While no one really knows what the future will hold for patients with Long Covid, it does appear that the Government is prepared to support sufferers, especially in the short term. The specification for the Long Covid Enhanced Service has a few points that are noteworthy, not least of which is the need to complete the self-assessment template and submit it to your CCG in order to receive the final 25% funding. We know that the response to this Enhanced Service wasn’t exactly overwhelming, so looking at in detail, should practices be expecting great things?

The specification draws a clear distinction between ongoing symptomatic COVID-19, which is defined as signs and symptoms of COVID-19 from 4-12 weeks, and Post-COVID-19 Syndrome, which covers symptoms that develop during or after COVID-19, which continue for more than 12 weeks and are not explained by an alternative diagnosis. This may prove to be quite challenging, as there’s such a wide range of symptoms experienced by patients who have contracted COVID-19.

The Enhanced Service also acknowledges the role that general practice will play in the long-term support of what is likely to be a complex condition.

It is noted that practices may have patients presenting initially with a range of symptoms that will require investigation, referral or diagnosis. Where the predominant symptom is a mental health condition, practices should consider referral within existing mental health pathways. Given the novel nature of COVID-19 and the changing symptoms that patients present with, it’s apparent that assessment may not be a one-time appointment.

From four weeks onwards, patients can be offered:

• Self-management support including the online platform Your COVID Recovery 
• Supported self-management which may include parts of the wider practice team or PCN
• Referral to a Post-COVID assessment clinic, where self-management alone isn’t appropriate, or where further investigations or additional support are required

There’s a template for the suggested clinical pathway for Post-COVID-19 Syndrome and this clearly illustrates GP practices as the very start of that pathway. The pathway makes it clear that coding for COVID at both four weeks post-diagnosis and 12 weeks post-diagnosis where patients are still symptomatic should be robust.

The Enhanced Service runs from 1^st July 2021 until 31^st March 2022, although it isn’t yet clear what will follow. Sign-up should have been completed by 31^st July, although this could have been waived with the agreement of the commissioner.

Practices must commit to ongoing education around COVID-19 as the condition is continually evolving. Practices must ensure that their learning is appropriate to the role of their team members. Practices must also agree to sharing information about their learning using both national and locally agreed methods.

Practices must develop their own individual or PCN-based pathways for self-supported management. Practices will need to understand the available local pathways in order to appropriately manage patients; this could include the Your COVID Recovery website, post-COVID assessment clinics and other available local rehabilitation or support services.

Practices must agree to ensure that appropriate coding is carried out and is robust. This includes coding at both four and 12 weeks post-COVID where appropriate, signposting and referral and, additionally where appropriate, that Post-COVID-19 Syndrome is resolved. Practices must also code appropriate clinical information from letters sent by Post-COVID-19 assessment services and specialist referrals.

Practices should seek to reduce the inequality of access to support and may consider working with existing partners, PPGs and through social-media channels to increase awareness of the support available including the Your COVID Recovery website, and should look to understand any barriers to access.

Practices should ensure that they submit the relevant self-assessment template to their commissioners for monitoring and payment purposes.

Practices will be paid £0.371 per patient (75% on uptake of the Enhanced Service). For a practice with 9,000 patients, this equates to £3,339.00. The remaining £0.124 per patient will be paid on completion of the self-assessment template before 31^st March 2022; for a 9,000-patient practice, this is an additional £1,116, bringing the total available funding to £4,455.

With the total number of people testing positive for Coronavirus in the UK sitting at an imposing 10.3 million against a total population of 66 million, that’s around one in seven people who have tested positive for Coronavirus, although the total may be significantly higher, as testing was not widely available in the early days of the pandemic. The COVID ZOE study has looked at people with confirmed infections of Coronavirus and noted that one in seven people diagnosed with COVID are likely to have symptoms for at least four weeks, with one in 45 still experiencing symptoms at 12 weeks post-infection. So, for the average practice with 9,000 patients, we’d currently expect to see 1,285 patients who have tested positive for COVID-19, with 184 still symptomatic at four weeks, and 29 who are still experiencing symptoms at 12 weeks. The funding of £4,455 for a 9,000-patient practice equates to £24.21 per patient who is unwell at the four-week mark, with no additional funding available for those who are still unwell after 12 weeks.

It’s noted that Long Covid is most common in working-age adults (25-69) with a whopping 29% reporting that their symptoms impact their abilities to carry out their day-to-day activities. Worryingly, the same document suggests that half of patients who were admitted to hospital with COVID reported not feeling fully recovered, with a median follow-up time of seven months. The additional funding of £30 million available to practices is not all of the story. A total investment of £94 million has been made available. With an estimated total fund of £30 million and an estimated 103,000 who will need support provided by general practice after initial assessment, even if we assume that the initial assessment has a nil impact on the available funding, this equates to only £291 per patient for longer-term support.

Using NHSE’s figures, the average cost of a GP appointment is £30. If the estimated 862,000 who will have Long Covid of any duration need at least one appointment, it effectively uses £25.86 million of the available budget. This would leave £4.14 million to support the remaining 103,000 expected to need longer-term primary care support. The remaining funding equates to £40.19 per patient. With enough for an additional GP appointment each, how do you think general practice can make up the shortfall for those who need longer-term support?