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Covid-19: Sidelining GPs in pandemic response was “a disaster,” says global health leader

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4128 (Published 28 October 2020) Cite this as: BMJ 2020;371:m4128

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  1. Gareth Iacobucci
  1. The BMJ

The sidelining of general practices in the UK’s response to the covid-19 is a “disaster” and “a national shame,” a leading global health expert has said.

Anthony Costello, professor of global health and sustainable development at University College London, said GPs and local public health teams should have been given additional funding to oversee covid-19 testing, rather than this being centralised and outsourced under the government’s struggling national test and trace scheme, run by private companies Serco and Sitel.

Costello, who is also a member of the Independent SAGE group, made the comments in a talk to the Royal College of General Practitioners virtual conference on 22 October.

He said that the high trust that GPs had from the public had been woefully underutilised during the pandemic, and set out what he described as “a thought experiment” of how the government could have organised things differently.

“What might have happened if we had mobilised the primary care system of GPs and the local public health outbreak management teams with sufficient funding for setting up covid-19 secure testing sites linked to your systems?” he said.

“Supposing we gave £300,000 (€330,000; $391,000) to the average GP practice of 8400 and adjusted it pro rata. That would cost about £2.1bn. Let's imagine we gave £10m to each of the 151 top tier local authorities. That would cost £1.5bn. And let's imagine we gave £30m to each of the NHS molecular virology labs to cover the cost of sustainable expanded testing. The total cost comes to £5bn. As I understand it, £10-12bn has been spent on an outsourced system that frankly doesn't work. This is a disaster, and is actually, I think, a national shame.”

Costello argued that connecting practices to the covid-19 testing system would have allowed them to send test samples to molecular virology laboratories that were bypassed under the existing system, and would get results back to GPs in 24 hours, as the national system has struggled to do. Practices could have employed new staff to contact and follow up with cases, as well as working with local public health contact tracers, he said.

“Bypassing that GP system with an outsourced one is crazy. I don’t know why we ever dreamt that up. Clearly, resources had to be made available so that GPs would not be overloaded. But I would argue that if they’ve got the right support and they are resourced properly to do that, they could do a fantastic job.”

Figures1 for England’s NHS test and trace system show that only 15% of people who were tested received their result within 24 hours in the week to 14 October, down from 33% the previous week. And only 60% of close contacts of people who tested positive for covid-19 were reached, down from 63% the previous week, and the lowest since the system began in May.

Prime Minister Boris Johnson said, “I share people’s frustrations and I understand totally why we do need to see faster turnaround times and we need to improve it.”

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