The BMA has received ‘many reports’ of ICBs considering decommissioning specialist Covid antiviral services and passing responsibilities to GPs, it has warned.
Since the pandemic, Covid Medicine Delivery Units (CMDUs) have prescribed antivirals to eligible patients but there are now suggestions that GPs should prescribe the treatments instead.
The union said that NHS England is planning for this to be a ‘referred to’ service but warned that it needs to be put in place ‘with sufficient time, knowledge, and links to safely prescribe’.
NHS England told Pulse that this is now an ICB-commissioned service and it will be down to each ICB to determine the ‘best delivery model’ based on their local population need.
It comes with ‘a funding mandate’ – subject to the funding variation request – and ICBs are ‘responsible’ for making funding available and arranging access as per NICE guidelines, NHSE said.
New BMA guidance said: ‘We feel it is important that GP practices understand what is happening as soon as possible as we have heard many reports of ICBs suggesting that GPs should be prescribing these treatments as “business as usual”.
‘Until now, these have largely been delivered through Covid Medicine Delivery Units (CMDUs). We are clear that we do not believe it is appropriate for every GP to be required to start prescribing these medications.’
The GPCE said that this is due to the ‘complexity’ of the current cohorts of eligible patients and the nature of the medications themselves.
NICE recently expanded the cohort of patients who are eligible for antiviral treatments, so that 1.4 million more people are eligible to be prescribed Paxlovid (nirmatrelvir plus ritonavir) if they test positive for Covid.
BMA members currently involved in running CMDUs said that the assessment of patients is ‘time consuming’ due to the large number of interactions and contraindications, and often required input from specialist colleagues before prescribing.
‘We therefore recommend that GPs do not agree to prescribe this unless as part of an appropriately commissioned service,’ the guidance added, as previously stated by the union.
It also pointed out that the Paxlovid is ‘very difficult to prescribe’, as it has interactions with many common and specialist medications that many in this patient group will be taking.
It added: ‘Current numbers of eligible patients suggest prescribing levels are around 2/100,000 patients per week.
‘This does not enable clinicians prescribing at practice level to develop the required knowledge or skill to safely prescribe this treatment.
‘Even with increased cohorts the number will not be such that every GP could become skilled in offering these treatments.’
It added that it is important that antiviral distribution services in all areas operate seven days a week and ensure a minimum of 95% of all eligible patients begin antiviral treatment within at least 48 hours of testing positive, and that ensuring this is being delivered ‘will require some level of monitoring’.
‘We believe patients must be able to get access to this potentially lifesaving treatment in a timely manner,’ the guidance added.
ICBs took on responsibility for delivery of treatments from the Covid-19 Medicines Delivery Units (CMDUs) in July last year.
Lancashire and Cumbria LMCs chief executive Dr Adam Janjua said his local ICB subcontracted the service to one local provider that bid for it.
He told Pulse: ‘We at the LMC would strongly resist any move to make GPs prescribe it. It was about GPs not having the training and expertise to carry out the provision, there simply was no appetite for it from GP practices.’
No. Complete sentences.
I thought government was going for ‘Prevention is better than Cure’, and this is a prime case where massive costs of hospital admissions, antiviral treatments, NHS staff sickness absences, and costs to industry from lost productivity through staff sickness, and costs to DWP of people off sick and permanently disabled as a result of Covid, not to mention rising clotting rates and diabetes rates need ing additional drug spends, could ALL have been avoided (and STILL COULD) by PREVENTING TRANSMISSION. But for some reason, government does not want to repair the economy, the NHS, and sickness work absence rates, they need us all to get Long Covid first – why is that?
No, this is non-contractual so we are not obliged to do it – especially for free.
They need to stump up the money to cover the service. Even then I don’t have the time, so wont be signing up.
The Government has just lost the plot on all this and seems intent on decommissioning the NHS!
If you look at the workload it is less than trying to get a patient with COVID treated now. I have never understood why when we have a very efficient community based service to provide medication they insist on parallel systems. They did it with Swine flu and now paxlovid. The main reason I suspect is numbers have dwindled so the provider of choice is not making money so they want to dump it. But hey we can’t have GP’s making profits off the back of delivering a service.
Don’t. Just don’t.