Capital to keep ‘total triage’ and ‘hot hubs’ for GPs

Documents seen by HSJ show how the city’s health leaders have significant ambitions for altering how London’s health economies commission and deliver care, including cementing remote assessment and patient stratification models across primary care.

This is part of a much larger piece of work to ensure the transformative nature of the current crisis is not allowed to go to waste. System leaders are quickly developing action plans to reconfigure services to meet both the covid and non-covid needs of London over the next 12 to 15 months.

The longer-term ambition is to bake into the city’s health service several long-discussed changes that have yet to be realised on a broad scale, such as the widespread use of remote consultation by primary, secondary, and tertiary clinicians.

NHS England and Improvement’s London region has asked the city’s five integrated care systems to form plans for restarting more non-covid care, but will also try to prevent the city from reverting to how services were organised before the crisis, according to documents seen by HSJ.

The plans should describe how care in all settings will segregate “covid-19 patients and undifferentiated emergency patient care from patients whose care can be planned where covid-19 risk and status can be determined in advance”.

This will include “primary care, mental health, learning disability and community services”. For primary care it will require “embedding remote ‘total triage first’” whereby patients are assessed and sorted into those with covid symptoms and those without, before being further stratified by clinical need.

GPs will also need to continue offering segregated services where patients with covid symptoms who must have a face-to-face consultation are seen in a so-called “hot hub” and patients without symptoms are seen in a cold hub.

A major component of returning the NHS to a more normal footing will be ensuring referral pathways start functioning again. GPs are meant to be referring patients into secondary care, with the hospitals accepting and holding clinical responsibility for the patients on their waiting lists. However, there are many reports from primary care that referrals have been a struggle with trusts not accepting patients.

Systems will set out plans for increasing the number of hospital specialists using remote “advice and guidance” systems, such as Consultant Connect or RAS, to reduce patients coming to outpatient clinics.

This should also increase outpatient clinic efficiency, and is part of a longer term plan to embed primary care in a “virtual by default” elective care system where patients are assessed and prioritised remotely at the front-end of elective and emergency care pathways.

The ICS are being asked to describe strategies focused on delivering “productivity gains through achievement of optimised clinical outcomes and compliance with best practice”.

These plans will include increasing the number of GPs “routinely delivering both email/web, video and telephone consultations” as well as increasing “the number of secondary and tertiary care specialities offering video consultations”.