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Continuing healthcare assessments must resume from 1 September, NHS England says


By Awil Mohamoud
Reporter
4 August 2020

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Clinical commissioning groups (CCGs) must resume NHS continuing healthcare (CHC) assessments from 1 September, NHS England has said. 

In a letter listing priorities for phase three of the Covid-19 response, sent to healthcare bodies and providers on Friday (31 July), NHS England said that any patients discharged from hospital between 19 March 2020 and 31 August 2020, whose support package has been paid for by the NHS, will need to be assessed and moved to core NHS, social care, or self-funding arrangements. 

The CHC assessments were suspended under the Coronavirus Act earlier this year.  

The letter also said that GP practices should restore non-Covid services to usual levels where clinically appropriate to do so, and make use of the capacity available in the ‘window of opportunity between now and winter.

This includes making ‘rapid progress’ in addressing the backlog of childhood immunisations and cervical screenings ‘through catch-up initiatives and additional capacity’, it said.

NHS trusts are also being asked ‘ensure their e-referral service is fully open to referrals from primary care’, NHS England said, following reports that many have been rejected during the pandemic. 

Mental health investment

The letter said clinical commissioning groups (CCGs) must continue to increase investment in mental health services in line with the Mental Health Investment Standard, with independent audits to be repeated this year. In particular, it asked them to work on improving the services available and the support for people with learning disability and/or autism.

Meanwhile, GP practices were asked to ensure all patients with a learning disability are identified on their register, and that their annual health checks are completed and access to screening and flu vaccinations arranged.

GPs and community health services should also start a programme of structured medication reviews for care homes, while community health teams should resume ‘appropriate and safe’ home visiting care to vulnerable and shielding patients who need them,  the letter added..

The letter also recommended GP practices work with clinical commissioning groups (CCGs) to expand the range of services to which patients can self-refer, freeing up clinical time. 

‘May not be possible’

In addition to restoring services, NHS England asked GP practices to prepare for increased winter demand, the expanded winter flu vaccination programme and capacity to deliver Covid-19 vaccinations if and when a vaccine becomes available. 

GP practices should reach out to clinically vulnerable patients and those whose care may have been delayed, to boost the number of people coming forward, it added.

In the letter, NHS England said it recognises that ‘capacity is constrained,’ and pledged to ‘support practices to deliver as comprehensive a service as possible’.

‘To support restoration, and enable continued collaborative working, current financial arrangements for CCGs and trusts will largely be extended to cover August and September,’ it added.

Responding to the letter, Niall Dickson, chief executive of the NHS Confederation, said: ‘There is much to welcome in this ambitious letter. We all want to restore services as quickly as possible but we need to manage expectations. A full return to pre-Covid-19 levels of activity by October may not be possible.’

He said that the ‘window of opportunity’ between now and winter is ‘very short’, and many of the services restarting in GP practices across the country are ‘constrained and operating at significantly reduced capacity’.

Mr Dickson added that the need to socially distance and use PPE is making it more difficult to ramp up services quickly, while a possible second wave creates further uncertainty.

Continued funding

Andrew Ridley, chair of the Community Network, which is hosted by the NHS Confederation and NHS Providers, welcomed the letter for providing ‘clarity on the route ahead’, but said he would like to see financial commitments for the provider sector stretch beyond September. 

He said: ‘We would encourage Government to continue to work with the national NHS bodies to ensure the NHS has certainty of funding to continue to battle Covid-19 alongside restarting other services.

‘We are concerned that funding and workforce constraints will bring back tensions that the lack of bureaucracy during the pandemic bypassed.’

He added: ‘We are looking to the Department of Health and Social Care and NHS England and NHS Improvement to help reduce this bureaucracy on a longer term basis so that lengthy negotiations about funding don’t have a negative impact on people’s care or capacity in the system.’

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