Ministers have given GPs in England the green light to provide less care to millions of patients for the next four months so they can join the “national mission” to urgently deliver Covid booster jabs. Family doctors will spend less time monitoring people with conditions such as diabetes and heart problems, do fewer health checks on the over-75s and stop performing minor surgery until April. Sajid Javid, the health secretary, and NHS bosses have approved the controversial changes so that GPs and practice nurses can join the drive to administer top-up shots as quickly as possible. Doctors’ leaders sought to reassure the public that anyone falling ill or worried about their health would still be seen and assessed. However, the Patients Association immediately warned that the reduction in routine checks will lead to signs of illness being missed and disrupt the relationship between patients and GPs.
Family doctors will experience a substantial lifting of the requirements set out in the Quality Outcomes Framework (QOF) to monitor patients and help tackle public health problems such as smoking and obesity – lifting their workloads so they can help administer booster shots. Javid and NHS England have given them permission to undertake far fewer checks on people with a wide range of serious ailments, including high blood pressure, asthma, chronic kidney disease and obesity. GPs will also undertake fewer medication reviews with people who are taking drugs on a long-term basis to help manage their condition and reduce the danger of their health deteriorating, for example blood pressure tablets to reduce the risk of a heart attack or stroke. For the next four months family doctors will continue to carry out only a limited amount of these checks. Javid and NHS England have agreed to leave it to GPs’ clinical judgment which patients still need to be monitored. “This is a necessary temporary emergency measure because the booster rollout is now the NHS’s top priority,” a source said. “National GP bodies have assured the government and NHS leadership that most of the services should still go ahead, but based on clinical need.” However, GPs will still have to comply as usual with a few QOF duties, including administering non-Covid vaccinations, especially in children, and undertaking cervical cancer screening. The NHS has to ramp up the daily total of boosters delivered from 350,000 to 500,000 as soon as it can to help deliver Boris Johnson’s pledge on Tuesday that every adult in England will have been offered one by the end of January. The deal was hammered out during several days of complicated and protracted talks this week involving GP leaders, NHS England and the Department of Health and Social Care. The Guardian revealed on Wednesday that moves to set aside QOF obligations on GPs were under way after the emergence of the new Omicron variant of coronavirus left ministers, NHS leaders and scientists worried about a potential new surge in infections. Rachel Power, chief executive of the Patients Association, welcomed the fact that “the NHS is undoubtedly mobilising resources on an impressive scale for the booster programme.”
But, in a sign that NHS England will have difficulty explaining the rationale behind the move, Power added: “Withdrawing some regular GP services will further disrupt the relationship between patients and the NHS. The decision also risks building up future ill-health that would have been picked up in routine health checks, which will have to be dealt with at some point.” The changes were outlined in a letter which NHS England chief executive Amanda Pritchard and three senior colleagues sent on Friday to local leaders across England outlining how the health service will push forward with the booster programme. The suspension of so many of the QOF duties is a major victory for the British Medical Association (BMA). Javid has ignored the doctors’ union’s pleas in recent months to relax or scrap QOF altogether as a way of reducing their “unsustainable and impossible” workloads and angered them when he did not include it in his “GP support package” in October. That plan caused fury and consternation in the profession by insisting that GPs see any patient who wants it face to face, despite the threat posed by persistently high levels of Covid infection. The BMA GP committee chair, Dr Farah Jameel, said the nationwide shortage of family doctors meant that, while GPs intend to aid the boosters push as much as they can, “there must be a recognition that they cannot do everything for everyone all of the time. “Today’s changes begin to recognise this, and we hope that, by removing some of the more bureaucratic and target-based requirements within practices’ contracts, that staff’s time can be freed up to get more jabs into arms, while allowing practices to focus on patients who need their attention the most.” She added: “Patients need to know that if they are unwell or have concerning symptoms and need to receive care from their practice they will continue to be prioritised and GP teams will continue doing their very best to keep their sickest patients safe in every way they can and know how.” Ruth Rankine, director of primary care at the NHS Confederation, said: “Hopefully this guidance will free up much-needed time for primary care teams to vaccinate at speed and to prioritise patients with the greatest clinical need.”