22 December 2020

Dear colleagues,

We appreciate that the announcement from the Government regarding new restrictions that took place over the weekend may place new pressures on some parts of primary care. However, we are confident that you will continue to make clinically led decisions about risk for different patient groups, in line with the Infection, Prevention and Control guidance already in place to support you to manage patients safely across all areas.

We have now republished the GP Standard Operating Procedure to reflect some of the latest updates and guidance and the seven priority areas set out in the £150m capacity expansion fund letter remain critical.

As people are moved into different Tiers, it is important they continue to access services when needed and understand how some of the changes may affect the ways that care can be accessed, including the use of online/phone consultations and face-to-face appointments when clinically necessary.

For vaccination sites in particular, in line with previous announcements, local enhanced services should where possible be re-purposed by agreement with CCGs to make funded capacity available for COVID 19 vaccination, and extended access and hours capacity can similarly be reprioritised to provide additional capacity.

Clinically Extremely Vulnerable patients in Tier 4 areas should now be shielding, and as the SOP confirms, practices should provide care at home where possible, or in infection controlled clinical settings where needed in line with IPC guidance.

A special thank you message

The commitment you have shown this year has been inspiring. Now, with the rollout of the COVID-19 vaccination programme, there is hope and you continue to work tirelessly to protect the most vulnerable in your communities.

Our festive video celebrates your dedicated teams and highlights the achievements of the primary care workforce. We received so many pictures and videos that unfortunately we couldn’t include them all. Thank you - we couldn’t do this without you.

Raj and Ali

COVID-19 updates and guidance

COVID vaccination in care homes

This week we began to initiate the delivery of the vaccine through local vaccination sites to care home residents and their staff, starting with larger care homes. The roll out began this week through wave 1, 2 and 3 sites and will be followed shortly by local vaccination sites in later waves. A letter was sent to waves 1-3 sites with further details and the standard operating procedure for vaccination deployment in community settings was updated with a specific care home section. We have now sent a letter to workforce leads which confirms the roving vaccination model will be rolled out and details the specific arrangements that should be put in place to support this important piece of work.

Long COVID assessment services launched

Last week, we announced 69 Long COVID assessment services, located across the country, and taking referrals from GPs for people experiencing a range of debilitating, enduring symptoms of coronavirus. These services bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments. 

Each region has an identified lead for post COVID services, details of which are available on the Primary Care FutureNHS site, along with information on how local teams or post COVID assessment services can refer patients to the Your COVID Recovery online platform. Please contact your regional lead for further information on long COVID services and patient pathways in your area.

The National Institute for Clinical Excellence (NICE) has also issued official guidance on best practice for recognising, investigating and rehabilitating patients with long COVID.

COVID Oximetry @home

CCGs were advised in November to set up ‘COVID Oximetry @home’ services as rapidly as possible, as one of seven priority goals for the additional £150m General Practice COVID Capacity Expansion Fund. The vast majority of areas have now established services. We have published guidance for people with suspected coronavirus isolating at home (safety netting guidance) which supports monitoring for risk of silent hypoxia and we have increased the recommended number of oximeters in care homes to one oximeter per ten beds (up from one per 25 beds) based on developing clinical advice. 

CCGs can continue to request pulse oximeters by emailing england.home@nhs.net. PCNs should contact their CCG if there is an urgent requirement that their CCG is not already aware.  General practices will also want to consider whether they have sufficient oximeters to take account of potential minor delays in distribution over the holiday period.

Lateral flow testing in primary care

As described in the 16 December letter to primary care, Primary Care Support England (PCSE) started last week to send direct invitations to primary care contractors to order lateral flow testing devices for their staff.

Invitations to order are being sent in a staggered manner across NHS regions to ensure a smooth ordering process. Following receipt of an invitation, organisations should log on and complete their order as quickly as possible, with a final closing date for orders of Wednesday 30 December.

SOPs and FAQs on lateral flow testing in primary care are available for further information, as well as a brief guide for staff on how to self-administer the tests.

If primary care contract holders also hold contracts commissioned by CCGs for different NHS services (for example NHS audiology services) these providers can also order for the staff delivering those services through the PCSE portal.

Each organisation should order one box for each patient-facing member of staff, for example if there are 10 patient-facing members of staff delivering NHS services within an organisation, the order should be for only 10 boxes of test kits. This will provide each staff member with 25 single use test, enough for 12 weeks of testing. It is important that organisations order the correct amount, as orders in excess of this amount may prevent other primary care organisations from receiving on time enough test kits for their staff.

Communications to Clinically Extremely Vulnerable (CEV) individuals in Tier 4

Following the update in Sunday’s bulletin informing you that shielding was being reintroduced in Tier 4 areas in England, the Government has informed us that it will be sending texts to patients on the Shielded Patient List in these Tier 4 areas. This is to ensure affected patients receive the right guidance quickly, as we are aware that letters from Government advising people to shield may be delayed over the Christmas period. This text will be sent from GOV.UK and texts are expected to start being sent today (22 December).

COVID vaccination delivery for CEV patients in Tier 4

Thank you for the continued work you’re doing in vaccinating those in priority groups, including those who are Clinically Extremely Vulnerable (CEV). There are some considerations you may wish to make when it comes to administering the COVID-19 vaccination for those who are CEV in Tier 4 and have been advised by the Government to shield. CEV patients should be encouraged to come to your vaccination site with assurances of a safe and secure environment. Family and carers of those who are CEV should be allowed to come along to sites but may be asked to wait outside (if possible). You may want to consider clustering appointments for CEV patients in the same session or day. If patients are unable to attend the site (for example if they are unable to drive/be driven or not able to use public transport due to shielding guidance), their COVID-19 vaccination will need to be organised later in the programme.

Home delivery of medicines service commissioned

People who are clinically extremely vulnerable in Tier 4 areas are advised by the Government not to go to a community pharmacy. Therefore a letter has been sent to community pharmacy providers to confirm that the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service will be commissioned in accordance with the home delivery of medicines and appliances during the COVID-19 outbreak: service specifications and guidance for all patients on the Shielded Patient List living in tier 4 areas from 21 December 2020 until 18 January 2020. This means that all pharmacies and dispensing doctors in England will again be required to ensure patients on the Shielded Patient List receive their medicines at home.

Questions about Patient Specific Directions (PSD) and Patient Group Directions (PGD)

We are receiving enquiries as to whether or not written PSDs are required for supply and administration of COVID-19 vaccination. To clarify, doctors as appropriate practitioners can supply prescription only medicines without prescriptions and administer injectables without directions (Human Medicines Regulations reg.214(1) and (2)(a)). This means that a PSD or another type of direction written or otherwise is not required as long as the GP is carrying out the whole process of clinical assessment, consent and administration. A clinical record of this should be made (in this case on the Pinnacle system) as is normal practice.  

If tasks are being split with a different healthcare professional carrying out the clinical assessment and then the GP administering the vaccine, then this would require a written PSD to be in place to cover the other healthcare professional or trained member of staff administering the vaccine.

With a PGD the clinical assessment cannot be split from the administration and both of these need to be done by the same Health Care Professional authorised to work under the PGD.

COVID-19 Vaccination Programme – workspace

General practice

Support for Primary Care Flexible Staff Pools

The supporting general practice letter of 9 November 2020 referenced support for flexible pools to aid the process of recruiting and deploying employed GPs. Up to £120k per ICS/STP has been made available via NHS England and NHS Improvement regions so that virtual pool arrangements can be implemented or augmented at pace. This allocation is complemented by further optional enablers which systems may opt to utilise, including a template contract and a digital supplier’s framework.

GPs supported through the pool arrangement could have access to the flexibility of a locuming role, with the additional benefits of a salaried position. More information on this scheme can be found on our website and supporting materials on FutureNHS.

New to Partnership Payment Scheme portal launch

Partners working in primary care practices have a crucial role in developing the response to our patients. As people start planning for the New Year and thinking about their career development we would like to remind everyone of the opportunities offered by our New to Partnership Payment Scheme, which includes a financial sum to support health care professionals in their establishment as a new partner.

To make the application process even more straightforward we have developed an application portal which can also be used for processing payment claims once people are registered on the scheme. The portal will go live today. Individuals accepted on the scheme will receive a payment of up to £20,000 (pro-rata), plus up to £3,000 to support their non-clinical training needs and aid them in developing their partnership skills.

Electronic claims for reimbursement for Additional Roles Reimbursement Scheme

The Additional Roles Reimbursement Scheme (ARRS) aims to grow additional capacity in general practice by providing funding to PCNs to recruit across 12 specific roles.

We have launched a new online portal to manage claims for the scheme, designed in consultation with users from PCNs and CCGs. The portal provides a more effective and simple way for PCNs to claim, and CCGs to approve, reimbursement for the roles hired. As a reminder, claims should be submitted no more than a month in arrears.

To learn more about the portal please visit the PCN workforce FutureNHS page where you’ll find a user guide, videos and FAQs. For further support please email england.primarycareworkforce@nhs.net.

Workforce data – reminder to practices and PCNs

NHS Digital will extract the latest general practice and PCN workforce data from the National Workforce Reporting System (NWRS) on Thursday 31 December. Practices and PCNs should review their records and make any updates, including recording GP locums (practices) or commissioned services (PCNs), before then. This is a contractual requirement and a prerequisite for access to the Covid Capacity Expansion Fund. It is also crucial for planning new workforce supply and support to primary care teams.

Information on how to register and use the NWRS is available on the NHS Digital website with the latest published practice and PCN statistics.

General practice – latest updates

Community pharmacy

NHS Discharge Medicines Service commencing in February 2021

The NHS Discharge Medicines Service (DMS) is a new essential service for community pharmacy contractors. Due to the impact of COVID-19 on the capacity of contractors, the service will now commence 15 February 2021. The service has been established to ensure better communication of changes to a patient’s medication when they leave hospital. Referring patients to community pharmacy on discharge will improve outcomes, prevent harm and reduce readmissions.

Regulations guidance has been published to support pharmacy contractors in providing the service, which they are asked to familiarise themselves with and prepare for implementation. 

To support improving processes across hospital, community and primary care network pharmacy teams, a cross-sector toolkit will be published in January 2021 with information on the roles of community pharmacy, NHS trusts and PCNs.

New guidance explaining Community Pharmacy Regulations changes

The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2020, published on 19 October 2020, introduced nationally agreed changes to the Community Pharmacy Contractual Framework for pharmacy and dispensing appliance contractors. New guidance for contractors explains these important changes, including the new NHS Discharge Medicines Service which starts 15 February 2021 and the promotion of healthy living.

It also sets out requirements for consultation rooms, electronic communication and remote access, pandemic treatment protocols, health campaigns and activities to be carried out in relation to dispensing that contractors will need to meet and the dates the changes come into force.

Reprioritisation of contractual activities

In recognition of the ongoing workload pressures for contractors during the COVID-19 pandemic, several activities under the community pharmacy contract have now been reprioritised.

• The Pharmacy Quality Scheme (PQS) 2020/21 Part 2 requirements will have a flexible completion date. Contractors will still make their declaration in February and get paid on 1 April, but they will have until the end of June 2021 to collate the evidence to demonstrate that they are compliant.
• The Community Pharmacy Assurance Framework will not run in 2020/21. This will run as normal in 2021/22.
• The NHS England and NHS Improvement set audit and the pharmacy specific audit will be waived for 2021.
• The Community Pharmacy Patient Questionnaire will be waived 2020/21.
• No action will be taken against contractors who have not updated the Data Security Protection toolkit for 2019/20, provided they are working to complete the toolkit for 2020/21.

Blog on community pharmacy work with local care homes

A new blog by a community pharmacist outlines how her team has been working closely with local care homes to ensure teams are well protected this winter. Social care workers are a priority cohort for flu vaccination, and no ID is required. Guidance for social care workers and employers is available.

Dentistry

Dental practices to remain open

During the last period of national restrictions, NHS dental services remained open. We can confirm that regardless of the tier an area is in, NHS dental services in England should remain open to treat patients in line with the standard operating procedure and the national infection prevention control guidelines for dentistry. Private practices can also remain open. This was confirmed on Sunday on the Government's Tier 4 web pages.

Dental Contract Reform (DCR) Prototypes

DHSC organised engagement events for prototype practices over October and November to discuss some of the data which has been analysed from the first three years of prototyping, and to feed into the evaluation process.

The virtual meetings were addressed by minister Jo Churchill, who thanked the practices and staff for their work on contract reform and their response to the Coronavirus pandemic. NHSEI and DHSC also appreciate the range of care which has been delivered by the prototypes during this period, including involvement in the delivery of urgent care and in supporting the local dental and more general pandemic response. 

The pandemic has had a variable impact on the way prototypes have been delivering their services and meeting the needs of the patients, and discussions are currently taking place with the BDA, led by DHSC, regarding the best way to deal with the capitation and activity elements of the DCR contract models for the final quarter of the 20/21 year.

New poster: What can your NHS dentist do for you?

A new A4 two-sided poster is available to print, download and share with patients about their NHS dental service. It includes information on access during the pandemic, what treatments are available, the attributed costs (updated Monday 14 December 2020) and emergency care details, all signposting to the NHS website. We hope having this information all in one place is useful for patients and colleagues alike.

Primary care

Flu vaccinations – stock still available

Thank you for all the work you are doing in general practices and community pharmacies in vaccinating patients for flu. The flu vaccination programme is continuing and will do so into the new year, so please continue to offer vaccinations over the coming weeks to all eligible adults and children who have yet to be vaccinated.

There is still some vaccine available to order from the central stock. If you are a general practice please check with your local system for anyone who has spare vaccine before ordering from this stock.

Information on how to order is available in the DHSC stock guidance for general practices and community pharmacies.

Primary Care Network Dashboard

The Primary Care Network (PCN) Dashboard will support PCNs, commissioners and systems to see the benefits they are delivering for their patients. It includes data on performance against the Investment and Impact Fund, delivery of PCN services and progress with recruitment - generating shared and comparable views across the country.

User acceptance testing of the Dashboard will take place in January 2021, followed by a full release in February. The Dashboard will evolve based on user feedback; to participate in user acceptance testing please register here. If you have any questions, please contact england.gpcontracts@nhs.net.

Blood Pressure Monitoring @home to help thousands of patients better manage their health at home

Blood pressure monitors are available to people across the country so they can monitor their blood pressure at home, without the need to attend a GP practice. Potentially preventing hundreds of heart attacks and strokes, this NHS @home programme initially supported five early adopter areas of the country, with help from the British Heart Foundation. The current national rollout of 22,000 blood pressure monitors will support clinically extremely vulnerable people across who have high blood pressure with extra consideration for people from black, Asian and minority ethnic (BAME) communities, people aged 65 or over and people in socially deprived areas.

To find out more about the programme and how to access the blood pressure monitors, primary care colleagues should contact their local CCG. Please note: the current deadline for requesting blood pressure monitors is 31 December.

Changes to cost recovery policy from 1 January

DHSC has laid changes to charging regulations that will come into effect from 1 January if there is no negotiated outcome with the EU. The changes will mean that visitors to the UK from the EU could be chargeable if they use NHS services (more information is available here). The NHS visitor and migrant cost recovery page has the latest guidance. If the regulations come into effect, EU citizens will be chargeable at 150% of NHS tariff meaning CCGs may have to pay more under the risk share agreement.

Reciprocal Healthcare Arrangements – introduction of a time limited healthcare scheme

DHSC has announced, in the event of a no negotiated outcome with the EU, the introduction of a scheme to support UK residents with ongoing, routine treatment needs such as - but not limited to - regular dialysis, oxygen therapy or certain types of chemotherapy and who are visiting the European Economic Area or Switzerland. These types of treatment were previously covered under the European Health Insurance Card (EHIC) scheme.

The scheme comes into effect on 1 January 2021 and will support travel until 31 December 2021. DHSC will publish full guidance and eligibility criteria in due course.

Dates for your diary

Tuesday 29 December, 1.30pm - 2.15pm. COVID-19 Vaccinations webinar for the PCN rollout to care homes

New year webinars on working with people and communities in PCNs
Our webinar series for colleagues working in primary care networks continues next month, helping PCNs to provide inclusive services for people and communities from the most marginalised groups, who experience the greatest health inequalities. They include:

• Wednesday 6 January 2021, 1pm - 2pm. ‘Reaching out to communities at speed’ – Elliot Hall Practice Heroes project during COVID-19
• Wednesday 13 January 2021 12pm - 1pm. ‘A masterclass on conducting telephone surveys’
• Tuesday 26 January 2021 12pm - 1pm. ‘A masterclass on surveys’

Wednesday, 13 January 2021. 2pm - 3.30pm. Common Challenges and Proven Solutions for Teledermatology: (Part 2/3)

Link of the day

(RCGP webinar) Managing anaphylaxis: guidance for GPs delivering the COVID-19 vaccine