GPs in England may stop monitoring vulnerable patients

Ministers may allow GPs in England to halt regular monitoring of millions of patients with underlying health problems as part of the urgent new blitz on delivering Covid booster jabs.

Sajid Javid and NHS bosses are locked in talks with GP representatives at the British Medical Association (BMA) about relaxing rules which mean family doctors undertake checks on people with diabetes, high blood pressure and other conditions that mean they are at higher risk of having a heart attack or stroke.

On Wednesday the UK Health Security Agency (UKHSA) identified 10 further cases of the Omicron variant, bringing the total detected in the UK to 32.

The BMA, the doctors’ union, has been lobbying Javid for months to suspend or scrap the Quality Outcomes Framework (QOF), which it says is “bureaucratic” and interferes with GPs’ right to judge how they care for patients.

Ministers and NHS England want to free up more GP time to help increase the delivery of boosters from 350,000 to 500,000 a day to counter the threat posed by Omicron, which is feared to be more transmissible with the potential to evade vaccines. Vaccine firms are trying to establish whether Omicron has the power to reduce the efficacy of jabs, and whether the jabs can be tweaked in response.

Boris Johnson has pledged that every adult in England will be offered a top-up shot by the end of January, piling pressure on NHS leaders to come up with a plan to ensure that happens.

Officials with knowledge of the talks told the Guardian that those involved spent much of Tuesday discussing the suspension of part or all of the requirements under QOF. “They’re talking about a partial suspension of QOF. But they may well just bin it,” one said.

However, sources stressed that ministers are nervous about approving a move that could lead to claims that vulnerable patients could see any deterioration in their condition go undetected by GPs.

Javid told the BBC on Wednesday that dramatically increasing the number of booster jabs in England was “our new national mission – in terms of the public health of this country, there is nothing more important than this booster programme”.

He disclosed that he was in talks with GP leaders about unspecified plans to reduce their workloads, including his edict that they must see any patient face-to-face on request.

Under QOF, family doctors get payments in return for undertaking checks, often every six months or every year, of the blood pressure or cholesterol levels in patients already identified as at increased risk of a heart attack or stroke. The checks also include assessments of diabetics and drug reviews for those who are on long-term medication to reduce their risk of dying.

“The targets for monitoring blood pressure and diabetes are important for health. But if they remove them, then certain newspapers will claim that they are neglecting patient care,” said one official of the dilemma facing Javid. GPs across Britain have delivered the vast bulk of the 116m Covid vaccine doses which patients across the UK have received since 8 December last year.

The BMA says that patient care did not suffer when QOF was suspended in Scotland to help free up GPs’ time, and that GPs in England would still keep a close eye on patients at higher risk.

If agreement is reached to amend the QOF regime, it will represent a major U-turn by Javid, who ignored calls from the BMA to do that as part of the controversial “GP support plan” unveiled by NHS England in October. It caused fury among GPs for insisting they must see any patient in person on demand.

The BMA has also been pushing for Javid to scrap, or at least delay, his insistence on face-to-face consultations. However, one source pointed out that Javid “has so much invested in delivering that pledge” that he may find it difficult to do so.

While progress is understood to have been made during the talks, it was not enough for NHS England’s primary care chief, Dr Nikki Kanani, to send a letter to all NHS organisations outlining the detail of how the booster ramp-up will be delivered and, crucially, by whom. “These matters with the BMA need to be settled before that can happen,” one official said.

NHS bosses hope to significantly expand the number of people available to deliver jabs through a plan that will see the St John Ambulance and Women’s Royal Voluntary Service together recruit 30,000 volunteer vaccinators on top of the 10,000 that the NHS England chief executive, Amanda Pritchard, said on Tuesday it would hire and pay.

Pharmacists running Covid vaccination sites are also being urged to persuade colleagues at other pharmacies to set up jab centres, the Guardian has learned.

Health officials are scrambling to widen the number of sites in order to enable the dramatic expansion of the booster programme. More than 1,000 pharmacies are already offering the Covid vaccine to patients, it is understood, but officials are keen to expand this to about 1,500 within days.

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