Royal College of General Practitioners – Written evidence (COV0051)


Ongoing or persistent symptoms of Covid-19 (Long Covid)


The Royal College of General Practitioners (RCGP) welcomes the opportunity to share its response to this important inquiry on the ongoing health impact of Covid-19, currently called ‘Long Covid-19’. The RCGP represents over 54,000 General Practitioners across the UK. For the purposes of this document and until a formal definition is determined, ongoing/persistent symptoms of Covid-19 will be used rather than “Long Covid.


  1. Summary of recommendations



  1. Background

Throughout the pandemic, GPs have been working hard to deal with the direct and indirect impacts of Covid-19, including the growing emergence of patients presenting to general practice with persisting symptoms after the initial, acute infection with Covid-19 has resolved. General practice is the first point of contact in the NHS for people who have ongoing Covid-19 symptoms and has a key perspective on this newly emerging condition.

The RCGP successfully led the call for NHS England to commission a National Institute for Health and Care Excellence (NICE) guideline on the long-term effects of Covid-19 (NICE & SIGN, 2020). We have been instrumental in bringing together a multi-professional group from across the UK; and, by collaborating with both NICE and the Scottish Intercollegiate Guideline Network (SIGN), have realised our aim for a single UK-wide national guideline to be published by the end of the year.


Alongside national guidance in this area, more resources are needed to successfully manage patients with persisting symptoms following an acute infection with Covid-19. Much of the resource and infrastructure for Covid-19 has been based on managing the acute care of patients during the early stages of the pandemic. Now is the time to act to ensure the long term management of those with ongoing symptoms matches that of the acute phase of the illness. We must also remember that there are many patients being cared for within primary care with other complex, multisystem disorders, such as chronic fatigue syndrome, who also require equitable access to multi-professional clinics – these patients must not be forgotten.


Finally, it is important to realise that, as knowledge changes with increasing evidence from research into the longer effects of Covid-19, support and treatment systems will also need to adapt.



  1. What is ‘Long Covid’?



  1. Community diagnosis of ongoing symptoms of Covid-19

From a GP perspective, there are three types of patient we have identified who may have ongoing symptoms of Covid-19:


a)   Initial infection not reported to health services and clinically diagnosed retrospectively

b)   Initial Covid-19 infection clinically diagnosed

c)    Initial infection diagnosed with positive Sars-CoV2 test


It is important to note that there is also a distinct group of patients who have end organ damage as a result of their acute Covid-19 infection. For example, having stroke due to thromboembolic disease or renal failure following an ITU stay. This group of patients must be considered separately as having “sequelae” of Covid-19 (health consequences of a complication of Covid-19) rather than having ‘Long Covid-19’.



  1. Managing ongoing or persistent Covid-19 in primary care (see Figure 1)







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  1. Experience of ongoing Covid-19 in primary care



Support for the profession affected by ongoing symptoms of Covid-19

In addition to supporting the population, there must be more focused support for GPs and their teams. Many health care workers in primary care contracted Covid-19 while caring for patients in the first wave and some are experiencing prolonged Covid-19 symptoms resulting in long-term sickness absence. This increases pressure on the primary care teams continuing to deliver services. Occupational health provision is readily available in secondary care, as hospitals are large organisations. GPs work in small businesses that are contracted to provide NHS services, with no centrally provided occupational health support. The RCGP would like to see provision of services, such as funded occupational health and funding for suitable staff cover, in place to ensure health care professionals are supported back to work and to continue to care for all patients.



  1. Future research

The long term effects of Covid-19 beyond 6 months are currently unknown, due to the nature of a new disease, and this is an important area for investment in research. Sufficient funding must be allocated to complete this work in a timely fashion, and to enable longitudinal research that is conducted over a significant period of time to capture a true picture of the disease and its impact. Research must be across primary and secondary care and include prospective data collection. Areas to consider include:



It is essential that government and healthcare leaders act now to ensure that there are the resources are used to build the necessary infrastructure to address the needs of long term Covid-19 patients. This must take place alongside the development of the guideline on persisting symptoms of COVID-19. The system must be ready to respond quickly, and clinicians across primary and secondary care must to be supported to care for the needs of patients at this time.


The long term effects of the virus should be taken as seriously as those in the acute phase of the illness, and our response to the long term management of those with ongoing Covid-19 symptoms should match that of the acute phase. Now is the time to act to ensure that people receive the care they need.


15 October 2020



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NICE & SIGN. (2020). 'Rapid Covid-19 Guidance will address Long Covid'. Retrieved October 2020, from

RCGP. (2020). RCGP survey of 300 GPs, in field 27 August to 8 September 2020.

Tay, M., Poh, C., Renia, L., & et al. (2020). 'The Trinity of Covid-19: Immunity, Inflammation and Intervention.'. Nature Review Immunology, 20, 1-12. doi:10.1038/s41577-020-0311-8

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