COVID-19 Primary Care bulletin

19 June 2020

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

Dear colleagues,

Yesterday, NHS Chief Executive Simon Stevens visited Pavilion Pharmacy in Brixton, London to hear first-hand how the pharmacy has been supporting the local community through the COVID-19 pandemic, and how the NHS Community Pharmacist Consultation Service is accelerating again as people start to return to normal life after the peak of the pandemic.

Mr Stevens said “High street pharmacists are highly qualified clinical experts who are playing a key part in the NHS’s frontline response to the greatest public health threat in our history, and they are making thousands of safe, convenient consultations available every day. This new service is part of a continually-developing NHS 111 service which is helping millions of people to safely access the right help fast, often without the need to go to a hospital A&E department. As the NHS adapts its urgent care services for the coronavirus era, these new options are going to be increasingly important."

We are continuing to collate 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. We would like to learn from you, and the communities you care for, about the innovations that have emerged in response to COVID-19, and understand which of these should be kept and protected in the months and years to come. Submit your examples by Thursday 25 June at ipsos.uk/COVIDinnovation. Please contact the team if you have any questions.

Wishing you a peaceful weekend.

Nikki and Ed

Primary care

Management of patients with musculoskeletal and rheumatic conditions

The British Society for Rheumatology and other partners have published Management of patients with musculoskeletal and rheumatic conditions who are on corticosteroids, require initiation of oral/IV corticosteroids or a corticosteroid injection.

This guidance relates to musculoskeletal (MSK) service provision across primary, community and secondary care and is applicable to adults and children. The use of steroid medication is one of the management options for a range of MSK conditions and in particular rheumatic conditions, and this guidance aims to assist decisions on the use of such medication during the pandemic.

The guidance supersedes the specialist guidance - Management of Patients with Musculoskeletal and Rheumatic Conditions on Corticosteroids - published as part of NHS England and NHS Improvement’s phase one response to COVID-19 pandemic.

Primary care network workforce data

Data about your primary care network (PCN) workforce is essential to planning, recruiting and training staff. This is now taken from the National Workforce Reporting System (NWRS) by NHS Digital with the next extraction due at the end of this month. Please ensure you are registered on NWRS and have updated your workforce records before 30 June. We recognise the time pressures you are under, but accurate information will ultimately support the future development of PCNs, practices, and staff. This is essential for all roles within your PCN, including social prescribing link workers, community pharmacists and other members of the multi-disciplinary team. Guidance is available here.

General practice

Reminder about ordering personal protective equipment (PPE)

All GP practices can register on the new online PPE portal for ordering emergency PPE from a central inventory. This is to supplement (not replace) the wholesale supply route that already operates.

The Department of Health and Social Care (DHSC) developed the portal in partnership with eBay UK, NHS Supply Chain, the Army, Clipper and Royal Mail. Throughout May and June 2020, DHSC have been emailing GP practices, inviting them to register with the PPE portal. The emails should be coming from PPE Dedicated Supply Channel (please note this email address does not accept incoming emails): ppe.dedicated.supply.channel@notifications.service.gov.uk Please ensure that you are regularly checking your email accounts registered with the CQC/MHRA in order to ensure that the invite is received and actioned.

Following review the current order limits mean GP practices can order one combined pack, containing 100 IIR masks, 200 aprons and 400 gloves (200 pairs), per week or up to this amount of separate items. These limits will continue to be reviewed and whilst it is recognised that current limits may not fully meet demand for larger practices they are still encouraged to register in order to access emergency supplies when required.  Orders through the portal should arrive within 48 hours if placed before 1pm. Orders placed after 1pm will be subject to an additional 24-hours.

If providers have any queries please contact the PPE portal customer services at: 0800 876 6802.

Temporary residents

We have heard concerns from some commissioners and practices about the significant impact that holiday makers can have on local areas and the difficulties this will bring for general practice.

The current rules on patient registration set out that a practice may register patients as a temporary resident if they are resident in the practice area for more than 24 hours but less than three months. However, given the introduction of total triage and the rapid and widespread increase in use of remote consultations by practices, registering as a temporary resident might no longer be necessary or provide the most appropriate access or care for the patient. Under these circumstances and where it is clinically appropriate to do so, patients may be referred back to their registered practice to be assessed by a clinician who knows the patient and can access their medical record.

Practices may still need to see patients face to face in certain circumstances and therefore register them as a temporary resident.  In addition, all patients, even if not on the practice list and not a temporary resident, must still be provided with primary medical services in core hours for any immediately necessary treatment, which may include medication.

Practices should note that if a patient needs a prescription while away from home, that some (not all) prescribing systems allow a prescription to be sent to another pharmacy as a ‘one off’. Further information on NHS Digital's website. 

Community pharmacy

NHS Community Pharmacist Consultation Service helps 332,000 patients in first seven months

More than 180,000 consultations have taken place between patients and community pharmacists under the NHS Community Pharmacist Consultation Service (CPCS) since the NHS stepped up its response to COVID-19 at the end of January, bringing the total number of CPCS consultations since the service was introduced in October 2019 to over 332,000. The service, available at 94 per cent of community pharmacies in England via referral from NHS 111, enables patients to quickly access expert advice from a community pharmacist for a range of minor illnesses, or to get an urgent supply of a previously prescribed medicine.

Our Chief Pharmaceutical Officer Keith Ridge said “Pharmacies across England have put their all into supporting their communities during COVID-19 and made a real difference to so many patients and their families. Now, more than ever, access to same day advice and care via the CPCS is even more valued - as demonstrated by these high usage numbers. The achievement of 332,000 referrals since the service started is phenomenal and demonstrates once and for all how much trust the public places in NHS 111 and their local pharmacist. Thank you to everyone who has worked so hard to make this a success.”

Dentistry

Jason is a general dental practitioner who qualified from the University of Birmingham in 1995 and also holds a Diploma in Postgraduate Dental Studies from the University of Bristol. He is a partner at the Maltings Dental practice in Grantham. He was awarded an MBE for services to Dentistry and Oral health in 2020.

Chief Dental Officer, Sara Hurley said ”Jason has a track record for outstanding delivery as a Local Dental Network Chair. He is a respected practitioner and trainer and a notable champion of children’s oral health. His experience and diverse portfolio will be invaluable as we navigate the ongoing challenges of COVID-19 and build on the integrated team approach alongside our colleagues in the wider health and social care sector.”

Jason Wong said: “It is a privilege to be appointed as Deputy Chief Dental Officer for England. I am very much looking forward to joining the Office of the Chief Dental Officer and working with the entire dental family”

Jason will share the role with Deputy Chief Dental Officer Eric Rooney MBE.

Urgent Dental Care and Transition to Recovery Standard Operating Procedures - updated

A number of amendments have been made to both dental standard operating procedures (SOP) published earlier this month. The following changes are highlighted in yellow in the documents for ease:

Urgent dental care guidance and standard operating procedure

• Appendix 2: Patient pathways
• Appendix 3: PHE guidance for infection prevention and control in dental care settings
• Appendix 4: Actions for dental services - Staff with symptoms of Covid-19 (page 24) and Staff exposed to someone with symptoms of covid-19 in healthcare settings’ (page 25). These subsections have been updated in line with new PHE guidance and for consistency with the GP SOP.
• Appendix 7: Staff support and wellbeing
• Appendix 8: Feedback – email template link corrected.

Dental standard operating procedure: Transition to recovery

• Non-AGPs (page 19)
• Appendix 6: Management of caries for the paediatric patient
• Appendix 7: Management of (non-AGP) Endodontics

Optometry

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

Health and wellbeing support

Psychological First Aid Training

Staff and volunteers at the forefront of the national COVID-19 response across England can now access a free Psychological First Aid training course.

This free online training has been developed by Public Health England and will equip staff to provide support and recognise people at risk of distress. This follows a globally recommended model for supporting people during emergencies, tailored to the specific challenges of COVID-19. Since the launch of the course on Monday 15 June, more than 8,700 people have already enrolled.

You can access the training materials through the Future Learn website.

NHS Practitioner Health

The last few weeks have taken a toll on many of us working across the NHS and now is the time to consider your own mental health and wellbeing. For doctors and dentists in England, NHS Practitioner Health is able to offer free mental health treatment and support, access to a network of clinicians and therapists as well as prescribing and inpatient care in a confidential service. Access is via self-referral and the service can see and treat mental health and addiction issues at any level. All other NHS staff can access a range of free wellbeing resources via the service, including online reflective spaces and webinars plus signposting to free offers of therapy and support.

Additional information

Mobile and broadband enhancements for frontline NHS staff

To support colleagues in unprecedented changes to working environments, major network providers have agreed to provide personal mobile data and broadband enhancements to identified frontline NHS staff, who are existing customers, throughout the response to the COVID-19 pandemic.

To find out about the offers and see if you are eligible visit the dedicated website.

Many offers are available through self-serve processes provided by individual network providers. Eligible staff can access other offers by nominating themselves to their CCG HR Director. HR Directors are responsible for validating and submitting requests to ensure eligible staff are prioritised for enhancements.

NHS Complaints process

On 26 March 2020, we wrote to NHS organisations explaining that, subject to local determination, you may pause the complaints process. Unless circumstances change significantly, we are not planning to extend the pause into July.  We would also be grateful if you could begin planning for a resumption in normal service.

Coaching support for all non-clinical and clinical primary care staff

Would it be helpful for you to talk to someone who can help you process the experiences you are facing, develop coping skills and importantly, develop practical strategies to manage the situation, so you can carry on with your work and your life? Book your session at a time to suit you. Sessions are available 7 days a week, either by video or telephone. More information about the #LookingAfterYouToo coaching support.

Dates for your diary 

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

How to Make a Cultural Transformation presented by Simon Sinek