Last reviewed 11 May 2021
NHS England has published updated national guidance on referral pathways for patients experiencing “post-Covid syndrome”, which says general practice “plays a key part” in the long-Covid clinical pathway.
It describes “three main referral routes” into post-Covid assessment services, covering patients not admitted to hospital but managed in the community during the acute phase of Covid-19 infection; patients hospitalised with Covid-19; and those admitted to intensive care units.
Guidance for GPs said patients “with previously confirmed or suspected Covid-19 may present with a wide range of symptoms” such as “breathlessness, fatigue, chest pains, cognitive impairment or psychological symptoms all potentially linked to prior infection”.
NHS England said the initial role of the general practice clinician is to exclude acute or life-threatening complications and other unrelated diagnoses. It states: “Assessment may include blood tests, chest X-rays or clinical tests, including sit-to-stand or lying and standing blood pressure, depending on the person’s signs and symptoms”.
The advice says symptoms of long-Covid can be “relapsing and remitting” and that repeated assessment may be necessary.
Patients who have been hospitalised with acute Covid-19 should be followed up at 12 weeks by secondary care. However, patients who have ongoing symptoms after the 12-week check should be reviewed by their GP and, once alternative diagnoses are ruled out, they can be referred to post-Covid assessment services.
Those who have not been hospitalised with Covid-19 can be “signposted to contact their GP” through pharmacies, the NHS website and other routes, including Test and Trace if they have new symptoms four weeks or more after initial infection.
GPs assessments should include a “comprehensive clinical history and appropriate examination that involves assessing physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities”, according to the guidance, and “tests and investigations should be offered that are tailored to people's signs and symptoms to rule out acute or life-threatening complications and find out if symptoms are likely to be caused by ongoing symptomatic Covid-19, post-Covid-19 syndrome or could be a new, unrelated diagnosis”.
Patients can then be referred to post-Covid assessment services if needed, although “this may be most appropriate from 12 weeks for many”.
Currently, there are 83 locations across the country offering post-Covid assessment and diagnosis of people experiencing long-term health effects as a result of Covid-19 infection.
The National Guidance for Post-Covid Syndrome Assessment Clinics is available here.
The NICE Guideline, Covid-19 Rapid Guideline: Managing the Long-term Effects of Covid-19 (NG188), published on 18 December 2020, is also available here.