COVID-19 Primary Care bulletin

13 August 2020

COVID-19: this week's round-up for primary care

Dear colleagues,

As you will be aware, COVID-19 has had a disproportionate impact on people in areas of high deprivation, BAME communities, those with a learning disability and others with protected characteristics. We know we need to take specific action to tackle health inequalities.

An NHS England and NHS Improvement national advisory group has identified eight urgent actions for NHS Leaders to tackle health inequalities – from protection, prevention, leadership and data.

You can read more about the detail and context of the eight actions in the document Urgent Actions to Address Inequalities in NHS Provision and Outcomes.

Expanding the primary care workforce

This week we shared a letter about the need to expand the primary care workforce, with a reminder for all primary care networks (PCNs) to plan to take full advantage of their guaranteed funding and recruit as soon as possible. 

We recognise that COVID-19 has meant that many areas will have struggled to find time and energy to recruit. The letter contains details on schemes which should help to secure additional GP capacity and recruit additional roles as part of the Additional Roles Reimbursement Scheme (ARRS). 

Staff risk assessments  

We are grateful for those who have contributed data around completion of staff risk assessments. We want to ask any contractor who has not done so yet to do so and to emphasise again the importance of competing all risk assessments for staff as soon as possible.

August bank holiday

Finally, August bank holiday is rapidly approaching - we do not anticipate primary care will need to offer additional services over this period unless under a specific local lock down or local arrangement which has been agreed with the local commissioner.

Nikki and Ed

General practice

Updated Standard Operating Procedure (SOP) for general practice

The GP Standard Operating Procedure has been updated with current information and guidance in the context of COVID-19.

This includes information on preparing for face-to-face consultations, which highlights government advice on the use of face masks and face coverings by staff and the public in primary care.

The safety of both our staff and our patients is of paramount importance and face coverings or face masks should be worn by patients in a practice setting, in-line with government guidance. We expect that all patients who are able to do so will follow these recommendations. For the small number of patients who may not follow this guidance we fully support practices in ensuring that they can take all reasonable steps to identify practical working solutions with the least risk to all involved.

Practices should undertake a risk assessment which should consider, for example: offering the patient a mask, if the patient is willing to wear one; booking the patient into a quieter appointment slot, or in a separated area or providing care via a remote appointment.

Please refer to the current SOP for the latest information.

General Practice Fellowship Programme and Supporting Mentors scheme launched

Guidance and information on two schemes which were announced in the Update to the GP Contract agreement 2020/21–2023/24 are now available, forming part of a suite of interlocking GP recruitment and retention initiatives.

The General Practice Fellowship programme is a two-year programme of support, available to all newly-qualified GPs and nurses working substantively in general practice, with a focus on working in a Primary Care Network (PCN).

The programme supports nurses and GPs to take up substantive roles, understand the context they are working in and become embedded in the PCN. The first stage of the offer was launched in the latter part of 2019/20, with the enhanced 2020/21 offer being delayed from 1 April to August to respect local capacity needed in relation to COVID-19.

The Supporting Mentors Scheme is designed to upskill experienced GPs and provide a portfolio working opportunity. The vision is for systems to develop and access a cohort of locally based and highly experienced doctors to support their own more junior doctors.

GP mentors will be able to connect with newly qualified doctors on the GP Fellowships programme and to support them embed into the local general practice environment and become an integral part of the local primary care team.

Cervical Screening Administration Service

Following the successful Phase 1 transfer of the Cervical Screening Administration Service (CSAS) back to the NHS in August 2019, Phase 2 involves the allocation of a new telephone number, the staff relocation to NHS run buildings, and the move to working on NHS systems.

From 19 August 2020, the new telephone number for CSAS will be 0300 124 0248; the postal address will remain as PO Box 572, Darlington DL1 9AG.

As part of this second phase, CSAS will also be deleting all old email addresses on 31 August 2020 which link to Capita / PCSE. The quickest and most efficient way of contacting CSAS is by completing this online form.

The We Are The NHS: People Plan for 2020/21 has outlined some new developments for the pharmacy profession

As part of the future mental health workforce, NHS England and NHS Improvement will be funding the employment by mental health trusts of 50 new specialist mental health pharmacists to work as part of multi-disciplinary teams in new models of community-based mental health care for adults and older adults, including supporting PCN clinical pharmacy teams.

To support this, Health Education England will be exploring a new training strategy to support these pharmacists to be responsible for medicines optimisation for people with severe mental health problems – particularly those with complex co-morbidities and physical health needs.

Reminder to complete review of children and young people on the Shielded Patients List (SPL) by September

In our letter of 8 July we outlined the process for all children and young people currently identified as clinically extremely vulnerable to be reviewed and, where appropriate, removed from the SPL following consultation with their specialist clinician or GP. This is in line with guidance from the Royal College of Paediatrics and Child Health.

To date, while there has been a reduction in the numbers on the SPL, they have not fallen significantly. It is important that this review is completed ahead of the new school term (early September) to avoid children and young people receiving inappropriate advice in the case of new public health measures being applied in their area.

While many of these children will be under the care of specialists, who have also received instruction to review their patients, there will be a small number of children and young people who have previously been identified as clinically extremely vulnerable and who are not under the care of a specialist.  

Practices will need to identify and advise these individuals. Once a conversation with the patient/patient’s family has taken place, the patient must be removed from the SPL if deemed clinically appropriate. To do this, the high risk flag on their patient record should be changed to moderate or low risk. This patient should also be written to, to confirm they have been removed. For more detail about removing a patient from the SPL visit the NHS Digital website.

Indemnity cover for GP Trainee Nursing Associates role

The range of providers who can employ Trainee Nursing Associates (TNA) has been widened to include General Practice. For clinical negligence, TNAs employed by Trusts, but on rotation in general practice will be covered under the employing Trusts membership of state schemes operated by NHS Resolution (the Clinical Negligence Scheme for Trusts (CNST) and the Liabilities to Third Parties Scheme (LTPS)). 

Like other Practice staff, TNAs employed and working in General Practice, will be covered for clinical negligence liabilities under the Clinical Negligence Scheme for General Practice (CNSGP). As in their normal course of business, General Practices should maintain adequate employers and public liability insurance.

New GP practice profiles on the NHS website

New NHS website profiles that better meet the needs of patients and feature improved support for mobile and tablet devices are being launched today for GP practices. The new profiles have a clean, modern design in keeping with the rest of the NHS website and meet modern accessibility standards.

Your existing profile information will be automatically copied over to the new platform and the way you update your profile has not changed. Profiles editors should have received further information via email from the NHS website service desk.

This work is part of a programme to continuously improve the care and experience offered to patients through the NHS website, the UK’s largest health website for the public. New profiles will be live by the end of today, Thursday 13 August. Use the NHS website GP practice finder to find and view your new profile.

Estates planning support and guidance

The GP Contract makes reference to ensuring sufficient space is available for additional staff employed under the Additional Roles Reimbursement Scheme (ARRS) in terms of estates. A number of documents offering advice and guidance to PCNs, constituent practices, and commissioners in receipt of applications for additional funding to accommodate additional staff are available on FutureNHS.

We hope you find these resources helpful. 

Community pharmacy

Updated Community Pharmacy Standard Operating Procedure published

On 10 August, NHS England and NHS Improvement published an updated Standard Operating Procedure (SOP) for community pharmacies in relation to the COVID-19 pandemic which came into immediate effect.

Now that public demand for pharmacy services has returned to normal levels, the flexible opening provision that allowed pharmacies to close their doors to the public for up to 2.5 hours a day has been removed from the SOP.

Regulatory provisions to enable contractors to make temporary adjustments to opening hours as an emergency measure as a result of the COVID-19 outbreak are still in place and require agreement with the local NHS England and NHS Improvement office.

Other updates include information about when and where a delivery service to shielded patients will be commissioned.

Optometry

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

Dentistry

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

Additional information

National Patient Safety Alert - Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults

A National Patient Safety Alert has been issued asking providers to ensure all eligible patients with adrenal insufficiency are issued with a Steroid Emergency Card; and that processes are put in place to check if a patient has a Steroid Emergency Card ahead of any emergency treatment, elective surgery, or other invasive procedures.

Continuing to make our website better for you

We are continually working to improve our online services. We’ve already discovered what many of you need from our website, and we want to keep learning, testing prototypes and gaining a greater insight so our website is the best it can be.

If you are interested in participating, please use our short form to register your details. Appreciating the pressures you’re under, we’ll ensure we take up as little of your time as possible. Please share this request with your stakeholders – fresh voices and insights are always welcome.

Improving support and collaboration for digital innovation 

The latest NHSX blog sets out support available to NHS staff across STPs, trusts, primary and community care as they implement proven health technologies, remote monitoring and new digital pathways.

Support includes topic-led online workshops focused on specific aspects of scaling tech and a new Innovation Collaboratives - Digital Health (ICDH) workspace on NHS Futures. The vibrant workspace brings together NHS staff and resources to foster collaboration and share learning, guidance, best practice case studies, blueprints and digital and improvement science tools.

This week's case study

Shaftesbury Medical Centre – video case studies

By making greater use of digital technology, GPs and practice staff up and down the country have been able to treat and support their patients in new ways during COVID-19. Since March 2020, GP practices have been rapidly upgrading or expanding their digital healthcare capabilities to keep people well, while maintaining social distancing.

Shaftesbury Medical Centre in Leeds is an example of one practice who have been making greater use of technology, both for consulting with patients and for cross-site working. Watch these two short videos to find out how they have revolutionised their way of working for both patients and practice staff.

• Using remote consultations in general practice
• Accessing my GP remotely

Dates for your diary

Wednesday 19 August, 5 - 6pm - Digital Primary Care Online presence - accessibility compliance webinar. Public sector organisations have a legal duty to make sure websites and apps meet accessibility requirements. CCGs and GP practices are invited to attend and learn more about meeting the standards before the deadline of 23 September 2020.

NHS Volunteer Responder programme updates

Fortnightly webinars are being held to provide regular updates on the NHS Volunteer Responder programme. The webinars are for referrers and colleagues working across health and care including: primary care; social care; local authorities; government departments; voluntary sector organisations; STPs and ICSs; and NHS England and Improvement regional teams.

These webinars will provide an overview of the programme, including facts, figures and the most recent updates on programme adaptations in response to policy changes and the needs of vulnerable people.

• Thursday 20 August, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 3 September, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 17 September, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 1 October, 11am - 12pm - Join Microsoft Teams Meeting

Online workshops on remote monitoring

During the COVID-19 outbreak, some NHS organisations used technology to support people with COVID-19 at home. If you would like to know more, and are keen to establish a similar service locally, join this webinar series to hear from the clinicians involved about how this worked, what they did and what the benefits were.

• Tuesday 8 September, 10am - 11am - Tech-enabled Virtual Ward Model - the West Herts experience, led by Dr Matthew Knight
• Tuesday 22 September, 10am - 11am - The primary care hot hub - the West London experience, led by Dr Tony Willis and Dr Kuldhir Johal

The online workshops will use Microsoft Teams and will be recorded. To talk about the workshops please contact us via email at InnovationCollaborative@future.nhs.uk.

Nikki and Ed's link of the day 

Black & brown skin