Intended for healthcare professionals

Rapid response to:

Practice 10-Minute Consultation

Covid-19: a remote assessment in primary care

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1182 (Published 25 March 2020) Cite this as: BMJ 2020;368:m1182

Read our latest coverage of the coronavirus outbreak

Rapid Response:

Re: Covid-19: a remote assessment in primary care

Dear Editor

This article published in the BMJ and widely circulated by GPs has been very helpful in providing clear concise advice to primary care service who are learning how to navigate remote consultations.

However, we consider the advice as to when to consider hospital admission is far too risk averse and has the potential to unnecessarily overwhelm our hospital colleagues in an already fragile system.

The physiological values suggested are simply 'anything other than normal' observations. There will be many (probably most) suspected Covid-19 patients who meet these criteria who do not require any hospital evaluation or treatment. Any clinician who works in out of hours or urgent care services will be used to safely managing patients at home without such a low threshold for admission, which puts hospital nhs staff and other patients at risk.

We also must remember that not every fever is caused by Coronavirus, and there will be a small cohort of patients (usually children) that can not be safely assessed over telephone or video and will still require a face to face assessment in primary or urgent care. Otherwise there will be many avoidable non-coronavirus treatable illnesses and deaths, including from sepsis.

As a national urgent care provider which is primary care led, with decades of experience in safely managing patients over the telephone we have produced our own telephone triage support tool. Although this is also not validated by evidence from the current outbreak and there is no perfect tool, we believe it is more robust for helping clinicains safely navigate the current pandemic. This available to anyone who would find it helpful: https://vcentral.vocare.org.uk/Covid%20Telephone%20Triage%20Tool%20V2.0.pdf

Dr Jim Heptinstall
National Medical Director
Vocare & Totally Urgent Care
email: jim.heptinstall@nhs.net

Competing interests: No competing interests

27 March 2020
Dr Jim Heptinstall
Urgent Care Medical Director & GP
Vocare, Totally plc Urgent Care Division
Totally plc, Cardinal Square, Derby