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GPs urged to see all children with respiratory symptoms in person

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1487 (Published 09 June 2021) Cite this as: BMJ 2021;373:n1487

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  1. Gareth Iacobucci
  1. The BMJ

General practitioners should consider seeing all children under five with respiratory symptoms in person and referring them to secondary care if necessary, NHS England has advised.

The guidance, given in NHS England’s latest bulletin to primary care staff, comes amid concerns that respiratory viruses which have been suppressed by measures such as social distancing and mask wearing during the past year will rise as covid-19 restrictions are eased.

Government guidance continues to state that children with respiratory symptoms should be tested for covid-19 if they have a high temperature or a new, continuous cough, and to stay at home until they receive their result. But while children should follow this guidance, “this should not take precedence over clinical assessment,” the bulletin said.

NHS England’s medical director for primary care, Nikita Kanani, and director for primary care, Ed Waller, said they had given the advice in the context of “a remarkable reduction” in viral respiratory infections other than covid-19 during the past year, which means that “there is an increasing number of young children who have never been exposed to these common viruses.”

“Around the world we have seen evidence of unseasonal outbreaks of these infections as measures such as social distancing and mask wearing are relaxed,” they wrote.

The leaders stressed that covid-19 “tends to be a mild, self-limiting illness in children” and that “prolonged illness or severe symptoms should not be attributed to covid-19 and should be evaluated as usual.” But they added, “We are asking that all children under five with respiratory symptoms are considered for face-to-face consultations and referred to secondary care as appropriate. While children with respiratory symptoms should follow government guidance, including on covid-19 testing, this should not take precedence over clinical assessment.”

The updated advice comes after NHS England published new guidance for GPs last month,1 stating that they should return to offering patients the option of face-to-face appointments without needing prior telephone or online triage, reversing a policy that has been in place since the start of the pandemic.

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