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NHS England & Improvement have published an extensive series of measures to help the NHS prepare for COVID-19. The measures are divided into six areas with different objectives:

1. Free-up the maximum possible inpatient and critical care capacity
2. Prepare for, and respond to, large numbers of inpatients requiring respiratory support
3. Support our staff, and maximise staff availability
4. Support the wider population measures newly announced by Government
5. Stress-test your operational readiness
6. Remove routine burdens

A full outline of the measures included under each of these objectives is included below, but interestingly for our sector:

• The whole NHS will move to block contract payments from 1 April – 31 July for an ‘initial period’, meaning the whole payment by results architecture will be dropped
• Providers should roll out remote consultations to support these populations who have routine or urgent GP, diagnostic or outpatient appointments over the coming months.

A detailed summary of the proposals is included below.

1. Free-up the maximum possible inpatient and critical care capacity
   1. All non-urgent operations will be suspended for three months from April 15. This will exclude cancer operations and other critical care
   2. Providers should use as much independent sector capacity as possible to support elective activity
   3. Hospital inpatients should be urgently discharged if they are medically fit to leave. This will include emergency legislation to ensure that eligibility assessments do not delay discharge
   4. Independent sector capacity is in the process of being block bought to increase capacity by 10,000 beds. This will then be used flexibly to support the response to COVID
   5. NHS trusts should free up their own private beds
2. Prepare for, and respond to, large numbers of inpatients requiring respiratory support
   1. Secure oxygen distribution to hospitals
   2. National procurement for assisted respiratory support (ventilators) is underway, and the manufacturing sector is being asked to support a significant uplift in production
   3. The Department is managing PPE (protective equipment for healthcare staff) supplies and is not currently seeing shortages
   4. Additional training is needed for all staff who could be deployed to the frontline
   5. Patients with respiratory symptoms will be segregated from now on (under the presumption that they could have COVID)
   6. Mental health, disability and autism providers need to plan for COVID 19
3. Support our staff, and maximise staff availability
   1. A number of measures have been included to support staff to stay well at work
   2. NHS staff will be tested as a priority once the national testing capacity is online
   3. Clinicians who have recently relinquished their licences will be encouraged to come back (in concert with the GMC, NMC and other regulators)
   4. Medical and nursing students and clinical academics will be deployed, a scheme will be finalised this week, as will registered nurses, midwives and AHPs in non-patient facing roles
4. Support the wider population measures newly announced by Government
   1. The NHS will support other areas of Government to support older and vulnerable populations who are going to be shielded at home
   2. Providers should roll out remote consultations to support these populations who have routine or urgent GP, diagnostic or outpatient appointments over the coming months. David Probert, CEO of Moorfields, is leading a taskforce to support acute providers to do this
      1. It is not clear at this stage how the NHS plans to deliver treatments that would usually only be delivered in an outpatient or inpatient setting. Further guidance is expected on this
   3. Higher risk patients will be contacted by the NHS in the coming week to arrange enhanced support
5. Stress-test your operational readiness
   1. System wide stress test exercises are being undertaken this week
6. Remove routine burdens
   1. All CQC inspections have been cancelled
   2. Emergency legislation to give greater staffing and regulatory flexibility will be introduced this week
   3. Some requirements on GPs and community pharmacies will be suspended, and income will be protected where appropriate. Guidance will be published on this (that will also cover some other parts of the NHS)
   4. The NHS People Plan, Implementation Framework and Clinical Review of Standards will be delayed until the Autumn. They also recommend that local plans are delayed
   5. The whole NHS will move to block contract payments from 1 April – 31 July for an ‘initial period’, meaning the whole payment by results architecture will be dropped
   6. Additional funding to cover costs from COVID-19 will be provided on an ad hoc basis. The letter makes clear that the financial considerations must not hamper any response and the funds will be there to support any COVID-19 related measures

The letter also includes an annex on reimbursement that, as well as setting out the process for block contract and additional COVID-19 funding, include a number of additional funding considerations:

• Purchase of enhanced discharge support services. CCGs will be asked to commission all possible community bed capacity to facilitate discharge from hospitals. This includes social care, hospices and home-care. Resources to support this will be available to support as many patients as possible, as well as new legislation to prevent eligibility requirements form preventing patients from accessing them
• Specialised services. Specialised contracts will be based on average 2019/20 expenditure. Arrangements for pass through drugs and devices costs will remain as they currently operate
• GP income. GP income will not be at risk from QOF or other activity metrics, although these will still be measured
• Community pharmacy. CCGs will be reimbursed for three key activities:
  • An NHS Urgent Medicines Supply Service for patients whose General Practice is closed
  • A Medicines Delivery Service to support Covid-19 positive and vulnerable patients self-isolating at home
  • Payments to contractors who are required to close due to Covid-19 related reasons
• Independent sector. Additional details of funding will be issued in due course
• Capital. All capital claims will have to show that they are directly related to the COVID response, and NHSE & I will bulk purchase some capital items nationally