Published 29 July 2020
GP practices could lose ‘significant’ income due to a pause on corticosteroid joint injections, now that income protection for minor surgery for the Covid-19 pandemic has come to an end.
NHS England has said it is time for GPs to resume enhanced services and that commissioners should stop applying income protection for the minor surgery DES, despite new guidance advising against performing corticosteroid joint injections during the pandemic.
GPs warned this would leave them taking ‘a significant cut in income’ or resuming delivery of the injections against the guidance.
Earlier this month, NHS England outlined its plan for the ‘second phase’ of the general practice response to coronavirus, including that GPs should resume patient reviews and health checks.
The letter added that local commissioners should stop making monthly payments to practices for the minor surgery DES – which includes joint injections and had been maintained ‘in line with the previous year’s achievements’ since April – from 1 July.
Dr Hugh Reeve, a GP in Grange-over-Sands, Cumbria, told Pulse that ‘the implication is that in order to maintain income we have to restart [the injections]’.
However, recent guidance advised GPs to exercise caution over delivering corticosteroid joint injections during the coronavirus pandemic due to risks of immunosuppression.
The guidance, supported by multiple groups including the British Orthopaedic Association, the British Society of Rheumatology and the RCGP, said GPs should ‘only give steroid injections for severe symptoms and where there are no other options’.
It said: ‘During the coronavirus pandemic, clinicians need to give extra consideration as to whether the benefits outweigh the risks.
‘Giving a steroid injection to an asymptomatic patient who is carrying the virus could potentially put them at increased risk of an adverse outcome from the virus.’
It added that GPs must take ‘great care’ over patients who are ‘clinically extremely vulnerable’ to Covid-19.
It said: ‘Great care will need to be given to assessing and discussing the risks both of any immunosuppression resulting from the injection and also attending a clinical setting where higher levels of Covid-19 may be present.
‘The risks for these patients may outweigh the benefits so clinicians need to exercise great caution and explain the risks to the patients. ‘
Dr Steve Kell, GP partner at Larwood Health Partnership in Worksop, reiterated that stopping income protection implies practices should restart delivering the injections – or face a ‘direct cut in funding’ if they follow the guidance.
He said: ‘[NHS England’s letter] doesn’t say you must start again, what it says is that the support for it stops on the 30 June. So you either take quite a significant cut in income or you start minor surgery again at your own risk and at the patient’s risk. That’s not good enough.
‘It feels like we’re having to make things up as we go along, sometimes despite the guidance.’
Dr Kell added: ‘I don’t know many GPs who would be happy to do minor surgery involving local anaesthetic in full PPE when it can wait, but we need the support financially.’
As reported previously in our sister publication Pulse.
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