New BMA Guidance on COVID Therapeutics for GPs

The BMA have published guidance on COVID therapeutics for General Practice. The key statement is below.

“We therefore recommend that GPs do not agree to prescribe this unless as part of an appropriately commissioned service.”

Wessex LMC’s agrees with this guidance but we wanted to highlight wider related issues in this introduction.

We have recently seen discussions on this topic in one of our four Integrated Care Systems. We were informed the COVID Medication Delivery Unit would be ceasing from early May. This decision has now been reviewed and amended, but expectation was that General Practice would take on prescribing for this vulnerable cohort.

We have spoken with many GPs and Practice Managers and been struck by the depth and breadth of feeling expressed. It appears the third contract imposition in three years has changed how practices respond to circumstances such as this. The financial situation and outlook are such that changes like this cannot be safely absorbed any more.

Practices swiftly communicated with each other and aligned in their local areas around a common position that they were able to express and supported the BMA view. The proposed change was described to us as a “red line” and “final straw”. The idea was advanced that any other proposal without resource would also be impossible to accept and General Practice is already beyond saturation point.

There are important ideas to emphasise here of not being forced to work beyond clinical competence or practice capacity and not being responsible to fill a commissioning gap. However, we want to focus on this concept regarding resource which can be summarised as “When activity moves, resource must move with it”.

It is not in the interests of our populations or Integrated Care Systems for movements of activity without funding or workforce moving with it. We have seen too many workload shifts like this in the last few years. With increasing pressure on the rest of the system General Practice has often borne the brunt of efforts to maintain other services. Examples of this include attempts to mandate additional tests or questionnaires within a referral process, restricted criteria that will be accepted for a referral and a perception that it is acceptable to issue a large list of “GP actions” in a discharge summary or outpatient letter.

Practices are increasingly collaborating to define and enact healthy boundaries for workload shifts that are not resourced. This is incredibly effective and can change the entire view of the system around them.

Whilst seeking to constructively engage with Integrate Care Boards and Trusts, one of our aims at Wessex LMCs is to empower practices and part of that is sharing the privileged view we have on current trends and thinking.

We would encourage you to discuss within your teams the concept of resource needing to move when there is an activity shift and consider what the position of your organisation is on it. How will you approach current and future issues and prioritise the areas that have most meaningful impact on your day-to-day work?

We will of course be saying this on your behalf but there is power in embedding this as a key concept in the many practices we represent and support.