17 November 2020

Dear colleagues,

We would like to remind you about our Primary Care COVID-19 vaccination programme webinar that is taking place tomorrow from 1pm – 2:30pm. This webinar provides an opportunity for primary care networks, general practice, CCGs and community pharmacy to hear from NHS England and NHS Improvement as well as guest speakers about the COVID-19 vaccination programme. Register your place before 12pm on Wednesday. If you’ve registered previously for a general practice webinar you don’t have to sign up again.

Recommended expansion of remote pulse oximetry services (COVID virtual wards)

Clinical commissioning groups (CCGs) have been advised to set up ‘COVID Oximetry @home’ services (also known as COVID virtual wards) as rapidly as possible during November 2020, further to guidance on the use of pulse oximetry first published in June 2020 and the COVID Oximetry @home standard operating procedure published last week.

Learning from pilots and emerging practice, we have developed a simple model designed for ease of adoption at scale. We are recommending that following COVID diagnosis, patients who are symptomatic, and either 65 or highest risk i.e. those on the Clinically Extremely Vulnerable list, are supplied with an NHS pulse oximeter for patient self-monitoring. A supply of oximeters can be drawn down from national stock and reused following decontamination. 

This gives an additional intervention option for general practice and is intended to help reduce mortality by detecting hypoxia and ensuring timely hospital treatment. 

All CCGs can continue to request pulse oximeters for local use - email england.home@nhs.net. Primary care network colleagues should contact their CCG if they feel there is an urgent requirement of which their CCG is not already aware.

Nikki and Ed

COVID-19 updates and guidance

PPE Portal – some common user questions

If you have questions about when you can place your next order or why items are showing out of stock or any other queries, please see the PPE portal FAQs. They can be found by logging into www.nhs-ppe.co.uk and scrolling to the bottom and selecting help/FAQ. If you have any concerns that aren’t answered in these, please do get in touch with the customer service team on 0800 876 6802. The team is available from 7am to 7pm, 7 days a week.

Update on COVID swab testing in general practice

Last week, NHS Test and Trace rolled out a new service making COVID polymerase chain reaction (PCR) swab testing capability available to all general practices in England on a voluntary, opt in basis. This has been positively received with high levels of interest – over 1,700 practices have registered to use the service with over 68,000 test kits ordered.

All practices should have received a Unique Organisation Number (UON) via email that enables them to register to use the service. The email address originates from  ‘organisation.coronavirus.testing@notifications.service.gov.uk’. If you have found that you have not received it, please first check your emails including spam folders. If are still unable to identify it, please call our 119 helpdesk and they will be able to assist you.

You can find further information here or you can attend one of our webinars.

Management of the long-term effects of COVID-19

A survey of the Royal College of General Practitioners (RCGP) members in September 2020 showed 67% of those who responded were looking after at least one patient with ongoing symptoms of COVID-19 lasting more than 12 weeks. The RCGP has provided a response and top tips for caring for patients.

General practice 

SMI health checks
The NHS has committed to ensure that 60% of people with Severe Mental Illness (SMI) receive a comprehensive physical health-check, as part of the NHS Long Term Plan. People with SMI face reduced life expectancy of 15-20 years when compared with the general population, and evidence shows they have been disproportionately impacted in the first wave of the COVID-19 pandemic, including significantly higher mortality rates.

As part of the revised Quality and Outcomes Framework (QOF) requirements for 2020/21, practices have been asked to identify their most clinically vulnerable patients for proactive review, including those with an SMI, and ensure that are offered the following:

• Access to flu vaccinations for people with SMI who are eligible under the NHS free flu programme;
• Completion of the annual comprehensive physical health check where appropriate and adapting service provision to meet service user choice. This could include completing some elements of the check remotely where possible; and
• A care plan review where this is deemed appropriate.

Some people with SMI may require additional outreach and support to access their flu vaccinations and/or physical health checks. Areas may wish to consider working with local voluntary, community and social enterprise (VCSE) partners to provide outreach and engagement support to facilitate access to these vital services.  

General practice - latest updates

Primary care

New initial education and training standards for pharmacists on the horizon

On 12 November, the Council of the General Pharmaceutical Council (GPhC) met and agreed the overall direction of the review of the standards for initial education and training of pharmacists. The GPhC is continuing to work closely with key stakeholders, including the Pharmacy Schools Council and the statutory national education bodies, to inform the final drafting. The Council will consider the final draft of the standards at its Council meeting on 10 December. There was clear support for the aim that pharmacists can independently prescribe from the point of registration, and that this should be implemented at the earliest possible opportunity.

Primary care continues to play a vital role in cardiovascular disease prevention

In July, Dr Nikita Kanani and Ed Waller wrote a letter to GPs and their commissioners to thank them for their role in supporting high-risk patients with ongoing care needs during the first peak of the COVID-19 pandemic. In addition, practices were asked to resume certain services which may have been paused, for patients with high risk conditions. This included the restoration of annual blood pressure reviews for patients with hypertension, which we know is critically important to reducing their risk of stroke and heart attack and improving their quality of life.

Evidence shows that every month of disruption to pro-active hypertension management and intensification of medication where needed will likely result in additional acute cardiovascular events. Internal modelling has estimated that a 9 month period of disruption to the delivery of routine care for those diagnosed with hypertension could result in around 12,000 additional acute cardiovascular events (strokes and heart attacks) or deaths over a three year follow up, as compared to what might have been expected from pre-COVID levels of achievement. Primary care plays a vital role in cardiovascular disease prevention and we want to thank you for your continued attention to saving lives and reducing health inequalities.

World Antimicrobial Awareness Week (WAAW) (18-24 November) and the continued importance of Antimicrobial Stewardship during the COVID-19 pandemic   

This year, the COVID-19 pandemic has presented numerous additional challenges for health professionals managing patients with infections. Now, more than ever we need to continue to work together to prevent serious infections – including COVID-19 – whilst reducing inappropriate antibiotic use.   

To avoid inappropriate antibiotic prescribing, it’s recommended to:   

• follow latest NICE guidelines to optimise antibiotic treatment of pneumonia which may have a COVID-19, viral or bacterial cause   
• treat coughs, fevers and breathlessness related to COVID-19 in line with latest clinical guidance, not with antibiotics. Please consider the COVID-19 and flu pathway for diagnosis, testing and clinical management   
• explain to patients that antibiotics do not prevent or cure viral infections including COVID-19. Antibiotics can cause side-effects, including nausea and diarrhoea. Antibiotics use can also increase the risk of spreading infections that are caused by bacteria resistant to antibiotics.  

Find out how you can support raising awareness through the WAAW Resource Toolkit; a digitally focused resource to support WAAW from 18-24 November.

Actions and useful resources following publication of a report looking at the deaths of people with a learning disability from COVID-19

The University of Bristol has published a report looking at the deaths of people with a learning disability who died between 2 March and 9 June 2020.

NHS England and NHS Improvement has also published a response to that report in our Action from learning response to learning from deaths of people with a learning disability (LeDeR) review of COVID pandemic deaths - as well as useful guidance and resources.

We would urge all primary care partners to review the actions outlined and ensure that follow up actions are in place in their practice/system.

Dates for your diary

Wednesday 18 November, 3pm - 4pm. Implementation support for COVID-19 remote pulse oximetry services. GPs and CCG colleagues are invited to attend.

Wednesday 18 November, 1pm - 2:30pm. Focus on COVID-19 vaccination programme

Thursday 19 November, 10am – 12pm. NHSX Innovation Collaborative virtual event

Monday 23 November, 1pm - 2pm. Antimicrobial Stewardship in Primary Care webinar

Wednesday 25 November, 2pm - 3pm. Harnessing health and housing support to improve population health

NHS Volunteer Responder programme update webinars. Fortnightly webinars are being held to provide regular updates on the NHS Volunteer Responder programme.

• Thursday 26 November, 10.30am - 11.30am - Join Microsoft Teams Meeting
• Thursday 10 December, 10.30am - 11.30am - Join Microsoft Teams Meeting

Various dates - REACT Mental Health Conversation training

Link of the day

Author Nora Roberts on Juggling Kids and Work: Know Which Balls Are Plastic and Which Are Glass