Primary Care Workforce in Alternative Settings - General Practitioners in the Covid Clinical Assessment Service

In March 2020, in response to a request from the Secretary of State for Health and Social Care, NHS England and NHS Improvement commissioned a temporary service in response to the COVID-19 pandemic.

The COVID-19 Clinical Assessment Service (CCAS) was created by the South Central and West Commissioning Support Unit as part of the National Pandemic Flu Service and was hosted and managed by the South Central Ambulance Service NHS Foundation Trust (SCAS).

The service, which was rapidly established and deployed, was operational from late March 2020 until May 2021.

Patients accessed CCAS via the NHS 111 service. Patients with COVID-19 symptoms who contacted NHS 111 were triaged into three categories:

• Patients with severe COVID-19 symptoms requiring urgent hospital admission
• Patients with COVID-19 symptoms requiring further assessment
• Patients with mild COVID-19 symptoms who were given guidance to manage their symptoms, and with the advice to consult NHS 111 again should their condition deteriorate

Those patients requiring further assessment were referred to CCAS for a remote, telephone-based consultation with a clinician. Following this assessment, these patients were either reclassified as able to manage their symptoms, requiring hospital treatment or were referred to their own GP for ongoing monitoring.

The main GP groups “onboarded” to work for CCAS were:

• Retired GPs returning to the NHS during the COVID-19 crisis
• Partner and salaried GPs working in general practice who were able to offer some of their usual practice-based working hours to CCAS or work additional hours during the crisis
• Locum GPs

Where GPs were retired, arrangements were made for them to be given Emergency Registered Practitioner status by the General Medical Council and all clinicians employed by the service were given appropriate training.

The service briefly included some other staff groups such as nurses, paramedics, and physiotherapists but employment of these staff groups ceased after a few months and the service has been staffed solely by clinicians since that stage. As a result, this release relates only to GPs working for CCAS.

Recruitment to the service began late March 2020 and ended in January 2021, and the last GPs were onboarded by March 2021. Due to varying demand during the pandemic, recruitment was suspended during the summer of 2020 and resumed in October.

GPs were employed on a zero-hours basis and paid for the sessions worked under two types of contractual arrangements:

• GPs were employed directly by the South Central Ambulance Service (SCAS) on behalf of CCAS and paid via the NHS Shared Business Services (https://www.sbs.nhs.uk/) which is the payroll provider for most directly-employed NHS employees
• Practice-based staff could choose to be employed directly by SCAS and paid by SBS, or to work for CCAS via an honorary contract whereby information about their worked hours was sent to NHS England which calculated and made payments to their practice, which included additional costs such as employers National Insurance payments and pension contributions.

The process for onboarding GPs to CCAS included ensuring that all recruits had the appropriate qualifications, right to work in the UK and Disclosure and Barring Service (DBS) checks if necessary.  

All GPs had to complete a specified number of hours of paid training and were not eligible to work for CCAS until this training has been completed.

South Central Ambulance Service NHS Foundation Trust (SCAS), as the host employer was responsible for all onboarding activity, issuing contracts and arranging for payment.

The administration associated with onboarding GPs (such as GMC re-registration if required, training and other checks, issuing of contracts and equipment, registering with the rostering system and so on) took time, so there were limited numbers of GPs available to work in the service in its first weeks of operation.

CCAS was available via NHS 111 24 hours per day, seven days per week. A rostering system was developed and deployed which allowed GPs to register to work sessions in four-hour increments although the actual number of hours worked and paid for may have exceeded the four-hour session according to the patient needs.

During the time that CCAS was operational, there were significant fluctuations in demand for consultations.  Demand for appointments varied according to peaks and troughs in infection rates. For example, there was a reduction in demand during the summer of 2020 when the number of COVID-19 cases fell, but this demand increased during the autumn and into the winter season.