Changes to the way Covid treatments are obtained by those most at risk from the disease could lead to a “postcode lottery” for access, experts have said, with charities saying that patients have been left confused and frustrated by the new system.
Previously, people eligible for Covid treatments in England were contacted by their local Covid Medicines Delivery Unit (CMDU) once they reported testing positive for the virus.
But in late June the system changed, with arrangements for prescribing Covid medications, which include antivirals and neutralising monoclonal antibodies, devolved to the 42 NHS integrated care boards (ICBs) in England.
Patients were informed that if they tested positive they should contact their GP practice, NHS 111 or a specialist. However some ICBs have a different procedure, for example requesting that patients contact their local CMDU.
Now experts have warned the shift is leaving eligible patients struggling to get hold of Covid treatments.
“Nurses on the British Liver Trust helpline regularly receive calls from people with a liver condition who find themselves in a state of uncertainty regarding their eligibility for antiviral treatment,” sad Pamela Healy, chief executive of the British Liver Trust. “The callers often express frustration and confusion, as they have not been adequately informed about whether they qualify for such treatment or how to go about accessing it.”
Azeem Majeed, a professor of primary care and public health at Imperial College London, added that the new system puts the onus on eligible patients to work out how to get hold of the medications.
“This may lead to variable uptake of treatment and increased health inequalities as people from poorer backgrounds, with lower educational levels or poorer English language skills may be less able to navigate the new system and therefore be less likely to receive treatment,” he said.
“Furthermore, as each integrated care board will now have its own system, opening hours and access arrangements will vary, potentially leading to a postcode lottery in obtaining treatments. Some patients may not even be aware they are eligible for treatment, leading to further potential health inequalities. It’s people from more marginalised groups who are likely to fall into this category.”
Laura Challinor, senior policy and public affairs manager at Blood Cancer UK, said details on how to access Covid treatments from different ICBs have been made available on its website, revealing significant variations across England.
“It is evident that more needs to be done to let patients know about what they should do if and when they get Covid-19,” she said.
Among possible antiviral treatments for Covid is Paxlovid, which involves two drugs, nirmatrelvir and ritonavir. According to the NHS, eligible patients should typically start Paxlovid as soon as possible after testing positive for Covid, and within five days of symptoms.
But Lara Wong, founder of Clinically Vulnerable Families, said the new system was concerning given many people have difficulties contacting their GP. What’s more, she noted, patients may be unwell when attempting to access such medications.
“Antivirals are a vital line of defence for clinically vulnerable people, particularly those whose vaccines may not have provided them with sufficient protection,” said Wong. “Timely access to such treatments is significant for patient outcomes and it is essential that patients understand how to get hold of those treatments as rapidly as possible.”
Sarah Stevens, who has multiple sclerosis, said that when she had Covid in 2022, getting antivirals was “a breeze”.
“I rang 111, and it was a very smooth process,” she said.
But when Stevens, 52, caught Covid in August this year, it was a different matter.
“When I rang 111 this time, no one knew what I was talking about,” she said. “Eventually someone rang me back and it was a nurse practitioner. That person didn’t know what to do either. They said they’d get my GP service to call me back. Again, they were perplexed.”
Eventually Stevens managed to access the treatment, receiving an antiviral infusion three days after her initial call.
“I can’t fault the nurse [who dealt with me], but it was nowhere near the system it was before” she said.
The concerns come amid a delay to new guidance from the National Institute for Health and Care Excellence (Nice) that is poised to expand the pool of adults eligible for the nirmatrelvir plus ritonavir antiviral treatment to include all those aged 70 and over, as well as people with a body mass index of 35 or above, people with diabetes, and people with heart failure – should they have Covid and do not need supplemental oxygen.
However despite confirming there is no stock or supply issue around the drugs, NHS England has asked for a delay, citing “operational implications” which it says were not fully considered in the appraisal.
An NHS spokesperson said: “We are working through these issues with Nice as quickly as possible in order to ensure this treatment can be made available in a way that ensures a cost effective use of NHS resources and value for money for taxpayers.”
But Wong said time was pressing. “In this current wave of the vaccine evasive XBB variants we urgently need to see rapid access to antivirals improved and extended to cover those vulnerable populations proven to remain at a significantly increased risk in order to protect both lives and health,” she said.
