Management of patients with post Covid-19 Syndrome (Long Covid) in WEL


The WEL CCGs, in collaboration with partners, have developed a post COVID-19 community based services pathway to support clinicians in the referral and management of patients recovering from COVID-19 to rehabilitation services. Please find attached the pathway for your information. 

Post-acute COVID-19 (“long COVID”) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness.  It is generally accepted that clinical management requires a whole-patient perspective. The community based COVID-19 pathway has been designed to ensure patients can be referred to a multi-disciplinary team which includes a physiotherapist, occupational therapist and psychologist, with access to other specialists to help assess, diagnose and treat patients who need support with long COVID.  These MDT’s will be available via existing single points of access into community services, after excluding serious ongoing complications or comorbidities.  

The pathway is based on patients being managed pragmatically and symptomatically with an emphasis on holistic support while avoiding over-investigation.  The MDT will offer physical, cognitive and psychological assessment and could refer patients on to other NHS services where appropriate such as specialist lung disease services, sleep clinics, cardiac services, rehabilitation services, IAPT and other mental health services.   

WALTHAM FOREST PRACTICES SHOULD REFER PATIENTS TO THE NELFT S.P.A. STATING THE REASON FOR REFERRAL AS ‘POST-COVID REHAB’. THIS SERVICE IS ACCEPTING REFERRALS. 

NEWHAM AND TOWER HAMLETS PRACTICES WILL BE ABLE TO REFER PATIENTS TO THEIR BOROUGH-BASED SERVICES THROUGH THE ELFT S.P.A. IN NEWHAM FROM 11 JANUARY. DETAILS OF HOW TO MAKE REFERRALS WILL BE MADE AVAILABLE IN ADVANCE. 

As you may be aware, the referral criteria for the Respiratory Post-COVID Clinic at Barts Health has been amended. The clinic will only be accepting referrals for patients with COVID or highly likely COVID plus an abnormal chest X-ray. Any inappropriate referrals currently on eRS would be rejected directly by the clinician, advising the GP on the reason for rejection. The directory of services has been updated. 

If you are unsure about the need for secondary care assessment, please send an advice and guidance request via e-RS.