Covid-19 community hubs could become ‘lightning rods for contagion’, warns expert

Primary care doctors are meant to be seeing only a handful of patients face-to-face during the coronavirus pandemic, after NHS England told them to do remote consultations “as a default”.

For those who need a face-to-face consultation or routine procedure such as an immunisation, NHSE has told primary care to segregate covid-symptomatic from asymptomatic patients.

It suggested GPs could use different physical locations with a “hot hub” to treat symptomatic patients and a “cold hub” for asymptomatic patients. Practices can also choose to do this through zoning within a health centre.

However, Trish Greenhalgh, professor of primary care health sciences at the University of Oxford, told HSJ the hot hubs carry a potential risk of spreading the virus if they are not managed properly.

She believes they could work “but only if they’re used properly as part of a system where we default to video almost every case”.

She carried out a straw poll of GPs shortly after NHSE published the new operating model to gauge the views of primary care and guide her research. It was not an empirical study, she cautioned, but said some had flagged the risk that patients who should remain in self-isolation could be diverted to the hot hub.

She added: “What I think is going to happen and what some of the other GPs are saying… is ‘well, we’re already completely stretched so anyone who rings up who we can’t cope with and they sound like they’ve got covid, we’ll send them to the hot hub’.”

“Of course, what that’s going to do [is] these hot hubs could become lightning rods for contagion. So, people who should be self-isolating at home will come to the hot hub, give it to the staff… and they will then go back into their surgeries after a couple of days working in the hot hub and they’ll contaminate their surgeries.”

Professor Greenhalgh, a leading expert on primary care health care who has led evidence reviews around covid-19 for NHS England, said there is significant uncertainty around the hub policy, and more research is urgently needed to assess its impact and consequences.

The Surrey Heartlands Integrated Care System published its own plan for primary care on 16 March which said the system would be creating a hot site-cold site system.

David Triska, a GP and system planner in the ICS, told HSJ there will undoubtedly be patients that need to be seen face-to-face.

In the early stages of the pandemic, there will be capacity in primary care to provide this, he explained. But as more clinicians are self-isolating with covid-19 symptoms, it will be key to provide contingency capacity to ensure those patients do not then default to secondary care and going to emergency departments.