COVID-19 Primary Care bulletin

10 July 2020

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

Dear colleagues,

In our letter of 24 June 2020 on the completion of staff risk assessments, a request was made to NHS employing organisations for to ensure that all risk assessments were completed for at least ‘at-risk’ staff groups within four weeks. All NHS organisations will be asked to submit returns for the following four questions:

• Have you offered a risk assessment to all staff?
• What % of all your staff have you risk assessed?
• What % of risk assessments have been completed for staff who are known to be ‘at-risk’, with mitigating steps agreed where necessary?
• What % of risk assessments have been completed for staff who are known to be from a BAME background, with mitigating steps agreed where necessary?

If a staff member has concerns regarding risk assessment, organisations should offer assurance about confidentiality, signpost to occupational health and other support services, and reiterate that there will be no detriment to them, or their career, in the short or longer term. Primary care organisations have been contacted directly with details about the process used to collect this information this week, with deadlines for submission on 17 and 31 July 2020. Thank you for your support with this important issue.

Second phase of general practice response to COVID-19

This week we published a letter on the second phase of the general practice response to COVID-19. This letter confirms contractual arrangements from July and income protection arrangements. Please do take time to read this letter. Some key points are:

• We need general practice to continue its vital role in supporting high-risk patients with ongoing care needs, but also to resume as soon as possible services which may have been paused, managing pre-existing conditions and urgent demand.
• We recognise that practices will need to re-prioritise aspects of care not related to COVID-19 and intend to modify the Quality and Outcomes Framework (QOF) requirements for 2020/21 to support this.
• We are asking practices to resume new patient reviews, routine medication reviews, over-75 health checks and clinical reviews of frailty – but to prioritise these using their clinical judgement and a risk-based approach. The letter also describes how flexibilities under the GP contract may be reinstated to support with management of local outbreaks.

Nikki and Ed

General practice

GP patient survey 2020

The GP patient survey for 2020 was published yesterday (9 July 2020) and is an important indicator for how our patients feel about general practice and dental services. It is positive to see that more than 95% of patients have confidence and trust in their family doctor and thanks to hard working dental practices, nine out of 10 people were able to get an appointment when they needed one, with the vast majority reporting a positive experience with their NHS dentist.

The survey covers the period up until the end of March 2020 and the pandemic has radically altered the way our patients use primary care services, giving us a real opportunity to continue to improve access to high quality care. The full results of the survey can be accessed on the GP patient survey website.

Updated shielding guidance changes for children

The Government shielding guidance has been slightly relaxed so that those who are shielding can meet in groups of up to 6 outdoors and to form "support bubbles", if they wish. In addition to these changes, the guidance has been updated to reflect the Royal College of Paediatric and Child Health’s guidance on children and shielding, which the government has now endorsed. Children and young people should continue to shield until 31 July 2020.

From Saturday 1 August 2020, the guidance will then be paused so clinically extremely vulnerable people of all ages will no longer be advised to shield. We expect most children and young people will be removed from the shielded patient list following consultations with clinicians and GPs over the summer. This group will not be advised to shield if government guidance on shielding is changed in the future.

Transition between COVID-19 care home support and the Enhanced Health in Care Homes service in the Network Contract DES and training requirements for personalised care roles

From 31 July 2020, the interim COVID-19 care home service will transition into the more comprehensive Enhanced Health in Care Homes service as described in the Network Contract Directed Enhanced Service (DES).

To avoid disrupting the positive relationships that are developing between general practice, community services providers, and care homes, we intend to amend the Network Contract DES so that – by exception – the clinical lead role for the service may be held by a clinician, other than a GP, with appropriate experience of working with care homes provided this is agreed by the practices in the primary care network, the clinical commissioning group and the relevant community provider.

We are encouraging primary care networks to engage personalised care roles - social prescribing link workers, health and wellbeing coaches, and care coordinators - as these roles will be able to support the COVID-19 response through embedding personalised care approaches. Full details can be found on our website.

Rebuilding the NHS – resetting outpatient services for the 21st century in the context of COVID-19

The Royal College of Physicians and the Royal College of General Practitioners have set out principles and recommendations for the reset of outpatient services. It is hoped that they will help integrated care systems and/or the organisations that comprise them.

Community pharmacy

New risk assessment survey for community pharmacies

We recently sent a letter to all NHS providers reminding us as employers, we each have a legal duty to protect the health, safety and welfare of our own staff. Completing risk assessments is a vital component of this. Thank you to the many of you who have completed risk assessments and continue to provide support for your at-risk staff during this challenging period.

We will be seeking to understand the progress made in completion of risk assessments across the NHS, to help us to understand where assistance is needed locally, and help us to develop our wider support offer to systems. We are asking consistent questions across all NHS organisations, including Community Pharmacies and Dispensing Appliance Contractors. 

The NHS Business Services Authority sent out a briefing on Thursday 9 July, with a link to the SNAP survey for all pharmacy contractors to complete. The same survey will be repeated and there will be two windows for collection of information, by Friday 17 July and by Friday 31 July – please complete the declaration in both windows even if 100% of assessments have already been completed. Data will be collated immediately after close and shared with regional teams and commissioners to allow follow up where needed.

Resources to support community pharmacy owners and managers to complete the risk assessments are available here:

• Royal Pharmaceutical Society website
• National Pharmacy Association website

COVID-19 support developments

Work is ongoing to support community pharmacies with the impact of COVID-19:

• Negotiations between the Department of Health and Social Care, the Pharmaceutical Services Negotiating Committee (PSNC) and ourselves on specific additional community pharmacy costs associated with the COVID-19 pandemic began on 8 July 2020.
• The supply of personal protective equipment (PPE) has strengthened but any pharmacies experiencing problems obtaining PPE are asked to report issues to their local NHS England and NHS Improvement pharmacy contract team so issues can be followed up and resolved.
• Pharmacies are also asked to report any details of issues they encounter with local outbreaks of COVID-19 to their local pharmacy contract team to help the NHS understand the problem and provide appropriate support.
• The latest Public Health England COVID-19 ‘Stay Alert to Stay Safe’ public-facing campaign resources are available on the Campaign Resource Centre – please create a log-in to access these free materials.

Community Pharmacy Contractual Framework

There are several important updates for community pharmacies in relation to the Community Pharmacy Contractual Framework (CPCF):

• Several CPCF changes that were planned for implementation July will not be rolled out this month and negotiations are ongoing about future implementation dates. These include plans related to the: Discharge Medicines Service, Healthy Living Pharmacies, safeguarding, registration for CAS alerts, and the updating of the Directory of Service and NHS website details.
• We are working closely with the PSNC to publish some initial elements of the Pharmacy Quality Scheme in the near future.
• The Pandemic Delivery Service will be coming to an end at the end of July and pharmacies will need to transition their patients to the usual arrangements.

Primary Care Network clinical pharmacist role offers room to grow for a new recruit

Author, blogger and newly-appointed Primary Care Network (PCN) pharmacist Laura Buckley has written her first blog for us. In it she describes her transition from being a community pharmacy manager to working in a PCN multidisciplinary team and what she has learned from working in general practice helping patients during the COVID-19 pandemic.

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

NHS to launch ground breaking online COVID-19 rehab service

Tens of thousands of people who are suffering long-term effects of coronavirus will benefit from a revolutionary on-demand recovery service.

The new ‘Your COVID Recovery’ service forms part of NHS plans to expand access to COVID-19 rehabilitation treatments for those who have survived the virus but still have problems with breathing, mental health problems or other complications.

New guidance – key principles for intimate clinical assessments undertaken remotely

This guidance is aimed at clinicians who are consulting remotely with patients through a digital channel (e.g. online, email, text, video-link) across healthcare settings in England.

The principles described in this guidance aim to support patients to access care in a way that meets their needs and to support clinicians to provide care in a way that is in the best interests of their patients, whilst protecting both from the risks associated with remote intimate assessments.

The production of this guidance has also lead to amendments of legal guidance from the Crown Prosecution Service on indecent and prohibited images of children.

For any problems in accessing this guidance contact england.digitalfirstprimarycare@nhs.net

Freedom to Speak Up in primary care

Speaking up is about anything that gets in the way of providing good care. When things go wrong, we need to make sure that lessons are learnt and things are improved. If we think something might go wrong, it’s important that we all feel able to speak up so that potential harm is prevented.

Speaking up is about all of these things. If your organisation has nominated a ‘Freedom to Speak Up Guardian’ please contact the National Guardian’s Office who provide free training, currently as a two hour virtual meeting. 

They also provide support, information and materials. To book training, email enquiries@nationalguardianoffice.org.uk.

University practice patient lists

Concerns have been raised with us about the potential destabilising impact of a reduction in university practice patients lists this coming academic year due to the pandemic. In response we are working closely with Universities UK to monitor student numbers and in turn patient registrations.

Universities UK have confirmed all universities are planning to welcome students back this autumn, offering physical campuses and significant in-person teaching. It is anticipated over 2 million students will again be in education this autumn. This is supported by recently published admissions data which confirmed that there are currently more applicants holding a firm offer to start a course this autumn than at the equivalent point last year, and fewer people accepting an offer for a deferred place.

Commissioners will recognise that if any university practice in their area did see a significant change in patient numbers this could trigger the need for a review of support to directly impact patient care and ensure the sustainability of services. We will keep the need for further guidance in this area under review in response to our ongoing monitoring.

Regional COVID-19 cases and triage figures published in new interactive dashboard

NHS Digital has published an interactive dashboard showing the number of COVID-19 cases identified through Pillar 1 and 2 testing and the total number of NHS Pathways triages through 111 and 999, and online assessments in 111 Online which received a potential COVID-19 final disposition.

What are training hubs and how do you access them?

Health Educations England’s training hubs are integral to our core purpose of helping deliver excellent healthcare through education and training to our current and future workforce, meeting the priorities outlined in the NHS Long Term Plan.

Training hubs are based in primary and community care, serving the local community. Watch this new animation which outlines what training hubs are and how you can access them.

The working of a primary care network in Wirral: experiences thus far

In order to meet the unique needs of local populations, health and care providers need to come together as a collective. This article describes how one primary care network in Wirral has engaged regularly in different ways and were able build on professional relationships, enabling a more streamlined approach to proactive, place-based patient care while providing professionals with improved working relationships, skill-sharing and increased job satisfaction.

Nikki and Ed's link of the day 

The ILE Network – aiming to create the next generation of working professionals from multicultural backgrounds