GPs have raised concerns that vulnerable patients may struggle to access Covid treatments in time under plans to move responsibility for the service to ICBs.
ICBs have been told to set up locally agreed pathways for Covid medicines by the end of June with the expectation that ‘potentially eligible individuals will need to contact local NHS services when they test positive, rather than being contacted proactively’.
In a letter to ICBs, NHS England medical director Professor Sir Stephen Powis said ICBs have 90 days to put plans in place for patients to access Covid medicines either through existing Covid Medicine Delivery Units (CMDUs) or equivalent services.
Arrangements will need to be in place to ensure equitable access to treatment for eligible patients, particularly hard-to-reach groups, the letter added.
It follows guidelines published by NICE at the end of March on Covid-19 treatments, which set out NHS recommendations for antivirals and monoclonal antibodies including nirmatrelvir plus ritonavir (Paxlovid), sotrovimab and tocilizumab.
There is a ‘clear expectation’ that each system must continue to ensure access to treatments recommended by NICE, the letter said.
After the 90-day transition period from national to local Covid medicine pathways ‘we intend to step down all national digital enablers, meaning patient communications and digital identification of patients will stop’, NHS England confirmed.
The letter added: ‘As part of any new arrangements, we expect oral antivirals to be available for community pharmacy. DHSC is finalising the distribution arrangements, which we expect to be in place ahead of the transition deadline.’
The Department of Health and Social Care will continue to make existing supplies of Paxlovid and sotrovimab available to the NHS free of charge ‘until stocks are exhausted or exceed their expiry dates’, ICBs have been told.
At current rates of demand, there is enough supply of Paxlovid for two years, and enough sotrovimab for the next 6-12 months, NHS England said.
‘Any other medicine costs will need to be met locally,’ they added.
It comes officials announced an end to all PCR Covid testing outside NHS settings this month, alongside routine asymptomatic testing of patients and staff across all parts of health and social care.
The UK Health Security Agency said the changes would ensure testing continues to focus on those at highest risk, enables appropriate clinical treatment and supports the management of outbreaks in high-risk settings.
Dr Paul Evans, chair of Gateshead LMC, said there is a risk that patients with learning disabilities, severe mental illness, those who lack IT access or those who don’t speak English will miss out.
‘It is hard to see how this is not discriminatory, inadvertently. On the other hand, the educated middle-class immunosuppressed patients are likely to be inconvenienced, but able to navigate the system.’
Dr Lis Galloway, a GP in Surrey, said the system as it currently stands already seems to be missing vulnerable patients.
‘In my experience referrals for treatment have largely been patient led in recent months with GPs picking up the workload of referring.’
Rachel Power, chief executive of the Patients Association, said NHS England needed to work with ICBs to support them in setting up systems to proactively contact patients, especially if the goal of ensuring access for hard-to-reach groups is to be achieved.
‘The advisory from NHS England requires local arrangements that ensure equitable access. But how will that happen if the NHS expects sick patients to contact services.
‘There are many barriers to some communities accessing different types of healthcare – to expect patients ill with Covid-19 to know they’re eligible for these treatments and ask for them, is unreasonable.’
