In an update to GPs, health leaders said all primary care and community testing must be stopped, except for clinically urgent testing – admitting that the situation would get worse ‘over the coming weeks’.
The BMA has warned that GPs are becoming increasingly concerned about the situation and has demanded that NHS England makes clear how surgeries should respond if they run out of stock completely. It said that the current situation meant that the quality of patient care was ‘under threat’ and questioned why measures had not been put in place earlier to mitigate the problem.
Last week GPs were asked to cut back on non-essential blood tests after disruption to NHS supplies of test tubes. However the latest guidance now goes even further and says only clinically urgent tests should be undertaken.
Examples of tests that can continue include those that are required for a two-week wait referral and tests that are ‘extremely overdue’ and/or essential for safe prescribing of medication or monitoring of condition, the guidance says. Other examples listed are tests that could avoid a hospital admission or prevent an onward referral and those that are needed for patients with suspected sepsis or conditions with a risk of death or disability.
Blood test tubes
Practices have been advised to move any blood tests scheduled before 17 September to ‘a later point in the year when supply improves’.
NHS England has said the problem is linked to a global shortage of supplies.
The BMA this week moved to seek QOF income protection for practices so that practices will not face funding shortfalls if they cannot complete blood tests that are contractually required for QOF work or NHS Health Checks.
However, NHS England leaders have said that there are ‘no current plans to change QOF payment arrangements’ for these indicators, but added it would keep the situation ‘under review’.
The letter said: ‘We appreciate that this temporary position is frustrating for patients and services alike. It may mean practices rescheduling certain QOF indicator checks for later in the year, when supply has improved.’
NHS England has said that alternative products are being sought to alleviate the current pressures on test tube supplies. But it warned that it would ‘take time’ for these to be ‘imported and delivered in volume to services’.
Health leaders have informed the CQC of NHSE’s updated guidance and confirmed with NHS Resolution (NHSR) that any clinical negligence claims relating to shortages would be covered ‘in the usual way’ by state indemnity schemes.
The guidance states that practices should notify their pathology incident director and their NHS England and NHS Improvement regional team if they are likely to run out of products within 48 hours.
It added: ‘Organisations are asked to ensure that they are prepared to provide mutual aid across local and regional systems for those sites experiencing acute shortages.
Responding to the updated guidance, deputy council chair at the BMA Dr David Wrigley, said: ‘[The] guidance does not explain what will happen if hospitals or GP surgeries do run out of stock, and this must be addressed as a matter of urgency.
‘Doctors have been left in an incredibly difficult situation, with no choice but to inform their patients that they cannot carry out certain blood tests for the time being and that appointments they may have for a test could be cancelled.’
Dr Wrigely added that it was ‘not unreasonable’ to ask if the government were aware of the shortages earlier in the year, and why measures had not been sought to address the issue. ‘Fundamentally, if shortages are due to a manufacturer not fulfilling its obligations, then it’s clear that much better resilience in the supply chain is needed,’ he said.
GP and senior clinical advisor at the NHS Confederation Dr Graham Jackson said the guidance provided ‘a little more clarity’ but highlighted concerns about the impact the shortage was having on frontline staff.
‘We have already heard of verbal abuse from patients anxious to have their blood tests, and clinicians will need to make a judgment based on these guidelines around who should have access to a blood test. Thousands of appointments will need to be cancelled, adding additional burden to a workforce that is already under significant pressure.’