Classification: Official
Publication approval reference: C1552

To:

• All GP practices
• PCN-led COVID-19 vaccination sites
• ICS leads
• CCG Accountable Officers and Clinical Leads

cc.

• NHS England and NHS Improvement regional directors
• NHS England and NHS Improvement regional directors of commissioning
• Directors of public health

27 January 2022

Dear colleague

Thank you for all you have done and continue to do to protect the nation against COVID-19, while continuing to support the most vulnerable patients including those with cancer and long-term conditions.

Together your efforts have delivered an incredible 6.8 million vaccinations during December and 53% of all boosters delivered during the booster drive. This is an historic achievement and the work of general practice is greatly valued, appreciated and noted.

It is now important that all services across the NHS, including in primary care, are able to restore routine services where these were paused in line with the Prime Minister’s request to focus all available resource on the Omicron national mission. This further guidance follows that issued by NHSEI, BMA and RCGP, in December 2021, and recognises that as we approach the end of January, we anticipate there will be lower demand for boosters given the high uptake levels to date.

Therefore, for the period up until 31 March 2022, we are now asking that practices and Primary Care Networks (PCNs) focus on the following three key priority areas while continuing to use their professional judgement to clinically prioritise care:

• continued delivery of general practice services, which includes timely ongoing access for urgent care with clinical prioritisation, the ongoing management of long-term conditions, suspected cancer, routine vaccination and screening, annual health checks for vulnerable patients, and tackling the backlog of deferred care events. As per our letter of 7 December 2021 on temporary GP contract changes and income protection arrangements, practices should agree with their commissioner a plan that sets out how QOF care will be delivered wherever possible, taking a clinical prioritisation approach and looking to minimise any health inequalities. The BMA and RCGP guidance set out at the end of last year stating ‘we must reassure the public that general practice remains open and that patients will be seen face to face where it is clinically appropriate’, remains in place. We know that colleagues in primary care are key to healthcare delivery, and before the Omicron wave we saw a record number of urgent cancer referrals through primary care. This, alongside wide NHS campaigns, ensures that the public continues to access non-covid care for their most worrying conditions and symptoms.
• management of symptomatic COVID-19 patients in the community, as part of the local system approach, including supporting monitoring and access to therapeutics where clinically appropriate. COVID-19 treatments will continue to develop and evolve as we learn more about the virus. Primary care will continue to play an important role in supporting the delivery of these treatments while caring for patients with COVID and long-COVID.
• ongoing delivery of the COVID-19 vaccination programme. It remains important that PCN Groupings focus on reaching the most vulnerable people and minimise any inequalities in uptake working with CCG, local authority, and community partners. We ask that PCN Groupings prioritise booster vaccination of care home residents and staff, those with underlying health conditions (as per table 3 in the Green Book) and carers, those who are housebound, and eligible 12-15 year olds, boosters (their fourth dose) for immunosuppressed people aged 12 and above, and the primary course of vaccination for at risk 5-11 year olds. Additionally, PCN groupings should undertake further outreach activity to the unvaccinated or hesitant, where not already done so. Your relationship with and knowledge of your patients is key, as always.

We recognise that winter pressures continue to present daily challenges and we have put in place support packages to help optimise, use and fund additional capacity which remain until the end of March, including the Winter Access Fund, temporary GP contract changes and support for annual health checks for people with severe mental illnesses (SMI) or learning disabilities.

Importantly, we value and support your professional clinical judgement in balancing the above priorities, with the help of your local system. In applying those professional clinical judgements, the needs of your most vulnerable patients will continue to be paramount, as will your concerns about the potential impact of unmet or deferred care needs and the impact of this for your patient population. The CORE20PLUS5 approach to reducing health inequalities identifies target cohorts and clinical areas for accelerated improvement and will help you in your clinical prioritisation. This includes the 302,000 people target for annual health checks for people living with SMI (bringing in line with the success seen in learning disabilities).

Thank you again for all you are doing for patients and communities, and please do continue to make use of the resources and support available for you and your team’s health and wellbeing.

Yours sincerely,

Ed Waller | Director of Primary Care | NHS England and NHS Improvement

Dr Ursula Montgomery | Interim Director of Primary Care

Dr Nikita Kanani MBE | Medical Director for Primary Care