Summary guide: new long Covid enhanced service

A new enhanced service worth a total of £30m is being offered to GP practices to support patients diagnosed with long Covid. Here Pulse Intelligence provides a summary of the requirements and payment mechanism for the new service.

Background

NHS England’s enhanced service (ES) specification document says the new service is to ‘commission GP practices to enhance their training and infrastructure to enable them to better support patients with long Covid’.

It notes that general practice plays a key role in supporting patients (both adults and children) with long-term symptoms of Covid-19, which includes assessing, diagnosing, referring where necessary and providing longer term holistic support of patients.

The new service is therefore being offered to practices in recognition that this is a new and complex condition that requires professional education, consistent coding of patients, planning of clinical pathways and measures to reduce the risk of inequity of access to support.

The term Long Covid is used to describe:

• Ongoing symptomatic Covid-19: signs and symptoms of Covid-19 from 4 to 12 weeks
• Post-Covid-19 syndrome: signs and symptoms that develop during or after Covid-19 and continue for more than 12 weeks and are not explained by an alternative diagnosis

The additional funding is for GP practices to plan their workforce set up, training needs and infrastructure to support patients with the condition – on top of their global sum funding, which ‘reflects their core contractual responsibility for the provision of essential services to this cohort’.

Key dates

The service officially start on 1 July 2021 and ends on 31 March 2022 (unless terminated earlier).

Practices should receive an invite to participate by 8 July 2021 and must sign up on or before 31 July 2021 (unless their commissioner agrees otherwise).

Overall role of general practice

Patients (with either previously confirmed or suspected previous Covid-19) may present in general practice with a wide range of symptoms including breathlessness, fatigue, chest pains, cognitive impairment or psychological symptoms.

The initial role of the GP or other clinician is to exclude acute or life-threatening complications and other unrelated diagnoses.  

Assessment may include blood tests, chest X-rays or clinical tests, including sit-to-stand or lying and standing blood pressure (in line with NICE/SIGN/RCGP guidance) and advice, treatment or referral may be required.

Where a mental health condition is identified as the main symptom, support and/or treatment should be considered in line with existing local mental health pathways.

If ongoing symptomatic Covid-19 is diagnosed (from 4 weeks after infection) patients can be offered:

• Signposting to self-management support including the online platform Your COVID Recovery (YCR) Phase 1 https://www.yourcovidrecovery.nhs.uk/ 
• Supported self-management from the practice or primary care network team; this may include input from social prescribers, health and wellbeing coaches and care coordinators with linking into community groups or other existing community services as appropriate
• Referral into a post Covid assessment clinic if self-management alone is not appropriate and if further investigations or support are required.

The service specification provides a more detailed treatment pathway algorithm, while further details on the clinical pathway and role of general practice are provided in national commissioning guidance.

Service requirements

Practices are required to ensure staff have the knowledge to identify, assess, refer and support patients with long Covid. This will involve:

• Educating staff as appropriate, including sharing of learning with specialist clinics and on national online platforms such as the Long COVID network on the FutureNHS platform.
• Knowledge of local pathways – practices (or their primary care network) will need to develop a clinical pathway to enable self-supported management, which could include referral to a social prescriber or health and wellbeing coach, and signposting to appropriate services, eg, the Your COVID Recovery website, post Covid assessment clinics and other rehabilitation or support services.
• Coding data consistently and accurately*
• Reducing potential inequity of access to services – eg, by working with the Patient Participation Group and raising awareness of support on the Your COVID Recovery website

*Coding includes:

• Using SNOMED codes – see Appendix B in the national commissioning guidance;
• Applying the diagnosis codes – Ongoing symptomatic COVID-19 (4-12 weeks after infection) and Post-COVID-19 syndrome (12 weeks plus);
• Applying the signposting and referral codes – Signposting to Your COVID Recovery and Referral to post-COVID assessment clinic
• Using the resolution code: Post-COVID-19 syndrome resolved
• Coding of key clinical information in letters from clinics or other specialist services.

Monitoring

GP practices are required to undertake a self-assessment to confirm the following is in place:

• Workforce education and training to identify, assess and manage long Covid
• Development of clinical pathway for supported self-management
• Knowledge of local clinical pathways and signposting
• Comprehensive coding
• Equity of access

Payment mechanism

Practices will be paid just under 50p per registered patient on their lists, with three-quarters of the payment delivered up front, and the remaining quarter paid upon completion of the self-assessment part.

• Practices will be paid £0.371 per registered patient* (75% of payment) upon sign up to the ES. This will be paid via monthly instalments.
• The remaining £0.124 per registered patient (25%) will be paid upon commissioner confirmation that the self-assessment has been completed by 31 March 2022.

The document stresses the payment is ‘in addition to the funding already available to practices through global sum which reflects their core contractual responsibility for the provision of essential services to this cohort of patients’.

*based on list sizes at 1 January 2021.

Source: NHS England. Enhanced service specification: Long COVID 2021/22. Published 21 June 2021