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Restore non-Covid services and address backlog before winter pressures hit, says NHS England

by Awil Mohamoud
3 August 2020

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GP practices should restore non-Covid services to usual levels where clinically appropriate and make use of the capacity available in the ‘window of opportunity’ between now and winter, NHS England guidance has said. 

In a letter listing priorities for phase three of the Covid-19 response, sent to healthcare bodies and providers on Friday (31 July), NHS England said general practice needs to ‘make rapid progress’ in addressing the backlog of childhood immunisations and cervical screenings ‘through catch-up initiatives and additional capacity’.

The letter asked NHS trusts to ‘ensure their e-referral service is fully open to referrals from primary care’, following reports that many have been rejected during the pandemic.  

GP practices should reach out to clinically vulnerable patients and those whose care may have been delayed, to boost the number of people coming forward, it added. 

Medication reviews and annual health checks

GPs and community health services should start a programme of structured medication reviews for care homes, while community health teams should resume ‘appropriate and safe’ home visiting care to vulnerable and shielding patients who need them, the letter said.

It also asked GP practices to ensure all patients with a learning disability are identified on their register, and that their annual health checks are completed and access to screening and flu vaccinations arranged. 

The letter recommended GP practices work with clinical commissioning groups (CCGs) to expand the range of services to which patients can self-refer, freeing up clinical time. 

In addition to restoring services, NHS England asked GP practices to prepare for increased winter demand, the expanded winter flu vaccination programme and capacity to deliver Covid-19 vaccinations if and when a vaccine becomes available. 

‘May not be possible’

In the letter, NHS England said it recognises that ‘capacity is constrained,’ and pledged to ‘support practices to deliver as comprehensive a service as possible’.

‘To support restoration, and enable continued collaborative working, current financial arrangements for CCGs and trusts will largely be extended to cover August and September,’ it added.

Responding to the letter, Niall Dickson, chief executive of the NHS Confederation, said: ‘There is much to welcome in this ambitious letter. We all want to restore services as quickly as possible but we need to manage expectations. A full return to pre-Covid-19 levels of activity by October may not be possible.’

The ‘window of opportunity’ between now and winter is ‘very short’, and many of the services restarting in GP practices across the country are ‘constrained and operating at significantly reduced capacity’, he said.

Mr Dickson added that the need to socially distance and use PPE is making it more difficult to ramp up services quickly, while a possible second wave creates further uncertainty.

Continued funding

Andrew Ridley, chair of the Community Network, which is hosted by the NHS Confederation and NHS Providers, welcomed the letter for providing ‘clarity on the route ahead’, but said he would like to see financial commitments for the provider sector stretch beyond September. 

He said: ‘We would encourage Government to continue to work with the national NHS bodies to ensure the NHS has certainty of funding to continue to battle Covid-19 alongside restarting other services.

‘We are concerned that funding and workforce constraints will bring back tensions that the lack of bureaucracy during the pandemic bypassed. 

He added: ‘We are looking to the Department of Health and Social Care and NHS England and NHS Improvement to help reduce this bureaucracy on a longer term basis so that lengthy negotiations about funding don’t have a negative impact on people’s care or capacity in the system.’


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