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GPs to manage discharged Covid hospital patients, says NHS England

by Nicola Merrifield
12 June 2020

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Primary care services should expect ‘increased demand’ placed upon them due to the care they will be expected to provide to Covid-19 patients recently discharged from hospital, NHS England has said.

New NHS guidance on the ongoing care of discharged coronavirus inpatients states nutritional rehabilitation needs and insomnia problems will likely create additional pressure on GPs.

Meanwhile, a lack of existing chronic cough management services in the community means GPs will be expected to work with other providers to set up care pathways, according to the official document.

But GPs have warned they do not have the capacity to provide this additional care on top of their normal service, warning it could be ‘dangerous’ for patients if GPs are expected to provide the extra support.

NHS England’s guidance, published on 5 June, says it describes the ‘typical expected health care needs’ of patients who have previously been hospitalised due to an acute episode of Covid-19.

It highlighted more than 95,000 Covid-positive patients had been hospitalised across England, and most had been able to recover and leave hospital.

But it warned: ‘However, it is clear that for many of those who have survived, the virus and the treatment required to combat it will have a lasting impact on their health.’

The guidance, which is no longer available on the NHS website but has been seen by Pulse, lists almost 30 healthcare issues expected to affect discharged patients, including respiratory, cardiac and urological problems.

It said nutrition is a ‘vital’ part of recovery for all Covid-19 patients, particularly those who have suffered cardiac distress, pulmonary distress, or those who have been critically ill due to the weight loss, frailty or sarcopenia associated with these conditions.

The guidance said: ‘The anticipated need for ongoing nutritional rehabilitation as part of recovery will place an increased demand on primary care services with the potential for readmissions.’

Diet enrichment ‘should suffice for most’, it added, but noted there also appeared to be an increased need to use oral nutritional supplements alongside this in malnourished patients.

The guidance highlighted that sleep disturbance is common in critically ill patients up to 12 months after hospital discharge, with prevalence ranging between 10-60% at six months.

It said: ‘Increased prevalence may place increased pressure on primary care (presenting as typical insomnia or as a consequence of ‘flashbacks’ and survivor guilt, along the lines of PTSD) and, in turn, on local IAPT services that may provide the appropriate evidence-based psychological therapy (CBT).’

Meanwhile, NHS England made suggestions on longer-term respiratory care for Covid-19 patients, though stressed these were only based on emerging data.

It said: ‘Few community services for chronic cough management exist. Despite extensive assessments and medical management, in up to 20% of chronic cough cases the cough persists and does not respond to medical treatment.’

‘There is emerging evidence to show that nonpharmacological treatment approaches and specifically physiotherapy and speech and language therapy interventions can improve/eliminate chronic cough.

‘Primary care should work with other providers to ensure appropriate care pathways exist.’

Essex LMC chief executive Dr Brian Balmer said: ‘This care should be in the community – you can’t just dump it on normal general practice. There’s nowhere for it to go. There are no people to do it.

‘That’s an increased workload – so what should we stop doing to accommodate that? The normal work is coming back quickly now so is there something they want us to stop doing, which will free up the time and the people to do it?’

He added: ‘There’s an illusion GPs haven’t got anything to do. Somebody is making the assumption that we have the capacity to do it – and that’s a dangerous assumption, especially for those patients.’

A spokesperson for NHS England pointed to recent comments made by the organisation’s chief executive Simon Stevens to mark the opening of a new rehabiliation hospital in Surrey for Covid-19 patients, called the NHS Seacole Centre.

Mr Stevens said: ‘The next phase of the health service’s coronavirus response will mean expanding and strengthening community health and care services in new ways, such as these new Seacole Centres.’

GP practices have also been told they should put together a dedicated home-visiting team for patients who are most vulnerable to complications from coronavirus and do weekly virtual ward rounds with care home residents.