This paper provides further information on the Post-Covid Syndrome pathway.
Dr Katie Coleman, Islington GP and North Central London (NCL) Clinical Lead for Primary Care Network Development, and Dr Melissa Heightman, Clinical Lead for the Covid follow up Service and NCL representative for the London Respiratory Network, introduced the item which provided an update on the Post-Covid Syndrome pathway. It was explained that the second wave of the Covid-19 pandemic had been significant and would likely be followed by increased demand for the Post-Covid Syndrome service. It was highlighted that this was a new condition and understanding of the disease was developing. It was important to have a Post-Covid Syndrome pathway and this had been developed with the recognition that it was a multi-system condition and required a multi-disciplinary approach. This had resulted in the NCL Post-Covid Syndrome Integrated Service and there was equity of access across NCL.
Cllr das Neves enquired whether there was confidence in the anticipated numbers of people with Post-Covid Syndrome and the extent of the role of immunology. Dr Katie Coleman stated that there was not a lot of confidence in the numbers but these were based on national figures which estimated that about 10% of the total people who contracted Covid-19 would have Post-Covid Syndrome. Work was ongoing to better understand the demand and presentation in the community and a specific Post-Covid Syndrome code would be added to the clinical system shortly. It was also noted that the numbers of Covid-19 cases had significantly increased and it was anticipated that there would be a similar increase in the numbers of Post-Covid Syndrome cases; there were concerns about capacity in the system to deal with these additional numbers. It was highlighted that sufficient funding would be key and it was important to be able to resource community teams who could assist in patient recovery. It was noted that funding conversations were ongoing with NHS England.
It was noted that previous cases had often started as a referral to respiratory and then another referral to the Post-Covid Syndrome service. It was explained that the Post-Covid Syndrome pathway aimed to have a single point of access which would minimise multiple referrals. Dr Melissa Heightman explained that Post-Covid Syndrome was a multi-system disease and that the best approach was often to wrap specialty teams around the patient. It was noted that immunology featured in some patients and that rheumatologists, who were included in the multi-disciplinary team, had immunology expertise. It was explained that immunologists were often based in laboratories but were sometimes contacted to provide detailed information by phone.
Cllr das Neves enquired whether NCL was considering the research that was being developed in Canada and other places. Dr Melissa Heightman explained that clinical services were reliant on peer reviewed publications but that there were currently no clear therapeutic options from research. It was noted that research would be continually reviewed and that some funded research programmes in the UK were due to be announced soon. Cllr das Neves also asked what advice was provided to GPs regarding people who were unable to work due to Post-Covid Syndrome. Dr Katie Coleman explained that some upskilling and information sessions were being provided to GPs and training videos were being developed to provide rapid training resources. It was anticipated that GPs would be able to support people to ascertain their aspirations around returning to work through fitness for work notes.
Cllr Clarke was reassured that Post-Covid Syndrome was being taken seriously but expressed concerns about people who could have the condition without having been diagnosed, specifically those who were in intensive care. Dr Melissa Heightman explained that patients who had been in intensive care for a long period generally needed significant support. It was noted that there were public health messages about Post-Covid Syndrome but there were concerns that the messaging was not strong enough to convince people to seek help from their GPs who were the gatekeepers for the Post-Covid Syndrome service. Dr Katie Coleman added that there was some consideration of whether searches could be developed within GP clinical systems to identify those who had previously contracted Covid-19 and were still experiencing symptoms. In addition, GPs were starting to contact any patients who had tested positive with Covid-19 after six weeks to see whether they had any ongoing symptoms; this was designed to increase early identification and treatment of Post-Covid Syndrome.
The Chair noted the importance of funding for the Post-Covid Syndrome service, particularly the funding of therapies teams in order to implement any treatment plans. It was also enquired whether there was equality of access and whether different ethnicities were sufficiently represented in the Post-Covid Syndrome service. Dr Melissa Heightman explained that there was an under-representation of about 20% of Black, Asian, and Minority Ethnic communities compared with the expected levels. It was also noted that there was a prevalence of Post-Covid Syndrome in people aged 35-49 and this seemed to be part of the nature of the illness. In relation to funding, it was commented that the required community services were in high demand and, as it was difficult to fund these roles, availability would depend on NHS England. The Post-Covid Syndrome service would be providing a business case to NHS England; this would set out the activities of the service and local demand and it was hoped that NHS England would agree to provide additional capacity.
The Chair noted that the Committee had previously supported requests for additional funding and would be happy to do this for the Post-Covid Syndrome service. Dr Katie Coleman noted that any support would be beneficial. Will Huxter added that highlighting the scale of the impact of Post-Covid Syndrome and the local focus on and importance of this service would be helpful. The Committee agreed to write to NHS England to support the request for funding and noted that it was essential for funding to be in place as soon as possible in order to assist the large number of people in NCL who required support and to plan for imminent increases in demand.
Cllr Cornelius noted that, throughout history, there had generally been more deaths in the second wave of a disease, which was the case for Covid-19. It was added that there were often third and fourth waves and it was enquired whether future planning had been undertaken. Dr Katie Coleman stated that this was a concern and that the vaccination programme aimed to mitigate this as much as possible; it was added that health services were aware of the risk of another wave and it would be possible to adapt quickly. Dr Melissa Heightman also noted that there were likely to be future diseases and that health services would benefit from continued preparedness.
Cllr das Neves noted that the plans for the Post-Covid Syndome service were well defined and that it would be important to provide guidance for GPs who were often the first point of contact. It was enquired whether it was possible to influence the public health message to encourage more people with symptoms of Post-Covid Syndrome to come forward. Dr Katie Coleman stated that this might require some conversations with public health colleagues. Dr Melissa Heightman explained that there had been some reluctance to increase communications until there was capacity for additional referrals; it was noted that the Post-Covid Syndrome pathway was now defined and it should now be possible to publicise more information.
The Chair thanked Dr Katie Coleman and Dr Melissa Heightman for the update and stated that it was important for the Committee to receive these updates to ensure accurate communications between their local areas and NCL.
1. To note the report.
2. To write to NHS England to support the request for funding for the Post-Covid Syndrome service.