crisis
We all understand that during the Covid-19 crisis, primary care services were under great strain.
GPs were dealing with an influx of extremely sick patients, suffering from an unknown and potentially deadly disease. NHS Guidance encouraged GPs to close their practices to most face to face visit, arrange remote appointments, and to avoid, where possible, referring patients to secondary care services. In the midst of such guidance, GPs were understandably unable to make the same number of referrals, especially in the case of non-urgent or elective procedures. It is arguable that the standard of care fell below usual levels, although this question is yet to be clarified in the courts.
However, NHS guidance has moved on since the height of the Covid-19 crisis.
On 29 April 2020, Simon Stevens, the NHS Chief Executive, and Amanda Pritchard, the NHS Chief Operating Officer, co-signed a letter to correspondents including all NHS Trusts, Health Services, GPs and Primary Care Networks.
The letter announced that the NHS was entering the second phase of their Covid-19 response.
With case numbers falling, the second phase prescribed measures to start the process of returning the NHS to some semblance of regular service provision. It hailed the start of the NHS’s return to normalcy.
From a focus on ramping up Covid-19 resources, the NHS was now to shift focus to some non Covid-19 urgent care needs. For GPs, the letter recommended they proactively contact high risk patients with ongoing care needs to ensure appropriate ongoing care and support plans were delivered. For instance, GPs were encouraged to make two week cancer referrals “as normal”. From late April 2020 then, the NHS guidance was to bring management of urgent referral needs back to normal, and to more proactively deal with non Covid-19, but high risk, patients’ needs. Since late April things have moved on even further.
On 24 June 2020, NHS England published further guidance on the second phase of their Covid-19 response, in a document entitled the “Guidance and standard operating procedures - General practice in the context of coronavirus (COVID-19)”.
For GPs and other primary care providers, whilst some Covid-19 changes will remain, such as the sustained use of remote appointments, this document seems to indicate a shift back to normal working practice for non Covid-19 care.
GPs are now to refer patients to secondary care using the usual pathways and to base judgement of need on usual clinical thresholds. And even beyond regular patient needs, GPs are now to proactively address health needs that may have increased, developed or gone unmet during the pandemic.
The message from the NHS seems clear. There is a clear shift back to business as usual, or something as close to it as possible. On top of that, there is an added duty placed on GPs to actually go back over things that were left in limbo during the pandemic.
For patients, it would appear that Covid-19 is no longer a reasonable excuse for a delay in referrals.
Whilst patients were understanding during the height of the crisis, with the heroic efforts of the NHS to treat and deal with the ravages of the Covid-19 virus, we have now reached a point where patient referrals should be made using the usual pathways, in the usual timeframes. So if a delay in a referral leads to a poor treatment outcome, a patient may have a potential clinical negligence claim.