COVID-19 Primary Care bulletin

22 June 2020

COVID-19: today's round-up for primary care

Dear colleagues,

As you will no doubt have seen, recent data has demonstrated the disproportionate impact of coronavirus on our black, Asian and minority ethnic (BAME) colleagues with Public Health England’s more recent data analysis reaffirming much of what we have learnt since the pandemic started.

Prerana Issar, our Chief People Officer, and I [Nikki] have today written an updated blog to touch on recent events and share what we are doing to address particular issues faced by BAME members of staff. We are committed to supporting BAME primary care staff and have asked Dr Sonali Kinra from Nottinghamshire to highlight some of this work below.

You will have seen that the Government COVID-19 alert level has been downgraded from Level 4 (epidemic is in general circulation; transmission is high or rising exponentially) to Level 3 (epidemic is in general circulation). This relates to an alert level, not an incident level - for now the NHS continues to operate under a Level 4 incident. Therefore the change is unlikely to have an operational impact for NHS providers and/or NHS England and NHS Improvement at the current time.

Today the Government has set out the roadmap for people who are clinically extremely vulnerable, outlining a phased easing of the advice. The Government has committed to writing to everyone who has been advised to shield (c.2.2M people) following the announcement to make them aware of the updated guidance. The NHS will continue to maintain the Shielded Patient List allowing us to continue to provide targeted advice and support to this cohort and to change advice and support if the incidence was to rise significantly. 

Finally, with regards to face coverings - for some people, wearing a face covering may be difficult due to physical or mental health conditions. If, following current guidelines, you have asked patients to wear face coverings before entering the surgery or pharmacy, for these patients, other measures should be considered, for example timed appointments or being seen immediately on arrival. No patients should be denied access to care, though, and for further information on the use of face coverings in primary care please refer to the following guidance:

• The advice published by Public Health England on the use of Personal Protective Equipment in primary care
• Further Government advice on working safely in non-hospital settings

Nikki and Ed

BAME Focus

Update from Dr Sonali Kinra, GP Retention Lead Nottinghamshire ICS

COVID-19 has presented us with unprecedented challenges for our population and workforce. It has disproportionately affected the BAME groups and exposed longstanding social, economic and healthcare inequalities.

Nikki and Prerana on 1 May wrote in a blog that this is not just an equality, diversity and inclusion issue - it is an urgent medical emergency and we need to act now. This was further substantiated in the report by Professor Fenton “Covid-19 Understanding the impact on BAME communities” published on 16 June where seven recommendations were made applicable across the wider BAME population.

We wish to bring into focus the support and priority areas for BAME primary care workforce and we need your help to shape the agenda. If you work in primary care (clinical and non-clinical, commissioner, provider and support teams) and belong to the BAME community please complete this survey which has been created by NHS England and NHS Improvement. It is vital we hear your thoughts as the time to act is now.

General practice

Mental health

As we move into the ‘restoration and recovery’ phase of the pandemic, mental health services – who since March have made great efforts to maintain, adapt and expand some services where possible – are in the process of restoring back to full capacity. Services will be supported to expand in line with new planned NHS Long Term Plan investment and in anticipation of greater demand relating to the pandemic.

Many services, including adult IAPT services and community mental health services for people of all ages, saw a drop-off in referrals in the early phase of the pandemic, which is why the GP SOP published on 29 May states that “patients should be referred as usual to mental health services”. This is important to note for people of all ages, but especially children and young people, in the context of referral routes via schools not having been available.

We would also like to remind practices of the importance of proactive physical health checks for people with Severe Mental Illnesses (SMI). Practice staff should work proactively with secondary mental health care services to identify which individuals on the SMI register are due a physical health check. Services should engage with eligible individuals to explain the purpose of the check and agree a suitable and safe way for the physical health check to be completed. Where face-to-face checks are not possible, practices should complete elements remotely, where practicable. Reasonable adjustments should be made to accommodate the needs of people with SMI in the completion of checks.

Covid-19 antibody testing - indemnity arrangements

We understand there has been some concern regarding the indemnity arrangements that apply for primary care staff who undertake antibody testing on other NHS workers. To ensure that indemnity is not a barrier to the NHS supporting the Government’s antibody testing programme, we are able to confirm that where you are not covered for this activity under your existing indemnity/insurance arrangements, the Clinical Negligence Scheme for Coronavirus (CNSC) will provide clinical negligence indemnity cover. This cover is for primary care staff who take blood samples from any NHS primary care contractor’s staff, including colleagues, or other NHS employees for the purpose of a Covid-19 antibody test. A FAQ covering this topic is also published on the CNSC FAQ pages of NHS Resolution’s website.

Landmark licensing deal will boost security and save the NHS Money

NHSX and NHS Digital have negotiated a new three-year Microsoft Office 365 licensing deal which will give staff access to robust, modern tools and capabilities including MS Teams and strengthen NHS defences against cyber attacks. While local organisations continue to be responsible for buying their own software to meet their needs, the deal has secured the lowest licensing cost for individual NHS organisations, including in general practice. Find out more about the deal.

Community pharmacy

Inclusion and Diversity Strategy

The Royal Pharmaceutical Society (RPS) has published a report on Inclusion and Diversity for pharmacy 2020-2025. Its initiatives support both immediate and long-term changes based on three priorities: creating a culture of belonging, championing inclusive and authentic leadership; and challenging inclusion & diversity barriers. NHS England and NHS Improvement’s Chief Pharmaceutical Officer, Dr Keith Ridge, has commended the RPS for the strategy and its focus on the need to promote wellbeing at work and address the unacceptable inequality in experience and opportunity some colleagues suffer, as well as the ongoing inequalities in outcomes experienced by some patients. The report sets out the actions that the profession need to take forward, working in partnership to bring about real and lasting change and we will be working with the RPS in its implementation.

Reviewing risk assessments during the COVID-19 pandemic

The General Pharmaceutical Council (GPhC) has issued a statement which encourages all pharmacy owners and employers to review their existing occupational risk assessments in the workplace to help identify and protect staff at increased risk in relation to COVID-19, and consider what further actions they could take to protect their staff, trainees and their patients. This would include using appropriate risk assessment tools to identify at-risk and vulnerable people within their team, including staff from BAME backgrounds, along with other vulnerable groups, such as those with existing health conditions. 

Dentistry

Respirator fit testing

Plans are in place to train 560 fit testers from the dental sector across NHS regions, who will each fit test colleagues in local practices. This is a collaborative arrangement between:

• NHS England and NHS Improvement Regions and their LDNs who, working with the local profession, will identify those to be trained;
• Health Education England Regions who will identify the venues and organise bookings for courses working with Respiratory Protective Assessment Ltd (RPA) who will provide the trainers; and
• Public Health England who have funded RPA to support the COVID-19 response and specifically support these courses.

Once trained, fit testers will be provided with a fit testing kit to enable them to begin testing in their region. NHS England and Improvement is arranging for fit testers to be engaged under an honorary agreement for these activities, which will cover any liabilities arising through that agreement. For further details on local arrangements, please contact your local regional dental team. Details of regional contacts are in this letter.

In addition to the plans above, RPA have a specific area on their website with helpful information.

Dental care provision PPE and IPC requirement

A reminder that despite the reduction in the national incident level to Level 3, the PPE and IPC requirements for dental settings remain unchanged, as described in Appendix 1 of the Transition to Recovery SOP and referring to Table 4 in the IPC Guidance. We continue to monitor and will advise as the threat level changes.

Optometry

The most recent guidance letter and standard operating procedure for optical staff is available on our website.

Community health

Share your innovative work in community health service settings

COVID-19 has changed healthcare delivery in England, and new and innovative ways of working have been rapidly developed across the NHS. As we move into the next phase of NHS recovery, NHS England and NHS Improvement want to hear from clinicians, clinical leaders, operational leads and others about changes community health service teams have made and resulting benefits. These will help to ensure beneficial changes to care are captured and embedded in our services, so that we can translate these into improved care for patients well into the future. Feed in your experiences here by 30 June 2020.

Admission and care of residents in a care home

The government has updated their guidance on the Admission and Care of Residents in a Care Home during COVID-19, using the latest domestic and international evidence brought together by Public Health England (PHE), drawing on the insights of care providers.

This document updates the previous Admission to Care Homes guidance published on 2 April 2020, in line with the latest updated advice on testing and Infection, Prevention and Control (IPC). It also reflects the support package for care homes announced in May 2020 by HM Government, backed by a £600 million Adult Social Care Infection Control Fund.

Additional information

PRINCIPLE Trial calling GPs and primary care professionals

PRINCIPLE, a national NIHR Urgent Public Health Prioritised trial, is evaluating possible treatments for COVID-19 in primary care. The trial is endorsed by the CMOs of all four nations, who have asked for doctors to make every effort to enrol patients.

PRINCIPLE aims to find out whether early treatment in the community speeds recovery and reduces the need for hospital admission for those with COVID-like-Illness. The trial urgently needs more of those who are still contracting the disease to be given the opportunity to participate. Fortunately, this innovative study is now available to every eligible person throughout the UK, as patients can now also be recruited centrally. Read more about how to support this national priority trial.

Collecting your examples of innovation

We have been capturing examples of new and innovative ways of working in general practice and community pharmacy, so that we can ensure beneficial changes are captured and, where appropriate, sustained. The deadline for submitting your examples is this Thursday 25 June, so please do send yours through via ipsos.uk/COVIDinnovation. Please contact the team if you have any questions.

Dates for your diary 

Wednesday 24 June, 1-2pm – Digital Nurse Network webinar

Thursday 25 June, 7pm - How to implement COVID-19 Urgent Care Service to support a collaborative care pathway for urgent eye conditions webinar jointly hosted by The Royal College of Ophthalmologists and The College of Optometrists.

Nikki and Ed's link of the day

The Shuri Network - The first NHS and care network of BAME women celebrating difference and diversity in digital health, challenging the system to take action and supporting BAME women to succeed in their careers.