COVID-19 Primary Care bulletin

28 March 2020

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

Dear primary care colleagues,

We are coming to the end of another challenging week and we will continue to urge you all to take care of your own health and wellbeing. 

You  can access support for managing your own mental health from the free, confidential NHS Practitioner Health Service The BMA also has a wellbeing support services.

We have produced the first in a series of psychological support for all NHS staff during the COVID-19 outbreak, as we recognise it is really important to look after your own health and wellbeing, whilst supporting patients and your family.  As such, we are pleased to offer the following wellbeing apps to all NHS staff for free.  Additional self-help apps and support will be available over the next few weeks. To see how to access these apps, please visit the NHS Employers website. We’d be grateful if you can share with your teams in primary care as we’re keen to get this offer out to all staff.

We have produced an update, published today, for general practice regarding the COVID-19 situation. This latest letter includes; guidance on COVID-19 Primary Care Operating Model and implementation within general practice, further support for the workforce, details on the Electronic Prescription Service (EPS) and preparations for the bank holiday.

This letter builds on the guidance we sent you on 19 March as we deliver care in an ever-changing environment.

The principles set out in this letter are intended to help achieve three key aims:

1. Successful shielding of those identified most at risk from complications of COVID-19 and actively managing their ongoing, often significant, health and care needs;
2. Supporting the rest of the population, including those who you suspect have COVID-19, by delivering primary care services, including to those discharged from hospital; and
3. Minimising health risks to yourselves, your practice staff and your local multi-disciplinary teams.

The next version of the standard operating procedure (SOP) will give further guidance on implementation, but the principles are fleshed out in this letter.

Published along side today's letter is advice on how to establish a remote ‘total triage’ model in general practice using online consultations.

We will be hosting another webinar on Thursday 2 April 5pm-6pm where you will be able to raise further questions. We will be using Microsoft Teams for the next webinar to make it easier for people to join. To take part use this link.

Earlier this week we wrote to you regarding the process for identifying and supporting patients at highest clinical risk from coronavirus. We have received a number of questions about this process and are producing an FAQ document which aims to answer as many of those queries as possible. In the meantime, the information below covers some of the key issues that most of you have raised with us:

• All patient letters generated by the central process have now been distributed and should have been received via Royal Mail.
• In line with the letters from Chief Medical Officer (CMO) and NHS England and NHS Improvement, all patients included in the CMO defined cohort that could be identified through centrally available data should have been flagged in practice IT systems.
• GPs should have received a report from their system supplier.  This report can be run locally on your practice IT systems – you will not receive separate notice about this.
• If your practice have not yet got your patient flags, or report, please contact your IT system supplier and let us know immediately, via: England.covid-highestrisk@nhs.net  Please do not send any lists of patients or other patient identifiable data to this email address
• We knew the data in the initial extract would not be complete due to the limitations of centrally available data.  Next week, NHS Digital will update the original cohort and identify some additional patients based on GP data.  Any additional patients identified will be flagged in GP systems in the same way as the original cohort and practices will have an updated report in their system.
• After this next update, we would like practices to review the list for accuracy and identify any additional patients who meet the CMO’s original criteria but are not included amongst those identified.  We will provide further details of how this should be done via GP system suppliers.
• As set out in the CMO letter and subsequent communications from Royal Colleges, there may be other patients, not included in the original CMO cohort, that GPs consider to be in the highest risk category and who should be advised to shield.
• Please do not run searches to identify these cohorts at this stage. NHS Digital and ourselves will be in touch next week to confirm how this process can be streamlined for GPs.
• In the meantime, please start to consider specific patients within your practice who may fall into this category of extremely vulnerable on medical grounds.  We expect this to be small numbers; shielding will only be effective if we focus these most stringent protective measures on those at the highest clinical risk.

Personal Protection Equipment (PPE)

We know that one of the issues we’re hearing most from you is about PPE distribution. For immediate short-term issues National Supply Disruption Response (NSDR) are able to issue ‘pre-packed kits’ with a minimum of (100 Type IIR face masks; 100 aprons and 100 pairs of gloves) within 72 hours.

Primary care providers who raise requests for kits through NSDR must to be able to make arrangements to receive emergency delivery of these ‘pre-packed kits’ outside of business hours.

The NSDR 24/7 telephone helpline is 0800 915 9964

Support to maximise use of electronic repeat dispensing (eRD)

Primary care is being asked to increase the use of eRD, in suitable patients, as part of the pandemic response. 

The NHS Business Services Authority (NHS BSA) is supporting this initiative by helping GP practices to identify patients who may be appropriate to transfer to eRD. They are doing this by creating individual practice lists of NHS patient numbers identified from their dispensing information to be suitable for eRD.

This service will allow GP practices to identify patients who have received the same medications in the last 12 months of dispensing data (up to January 2020). The initial practice list will identify patients receiving 1,2 or 3 medications allowing practices to start the process of moving patients to eRD, where considered appropriate, where the move is likely to be straight forward. 

Increasing eRD will have the following benefits in the current situation:

• Reducing footfall to your practice and to the community pharmacy, supporting social distancing.
• Reducing workload for prescribers, allowing better prioritisation of resources.
• Controlled management of the supply chain

Where eRD has been previously actively encouraged, GP practices have successfully achieved 70% of patients receiving their medications in this way.

Practices wanting to increase eRD are recommended to already have a tried and tested robust process in place for eRD before implementing to large numbers of patients.

Collaboration is key to the successful implementation of eRD:

• CCGs embarking on moving patients to eRD MUST discuss plans with their local pharmaceutical committee (LPC) prior to switching.
• Practices moving to eRD must discuss their plans with local community pharmacies.

To comply with GDPR this list must be sent to a practice NHS.NET address. The practice can then decide who it should be shared with to implement the change to eRD.

If you require any assistance, please email nhsbsa.epssupport@nhs.net

Pausing the NHS Complaints Procedure

Due to the ongoing COVID-19 pandemic we are supporting a system wide “pause” of the NHS complaints process which will allow all health care providers in all sectors to concentrate their efforts on the front-line duties and responsiveness to COVID-19.

The initial “pause” period is recommended to be for three months with immediate effect. All health care providers can opt to operate as usual regarding the management of complaints if they wish to do so and this “pause” is not being enforced.

Please note that as of 26 March 2020, the Parliamentary and Health Service Ombudsman has stopped accepting new NHS complaints and has stopped work on open cases.

The Coronavirus Act 2020

The Coronavirus Act 2020 received Royal Assent on 25 March, having been fast-tracked through parliament. The Act contains ‘emergency powers’ to enable public bodies to respond to the Covid-19 pandemic.

The Act eases the regulations relating to the registration and certification of deaths and still-births, and permissions to conduct cremations. 

The Act remove the requirement that any inquest into a death from coronavirus be held with a jury in England, Wales and Northern Ireland (as is required by law for other notifiable diseases)

We hope some of you get a break over the weekend.

Nikki and Ed

Additional information

Humanity First UK launches its National Coronavirus Support Line

In response to the United Kingdom Government calling out to the charity and voluntary sector Humanity First (UK) have announced the launch of a national support line to help and signpost people to services relating to the COVID-19 pandemic. Further information can be found on the  Humanity First UK website 

RCGP COVID-19 resources hub
The COVID-19 Resource Hub has been created to support GPs in understanding and managing this pandemic, with topics ranging from diagnosis to keeping your practice safe. This hub will be updated daily with the latest developments and guidance.

Dates for your diary

Nikki and Ed's Link of the Day

RCGP Top 10 tips for COVID-19 telephone consultations