How much is Covid-19 to blame for growing NHS waiting times?

The pandemic has had an enormous impact on health and care services, but to what extent is it to blame for the current pressures facing the NHS? | Nuffield Trust

This analysis looks at access and waiting times before and during the Covid-19 pandemic. The authors warn that the scale of the NHS backlog cannot be solely attributed to Covid-19 but instead is a predictable consequence of the collision between a pandemic and a health system already stretched beyond its limits.

General practice:

The number of appointments in general practice fluctuates from month to month, but there was around a 30% fall during the first wave of the pandemic. Appointments have since recovered to pre-pandemic levels and are following a very similar trajectory to before the pandemic. In May 2022, there were nearly 28 million general practice appointments and an additional 729,000 Covid-19 vaccination appointments.

Even though the number of appointments has returned to pre-pandemic levels, access and experience of general practice have been significantly impacted by Covid-19. The latest GP Patient Survey, collected between January and April 2022, shows poorer experience of making an appointment. Nearly half of respondents (47%) said it was not easy to get through to their GP practice on the phone, and a quarter had avoided making an appointment in the previous 12 months because they found it too difficult.

While appointment volumes have recovered, the number of GP referrals for a first outpatient appointment are still much lower than they were before the pandemic, although they are increasing. In May 2022, there were over 100,000 fewer GP referrals than in May 2019.

Full detail: How much is Covid-19 to blame for growing NHS waiting times?

Press release: Covid-19 not solely to blame for scale of NHS care backlog

Health and Social Care Secretary accepts JCVI advice on autumn booster programme

All people aged 50 and over will be eligible for autumn COVID-19 booster and flu vaccine | Department of Health and Social Care

The Health and Social Care Secretary has accepted the independent advice of the Joint Committee on Vaccination and Immunisation (JCVI) to offer an autumn COVID-19 booster to people aged 50 and over, residents and staff in care homes for older adults, frontline health and social care workers, unpaid carers, individuals aged 5 to 49 in clinical risk groups and household contacts of those who are immunosuppressed.

The programme is expected to start in early autumn. Details of how the programme will be delivered including how people will be invited for vaccination will be set out nearer the start of the programme.

Full detail: Health and Social Care Secretary accepts JCVI advice on autumn booster programme

See also:

• Covid continues to disrupt: what is the plan to deal with it? | BMJ
• Covid booster will be offered to all over 50s this autumn | BBC News
• Covid boosters: who could be eligible for autumn jabs in UK? | The Guardian

The rollout of the COVID-19 vaccine programme in England

House of Commons Committee of Public Accounts

This report calls for efforts to be redoubled to reach those not vaccinated or fully vaccinated as it warns that nearly three million adults in England are unvaccinated against Covid-19. It finds that comparatively low vaccination rates persist in many vulnerable groups and has even dropped further for some. It calls for NHS England and UKHSA to urgently evaluate which methods are most effective for increasing uptake, including fresh approaches to tackle the persistent low uptake observed in some ethnic groups.

Full report: The rollout of the COVID-19 vaccine programme in England

Press release: Redouble efforts on unvaccinated to reduce risks of Covid deaths, warn MPs

COVID-19 vaccination enhanced service specification for autumn/winter 2022 for general practice

Enhanced service specification for general practices: phase 5, and other documents relating to phase 5 of the COVID-19 vaccination programme | NHS England

The majority of the service specifications for phase 5 remain the same as in the previous phase, although there are some changes and alignments between the two contracts. Both community pharmacy and general practice must:

• have the ability to administer any adult vaccine type to ensure resilience across the network;
• ensure that delivery of COVID-19 vaccinations will not negatively affect their ongoing delivery of other services, recognising current pressures on general practitioners and pharmacy contractors;
• record COVID-19 vaccinations on the day that they are administered due to the clinical risks associated with data latency;
• agree with their Commissioner their role in the System to respond to a Surge where an increase in capacity is required both in terms of increased volume and/or timeframe.

Full detail: COVID-19 vaccination enhanced service specification for autumn/winter 2022 for general practice

See also: Cover letter accompanying the publication of the enhanced service specification for general practice

COVID-19 infections continue to rise across the UK

A roundup of the latest data and trends about the coronavirus (COVID-19) pandemic from the ONS and other sources | Office for National Statistics

COVID-19 infections have continued to rise across the UK, with more than 1 in every 30 people estimated to have tested positive in the latest week. An estimated 2,294,300 people in the UK would have tested positive for COVID-19 in the week to 24 June. Prevalence was highest in Scotland (5.47% of the population, or 1 in 18 people) and lowest in England (3.35% of the population, or 1 in 30 people). The recent rises in infections are likely to be linked to the Omicron variants BA.4 and BA.5.

The Office for National Statistics have also published data on deaths registered in 2021, which show London had the highest COVID-19 death rate across all English regions and Wales.

Full detail: Coronavirus (COVID-19) latest insights

Global impact of the first year of COVID-19 vaccination

The Lancet Infectious Diseases| DOI:https://doi.org/10.1016/S1473-3099(22)00320-6

The first COVID-19 vaccine outside a clinical trial setting was administered on Dec 8, 2020. To ensure global vaccine equity, vaccine targets were set by the COVID-19 Vaccines Global Access (COVAX) Facility and WHO. However, due to vaccine shortfalls, these targets were not achieved by the end of 2021. We aimed to quantify the global impact of the first year of COVID-19 vaccination programmes.

This paper finds that COVID-19 vaccination has substantially altered the course of the pandemic, saving tens of millions of lives globally. However, inadequate access to vaccines in low-income countries has limited the impact in these settings, reinforcing the need for global vaccine equity and coverage.

Full paper: Global impact of the first year of COVID-19 vaccination: a mathematical modelling study

RCGP long term conditions recovery guidance

via Royal College of General Practitioners

For the last 2 years GP’s and their teams have worked incredibly hard to respond to the challenges of the pandemic – providing Covid care, routine care as well as playing a key role in the delivery of the Covid vaccination programme. As we begin to exit the pandemic, primary care and the wider healthcare system has already started to tackle the challenge of recovering routine care for patients.

The “long term condition and pandemic recovery in primary care” guidance sets out suggested actions that can be considered to support long term condition management over the next six months and as we move through the next phases of the pandemic, recognising that in many instances that annual reviews were not possible during the pandemic. The aim is to ensure, where possible, that those who need care most and are at highest risk are seen first, rather than default to standard arrangements such as birthdays to determine when patients are called for review across the year.

UCLPartners has developed new search tools which underpin this new guidance , and will assist primary care teams across the country to identify which of their patients living with long-term conditions are most likely to have been put at risk during COVID-induced service disruptions.

• Full document: COVID-19: Long Term Conditions and pandemic recovery in Primary Care
• Related: New UCLPartners search tools for EMIS and SystmOne highlighted in national primary care pandemic recovery guidance

Government response to ‘Clearing the backlog caused by the pandemic’ report

Department of Health and Social Care

This paper is the government’s response to the House of Commons Health and Social Care Select Committee’s ninth report of session 2021-22. It sets out how the government is working with its arm’s length bodies to help the NHS clear the waiting list for elective care.

Full paper: Government response to ‘Clearing the backlog caused by the pandemic’ report from the Health and Social Care Select Committee

Related: Clearing the backlog caused by the pandemic | House of Commons Health and Social Care Select Committee

Challenges of safeguarding via remote consulting during the COVID-19 pandemic

British Journal of General Practice | 2022; 72 (716): e199-e208 | DOI: https://doi.org/10.3399/BJGP.2021.0396

The COVID-19 pandemic required general practice to rapidly adapt to remote consultations and assessment of patients, creating new, and exacerbating existing, vulnerabilities for many patients. The aim of this qualitative study was to explore GP perspectives and concerns about safeguarding practice during the pandemic, focusing on challenges and opportunities created by remote consultation.

GPs worried about missing observational information during remote consultations and that conversations might not be private or safe. Loss of continuity and pooled triage lists were seen as further weakening safeguarding opportunities. GPs experienced remote consulting as more ‘transactional’, with reduced opportunities to explore ‘other reasons’ including new safeguarding needs. However, they also recognised that remote consulting created opportunities for some vulnerable patients. While supporting known vulnerable patients was difficult, identifying new or unknown vulnerabilities was harder still. Most reported that remote consulting during COVID-19 was harder, riskier, and emotionally draining, contributing to increased GP anxiety and reduced job satisfaction.

The GPs interviewed raised important concerns about how to identify and manage safeguarding in the context of remote consultations. Current guidance recommends face-to-face consultation for safeguarding concerns, but pressure to use remote forms of access (within or beyond the pandemic) and the fact that safeguarding needs may be unknown makes this an issue that warrants urgent attention.

Full paper: Challenges of safeguarding via remote consulting during the COVID-19 pandemic: a qualitative interview study

Patients’ preferences for telemedicine versus in-clinic consultation in primary care during the COVID-19 pandemic

BMC Primary. Care 23, 33 (2022). https://doi.org/10.1186/s12875-022-01640-y

The Hybrid Patient Care system integrates telehealth and in-clinic consultation. While COVID-19 increased telehealth use, healthcare providers are still seeking the best combination of virtual and in-clinic consultation. Understanding patients’ tele-consultation-related preferences is vital for achieving optimal implementation. The discrete choice experiment (DCE) is the stated preference technique for eliciting individual preferences and is increasingly being used in health-related applications.

The study purpose was to evaluate attributes and levels of the DCE regarding patients’ preferences for telemedicine versus traditional, in-clinic consultation in primary care during the COVID-19 pandemic, in order to facilitate successful implementation.

Mozes, I., Mossinson, D., Schilder, H. et al. Patients’ preferences for telemedicine versus in-clinic consultation in primary care during the COVID-19 pandemic