Early hospital discharge plans could ‘destabilise’ GP practices, BMA suggests

NHS England’s bid to discharge more patients early from hospitals to free up beds could have a destabilising effect on GP practices, the BMA has warned.

NHS England said last month that discharge and care in the community should be stepped up to ease pressure on acute services amid rising Omicron cases.

In a letter to practices, it set out a new priority to ‘maximise capacity across acute and community settings, enabling the maximum number of people to be discharged safely and quickly and supporting people in their own homes’.

But the BMA’s GP Committee has written to NHS England to express its concerns about the move amid a lack of capacity in practices to deal with additional patients in the community.

In its latest email bulletin, sent to practices on Thursday, the GPC said: ‘We are particularly anxious about the wider impact on patients being discharged early into the community, given significant capacity constraints in all parts of the system and wholly inadequate support across both general practice and community care teams to meet the ongoing care and treatment needs of patients.

‘It is incredibly important that NHSE/I ensures that provisions designed to support one part of the system do not destabilise another.’

In the letter, sent to NHS England national medical director Professor Stephen Powis on Christmas Eve, GPC England chair Dr Farah Jameel added that community settings are ‘ill-equipped to cope with this sudden excess and unfamiliar care needs’.

And it is ‘unclear’ how the measures are ‘taking into account significant capacity constraints and pressures within general practice’, which is ‘currently under tremendous strain’, she said.

Dr Jameel added that ‘difficult conversations’ must be had ‘urgently’ about ‘daily asks’ can be ‘suspended’, such as pulse oximetry services, the new Covid medicines programme and virtual wards.

She said: ‘None of these programs have commissioned GPs in the community, none of them have considered our capacity, they have simply been added as an additional clinical responsibility. 

‘We do need to consider these matters all together and examine what must take priority, whilst suspending others. We also need to consider how much thinner we can spread a service or look at more drastic measures that seek to create urgent additional capacity.’

Last month, NHS England said GPs should work with ICSs to step up pulse oximetry services as a ‘Covid-19 response priority’ alongside the vaccination programme, to achieve ‘comprehensive coverage’ by the end of 2021.

Dr Jameel added: ‘We would expect to see secondary care support for those patients who are being assigned to virtual wards and Hospital @ home, given it is their expertise which will be most relevant to the patient at that point.’

The GPC has also written to NHS England to highlight concerns about the lack of capacity available to ‘provide safe care’ for patients not being admitted and instead being cared for in virtual wards or ‘Hospital @ home’ services, the bulletin said.

NHS England also last month set ICSs a target of ‘a minimum of 15% of all Covid inpatients’ to be treated via ‘hospital-supervised’ virtual wards by 31 December, as ‘an initial yardstick’, in a bid to reduce pressure on hospitals.

However, further guidance has said that patients admitted to a virtual ward could have their care reviewed daily by a consultant practitioner or ‘suitably trained GP’, both in a leadership role or as part of the multidisciplinary team.

Meanwhile, the GPC has also raised concerns that it is ‘unclear’ how new respiratory hubs will be staffed and has written to NHS England to request clarification, it said.

NHS England last month urged systems to set up combined paediatric and adult respiratory clinical assessment service (RCAS) hubs to tackle an expected rise in Covid, respiratory syncytial virus (RSV), flu and other respiratory infections.

Guidance said these ‘out-of-hospital’ hubs could be established using primary care Winter Access Fund monies and that one aim would be to ‘support general practice by providing access to specialist advice as needed’.

However, it said that the services may ‘draw on multidisciplinary staff from multiple settings and build on existing arrangements’, such as ‘hot’ hubs set up to cohort Covid-positive patients earlier in the pandemic.

The GPC said: ‘We have written to NHSE/I asking for clarification of timeframes and support for the establishment of these services. It is unclear how such hubs will be staffed.’

It comes as GP practices struggle with Covid staff absences, with 95% experiencing much higher levels of staff off sick than usual.

And GP leaders have warned that NHS England plans to bolster GP capacity by funding remote consulting through its ‘Winter Access Fund’ could worsen problems in under-doctored areas.