Do I have to work in a hot hub, hub or CAC?
It is for practices to decide, in collaboration with others in the locality, if they want to operate in a hub model during the COVID-19 pandemic.
There are suggested operating models in the NHS England SOP.
In Wales, it is a matter for the individual practice to decide based on local clinical assessment. There are suggested operating models agreed by health board AMDs, this is only a framework and local implementation will vary.
It is imperative that staff and organisations should work cooperatively in addressing chosen pathways of care and staffing at a local level. Where practices decide to operate a hub model, it will be for practice and staff to make decisions about the best way of staffing those hubs. This work should be allocated equitably between clinical staff according to hub needs and risk assessments for staff as appropriate.
It is not a contractual requirement for practices to provide GPs or practice staff to the community pathway hubs or CACs (COVID assessment centres). However their purpose is to cohort potential COVID patients, protecting the sustainability of practices during the current outbreak. It is therefore in practice's interests to ensure that they are adequately staffed from both primary and secondary care.
Extra funding for working in a hot hub, hub or CAC
England and Wales
This depends on what the hub model is delivering. If the hubs/practices are being commissioned to deliver services over and above their normal service provision, this should be funded in line with the Government’s statement on funding the NHS as needed to deal with COVID-19.
Any additional work outside core opening hours will automatically require additional investment.
If practices decide to work together to deliver their normal services through the hub model, then this should be organised and run in-line with existing funding and workforce available.
Hubs delivering normal services may still need additional funding for additional workforce, equipment and other costs (PPE, IT and so on) and this must be provided by the Government, Welsh Government or health boards.
Payment arrangements that have been put in place for staffing community pathway hubs and CACs vary from board to board. The majority of areas will pay individuals who are working outside their contracted sessions or pay practices if GPs are released from their normal working to fill shifts at a comparable rate to prevailing OOH shifts for that time of day. Sessional GPs are expected to be engaged on equitable terms.
Your liabilities if your practice is a designated hot hub, hub or CAC
Guidance published by NHS Resolution state that:
“During the outbreak, existing indemnity arrangements will continue to cover clinical negligence liabilities arising from the vast majority of NHS services, including staff working in a place that is not their ordinary place of work.
To ensure there are no gaps in indemnity coverage, the Coronavirus Act 2020 provides additional powers to provide clinical negligence indemnity arising from NHS activities related to the coronavirus outbreak, where there is no existing indemnity arrangement in place. It provides cover for services directly related to coronavirus and for any backfill arrangements that may be needed, as a consequence of coronavirus, to sustain the delivery of NHS services.”
The employer of a staff member redeployed to a ‘hot hub’ is still responsible for the health and safety of the employee but those running the hub share responsibility and a duty of care to those delivering services. All parties involved should be clear about their respective responsibilities.
A lead body (usually health boards) would become responsible for indemnity of staff, volunteers and partners working at that location.
Contracts, MoUs (memorandum of understanding) and SLAs (service level agreements) are still required to ensure premises requirements are met and duties of NHS are clear.
The GMPI (general medical practice indemnity) scheme continues to cover all claims.
All members of staff working in a community pathway hub or CAC are covered under NHS Scotland’s CNORIS indemnity scheme.
As a practice, do I have to redeploy staff?
England and Wales
Groups of practices who decide to join together to share their workload and offer hot and cold hubs (and where some might completely shut if needed) will need to decide how those hubs will be staffed.
We would expect all individuals and organisations involved to be aware of the staffing implications and agree the most appropriate way forward. This should always involve the practice and its staff, and may involve the PCN, CCG, NHSE local office and other primary care providers where necessary.
In the initial phase of the pandemic there was significant increased pressure on community pharmacies which saw some requests made to redeploy board-employed pharmacists into these settings. The deployment of NHS staff to care homes is also underway.
For practice-employed staff, such redeployment requests are entirely at the discretion of the practice. For board-employed members of the multidisciplinary team which would normally support general practice, such redeployments should only take place after full consultation with the local GP subcommittee.
As a staff member, do I have to be redeployed?
England and Wales
You cannot be redeployed against your wishes. The temporary movement of staff may be a necessary part of business continuity for all health care areas, but employers are expected to be flexible and any decision to change work patterns should be clinically led and reasonable.
Staff should consult with their manager and make concerns known verbally or in writing as soon as possible. We expect practices and staff to work collaboratively.
Can I request to be redeployed into a non-patient-facing role?
If you have concerns with regard to your personal safety, you have underlying health concerns, or you have vulnerable family members then you should talk to your employer about this.
Your employer may need to consider alternative ways of working as part of a risk assessment. If this is not possible then you should contact the BMA.
Who is responsible for redeployed staff?
England and Wales
This needs to be agreed between the employer, employee and ‘host’ prior to any redeployment.
The employer is accountable for the work of their staff and needs to take staff limitations into consideration when delegation or temporarily moving staff.
The employer needs to make sure individual staff have the appropriate skills and knowledge for the role into which they will be redeployed. It may be covered by an existing contract of employment, or it may need to be negotiated.
Where the work of the individual will be overseen by someone who is not their normal line manager, the roles and responsibilities, as well as policies and procedures to be utilised, will need to be agreed between the individual, the employer and the host. These should be clearly set out in writing so all are aware.
The key to whether the Coronavirus job retention scheme applies to GP practices is public funding; the rules and regulations do not specifically exclude organisations that are in receipt of public funding, but rather states they are not expected to furlough staff.
As a general rule, if the funding that is used to employ staff members is maintained, as is the case for GMS funding for general practice, then furlough will not be permitted. Where the funding has been reduced or halted, and there is a direct impact on the employment of staff, then practices may be able to furlough their staff.
Shielding and self-isolating staff
The scheme provides that you can claim for furloughed employees who are shielding in-line with public health guidance, or need to stay at home with someone who is shielding.
GP practices should however check the criteria carefully to see if they meet them, if so, the advice from HMRC is that they can use it in the same way as any other organisation.
However, if the funding that supports the employment of that member of staff is being maintained practices are expected to continue to pay at full pay.
In Scotland, funding has been provided to practices to meet the costs of replacing shielding or self-isolating partners or members of practice staff.
If your practice is forced to close
In the event that a practice is unable to maintain any kind of service to patients and is forced to temporarily close as a result of COVID-19, the practice should immediately notify the health board of its need to activate buddying arrangements.
This will see a neighbouring practice take on temporary responsibility for the closed practice’s patients until it is able to reopen. As set out in the revised SFE, the closed practice will continue to be paid as if it was open while the practice taking on the additional patients would receive additional payments on a per-patient, per-week basis.
If some members of staff at the closed practice are able to work, it is expected that they would participate in local arrangements until their practice reopens. If multiple practices in an area are simultaneously forced to close temporarily, local escalation procedures would come into effect.