COVID-19 Primary Care bulletin

26 June 2020

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

Dear colleagues,

As employers, we each have a legal duty to protect the health, safety and welfare of our staff. Completing risk assessments for at-risk members of staff is a vital component of this. Thank you to all those who have completed risk assessments and continue to provide support for your at-risk staff during this challenging period. All employers need to make significant progress in deploying risk assessments within the next two weeks and complete them – at least for all staff in at-risk groups – within four weeks.

All primary care organisations remain legally responsible for securing appropriate occupational health (OH) assessments (including staff risk assessments) for their employees. Access to OH services based on the national occupational health specification published in 2016 has been commissioned by NHS England & NHS Improvement and may be via a local NHS trust OH department or an independent OH provider. We ask commissioners, primary care networks and practices to work together to:

• ensure local primary care staff know how to access support from their OH provider
• review OH service providers’ current capacity and access to it
• share available OH capacity, or commission more to complement existing OH services via this Dynamic Purchasing Solution, if additional capacity or access outside normal working hours is needed

CCGs are asked to assure that this is happening comprehensively and speedily in their areas.

We have published a letter with further information about risk assessments for at-risk staff groups.

An update on social distancing guidelines

You will have seen the Government's announcement of the change in the guidance on social distancing. From 4 July, the guidance will change from ‘Stay 2 metres apart’ to ‘Where it is possible to keep 2 metres apart people should’. It advises people to keep a social distance of ‘one metre plus’, meaning they should remain at a minimum one metre apart, while also taking physical steps to reduce the risk of transmission.

Across the NHS, staff have been working hard to restore those services that had to be paused to deal with the first COVID-19 peak, and you have been doing this within social distancing guidelines and following infection control procedures to protect patients and staff.

NHS England and NHS Improvement is working urgently to consider the implications of the change of Government guidance on the service. If any change in the guidance for health services is agreed, based on clinical advice, new guidance will be issued. Our priority will be to enable those running services to see as many patients as possible, while keeping staff and patients safe.

In the meantime, it is essential that those running and planning services maintain social distancing at 2 metres and, even if any new guidance is communicated, continue to social distance at 2 metres wherever possible. As Chris Whitty, the Government's Chief Medical Officer said: "the advice to stay at 2m when you can stay at 2m remains".

Nikki and Ed

Primary care

Electronic prescriptions reach over 85% in England

Prescriptions processed using the Electronic Prescription Service (EPS) now make up over 85% of all prescriptions dispensed within primary care in England (latest data from April 2020).

During the coronavirus (COVID-19) pandemic, EPS has supported clinicians and patients to observe social distancing as it helps to reduce the need for face-to-face contact and unnecessary journeys, especially when nomination is used. Use of EPS has been expanded into GP Access/virtual hubs, walk-in centres and out of hours settings. Expanding not just the use of EPS to other care settings but also focusing on increasing utilisation in urgent care settings has contributed to the increase in prescriptions processed by EPS, significantly improving business processes within pharmacy.

One-off nomination is now available in many GP practices and other care settings, allowing prescriptions to be sent to an alternative pharmacy without affecting patients’ existing nominations and avoiding the need for paper. One-off nomination will also be available in more prescribing solutions soon.

Latest figures show that 51% of GP practices are now using Phase 4, which allows EPS to be used for patients without a nominated pharmacy and allows prescriptions to be downloaded using the unique prescription ID. 

General practice

GP Standard Operating Procedure updated

We have added two new sections to the GP Standard Operating Procedure and updated it with some additional information and links for ease of access – these can be identified as highlighted in the published GP SOP which can be found on our website.The updated sections are on:

1. Outbreak management in the context of COVID-19 – with a recommendation to review business continuity plans.
2. Suspected or diagnosed cancers, including ongoing cancer treatment – information on referral into secondary care.

Please refer to the updated SOP for further information.

Postnatal checks

As we restore critical services, we would like to remind practices of the importance of providing all women with a postnatal GP check at 6-8 weeks.

During the COVID-19 pandemic, women have experienced changes to the provision of maternity and health visiting care, reduced access to community services, changes to birth plans and birth partner policies, and for some, changes to bereavement care. COVID-19 has increased anxiety generally in the population and pregnant women and new parents may be under additional stress due to social isolation, decreased social support, bereavements, financial stresses, changes to healthcare services and limitations on their usual coping strategies. The risks for pregnant women with pre-existing mental health problems will be higher still.

Since 1 April the maternal postnatal check has been part of essential services. The continuation of postnatal checks, new baby checks and childhood vaccinations have been identified as high priority in BMA and RCGP guidance, and should continue regardless of the prevalence of COVID-19 for the duration of the pandemic.

Where the maternal check can be delivered safely on a face to face basis this should continue. Where a check cannot be delivered safely face to face, or where the woman has medical conditions that requires her to shield or socially isolate, the review could be conducted remotely either by video or phone. If there are outstanding issues after this, a face to face appointment could be offered at the same visit to the practice as the infant vaccination appointment. A postnatal check must be offered to mothers who have experienced stillbirth or neonatal death.

While the contract deal agreement for 20/21 sets out high level requirements for what the maternal check should ordinarily cover, we are working to produce best practice guidance for publication in due course, once the NHS has returned to business as usual.

Community health

Call for submissions: share your innovative work in community health service settings

Thank you to everyone who responded to our survey on innovation in general practice and community pharmacy. In addition, we are now seeking examples of innovation in community health services, or between community health services and primary care.  

As we move into the next phase of NHS recovery, NHS England and NHS Improvement want to hear from clinicians, clinical leaders, operational leads and others about changes community health service teams have made and the resulting benefits.

These will help to ensure beneficial changes to care are captured and embedded in our services, so that we can translate these into improved care for patients well into the future. Feed in your experiences here by 30 June 2020.

Additional information

Shielding letters for the NHS and patients

As announced on Monday, millions of people who have been shielding from COVID-19 will soon be advised of the plans to ease guidance. The Government shielding support package will remain in place until the end of July. Letters for both the NHS and patients have been added to our website.

RCGP Learning have also updated their guidance around shielding.

Building safety advice for building owners, including fire doors

We advise practices to draw their attention to the fire safety guidance recently published by the Ministry of Housing, Communities and Local Government (MHCLG).  

This guidance applies to overnight patient accommodation and buildings with occupants requiring significant assistance to evacuate. If these circumstances apply to any part of your estate, you are expected to utilise this guidance as part of the ongoing fire safety risk assessments and ensure any such risks identified are remediated as a matter of urgency.

Health and care video library available free to NHS

As part of the response to COVID-19, NHSX has secured a 6 month national licence for NHS clinicians to access a health and care video library of over 600 patient information videos free of charge. The videos have been developed and written by NHS clinicians to use within a wide range of care pathways including maternity, physiotherapy, rheumatology and podiatry. The library platform and the videos have been professionally produced by Health and Care Innovations (HCI). Join the onboarding webinars (see below) to get the most out of this resource.

Dates for your diary 

Friday 26 June, 6pm – NHS Virtual Pride. Today is the first ever NHS Virtual Pride, a staff-led initiative celebrating the diversity of our LGBTQ+ colleagues and allies. Follow @VirtualNHSPride and search #NHSVirtualPride on Twitter. Access the link here to join the event from 6pm through Microsoft Teams Live.

Thursday 2 July, 5-6pm – GP webinar with Nikki and Ed

Thursday 9 July, 3pm or Friday 10 July, 11am – Primary care video library onboarding webinar. HCI are inviting NHS staff to join onboarding webinars which will provide an introduction to the video library and how to enable staff to maximise the use of videos right across the health system.

Nikki and Ed's link of the day

Safe working for all NHS staff through COVID-19