COVID-19 GP diary: We still need more clarity on reimbursement

Our co-founder Dr Ishani Patel is a GP based in north-west London and the eHub lead for four primary care networks. In this series of weekly posts, she explains how she and her colleagues are managing in the face of the coronavirus pandemic.

I’m not going to dwell too long this week on the lockdown broadcast and messages that were shared with the public on Sunday and Monday. That’s not to say they don’t affect me and my patients, of course. But I’m sure everyone reading this will have already read plenty about those announcements. 

My number one concern is that people are enabled to return to work – and life – safely. And that’s not going to be helped by confusing and contradictory messages.

At last, details of the NHS England reimbursement scheme

The big news for those of us in primary care this week was further details from NHS England (NHSE) about reimbursements for practices. 

I wrote last week of my frustration that we still had no information about how practices would be reimbursed for the considerable additional expenses incurred during the height of the COVID-19 crisis – and ongoing. Finally, following the NHSE webinar last Thursday, we have a little more clarity. I hope the treasury has approved the plans and we receive confirmation this week. 

In the reimbursement plans, NHSE has agreed to fund locum and sessional GPs up to a maximum of £250 a session or £500 per day and partners could claim £289 per session. This GP Online article has further details.

My personal feeling is that we should have had this information and seen the scheme set up sooner. The crisis started for us – as one of the early hotspots – in February, yet here we are in May and only just receiving news (which is yet to be finally signed off by the treasury).

I think what’s been announced so far will go some way to supporting practices who are experiencing anywhere from a £2,000-£4,000 drop per month in income because they're not fulfilling additional service contracts. They're providing core contract services only at the moment.

However, what we still need is more clarity on timelines and how far back people can make claims. There are practices that went into ‘lockdown mode’ before the official lockdown was announced. Our practice is one of them. We did this because we could see what was going to happen and we knew we had to create increased capacity for our online consultation hub – another service that I believe requires reimbursement.

Ramping up online consultations

The subject of online consultations leads me neatly onto one of my big focuses over the last week. Across northwest London, there’s been a massive push to ramp up the delivery of online consultations. And I’ve been conducting lots of webinars with practices to get them ready to switch their online offerings on.

People are excited but also apprehensive about this switch. The main challenge we’re facing is interoperability – in other words, ensuring that all our systems speak to one another, so we’re not having to use lots of manual workarounds. At the moment, we’re not quite there and that’s a big barrier to adoption.

I spoke to Dr Zalan Alam this week, Director & Intermediate Tier Lead for GP Care Services in Rochdale. We’ve taken very similar approaches to online consultations during the crisis and it was great to compare notes. We’ve both been carrying out online consultations ourselves, working from home. While this has obviously been necessary during the crisis, we both agreed that we really value our days at the practice with the team (under social distancing conditions) and I’m sure we’re not alone in feeling like that.

Dr Alam’s patch in Rochdale is part of an exciting new project the Lantum team has been working on over the last few weeks, and which I’ve been closely involved with. Greater Manchester Health and Social Care Partnership is working with us to connect clinicians and primary care providers across an area that serves 2.8 million people. It’s fantastic to be part of the project, which will see them combine their existing workforce, as well as reach additional vetted staff, all in one place. 

The PRINCIPLE trial

Something else I’m really excited about this week is that our practice has been selected to take part in the PRINCIPLE trial, which aims to find treatments for COVID-19 for older people. 

The researchers, based at University of Oxford, want to find medicines that can help people with COVID-19 symptoms get better quickly and stop them needing to go to hospital. Patients will be randomly allocated to receive either a placebo or a drug treatment, to see whether they respond differently.

I hope that by taking part in this trial, and any others we’re able to find, that we’ll be contributing to the wider effort to control the disease.

And if you’d like to hear more…

Finally, if you’d like to hear about my experiences as a GP and encouragement for GP trainees, particularly in the context of this current crisis, then you can listen to my interview on Dr Aman Arora’s #CanPassWillPass podcast.