Primary Care Bulletin - today's round-up

16 March 2021

Dear colleagues,

Amazing progress has been made in the vaccine rollout, but it is absolutely critical that we continue to vaccinate within the priority cohorts and ensure we don’t move to lower cohorts until we have done everything possible to reach cohorts 1-6; in particular, cohort 6 (people with underlying health conditions).

We know there might be some reticence with these patients, but it is vital that nobody is left behind. We have seen some excellent examples of proactive work to reach these patients, including special clinics for people with learning disabilities and dedicated teams going out to target homeless communities, but we need to do more, particularly for patients with severe mental illness. It is important to note that there is currently no contract in place for vaccinating below cohort 9 so you must not do so.  

The success of our flu vaccination programme

Our flu vaccination programme has been an incredible success. General practice and community pharmacy teams have given the flu vaccine to over 19 million people – that’s over 4 million more than last year. We want to say a huge thank you for all your hard work in keeping people in your communities safe – you really are going above and beyond.

Shielding update

The Government is expected to give more detail later this week on advice to clinically extremely vulnerable patients after 1 April – the current advice to shield runs until 31 March. The Government’s COVID response ‘roadmap’ has previously indicated it anticipates that it will no longer be necessary to advise shielding beyond the end of March. We will keep you informed of announcements and implications via this bulletin.

Kiren and Ali

COVID-19 updates and guidance

AstraZeneca COVID-19 vaccine and blood clots: review of safety data

In a review of all available safety data from over 17 million people vaccinated with AstraZeneca vaccine in UK and EU, there was no evidence of an increased risk of blood clots among people vaccinated with its vaccine.

The MHRA have also released a statement advising that people should still go and get their COVID-19 vaccine when asked to do so, and EMA have also stated that there is no indication that the reported blood clots were caused by the AZ vaccine.

COVID-19 Clinical Risk Assessments

You will already be aware of the online tool that can help clinicians better understand how at-risk a person may be of catching coronavirus and being admitted to hospital or catching coronavirus and dying. The COVID-19 Clinical Risk Assessment Tool is powered by QCovid®, a coronavirus risk prediction model created by the University of Oxford. 

Clinicians can use the tool to risk assess individual patients or review those assessed as part of the COVID-19 Population Risk Assessment. Details of patients who were risk assessed, but who did not meet the agreed threshold for addition to the Shielded Patient List, are available here.  

There are instructions for individuals and practices to follow before using the tool, including the requirement for a Data Protection Impact Assessment (DPIA) and privacy notice in place that covers the tool’s use. A template DPIA and privacy notice have been provided to support you to do this. 

Reminder to place an order of lateral flow devices

All primary care contractors are reminded that they should place their order for lateral flow devices (LFDs) on the PCSE online portal by Sunday 21 March to receive a delivery as soon as possible in the following weeks. This order is to re-supply primary care staff with a new box of 25 tests, which will enable them to test for another 12 weeks. More information on how to order tests can be found on the PCSE website.

Position statement: vaccinating people registered with a GP in Wales in COVID-19 vaccination sites in England

People who are registered with a GP in Wales, whether they live in England or Wales, and meet the Joint Committee on Vaccination and Immunisation (JCVI) criteria, can get their COVID-19 vaccine at a vaccination site in England.

JCVI advises prioritising homeless people and rough sleepers for COVID-19 vaccine

New advice has been issued from JCVI to prioritise homeless people and rough sleepers for the COVID-19 vaccine. Many people who are homeless or sleeping rough are likely to have underlying health conditions which would place them in priority group 6.

The JCVI advises that local teams consider a universal offer to adults experiencing homelessness and rough sleeping alongside those in priority group 6. We have issued mobilisation guidance which will provide local vaccination services more detail on how this should be implemented.

Advice for women following COVID-19 vaccination

A recent BMJ article reported that advice in the US is that breast screening appointments should be scheduled to take place before women receive a first dose of COVID-19 vaccine or four to six weeks after the second dose where possible.

Public Health England (PHE) advise that breast screening service personnel should be aware of the potential for enlarged nodes following a COVID-19 vaccination. However, the advice regarding the scheduling of mammograms has not altered. There is currently no requirement for women to be advised to wait for a period of time following a COVID-19 vaccination before attending a screening appointment.

Women with noted lymphadenopathy at screening must always be recalled for assessment even if they report recent vaccination. This is to ensure that no other pathology exists. It may be useful for clinicians at an assessment appointment to determine the date of a COVID-19 vaccination and the arm in which this was given, where enlarged lymph nodes are being investigated. PHE will continue to monitor the evidence in this emerging area and take advice from relevant experts. Updates will be issued as necessary.

National provision Steward Volunteers for PCNs, GP practices and community pharmacies

All vaccination providers in England can now directly book NHS Volunteer Responders (NHSVR) Steward Volunteers from the national pool (except the North East and Yorkshire region, which books through Lead Employers). The programme is delivered for the NHS by Royal Voluntary Service (RVS) and the GoodSAM app.

We recommend using NHSVR Steward Volunteers because they are rapidly available and easy to book online, paid expenses and supported by RVS, ID-checked, trained and have NHS high-vis clothing, and are fully insured when booked through the GoodSAM app.

View the step-by-step guide to requesting Steward Volunteers, which includes a link to the GoodSAM portal.

COVID-19 Local Vaccination Services waste management

It is vitally important that vaccination sites segregate all waste into the proper waste stream. Doing so reduces pressures on the waste services infrastructure, reduces the impact on the environment, significantly reduces costs, and ensures compliance with relevant waste regulations. All waste should be disposed of into the allocated consumables and stored securely on site or transferred to another site as required (e.g. roving vaccinators) following each vaccination session. The principles of the COVID-19 waste management SOP should be followed.

UK COVID-19 research passes one million participants

Sir Simon Stevens, NHS Chief Executive and Professor Chris Whitty, Chief Medical Officer for England, have paid tribute to this remarkable feat thanking the public and NHS staff for making it possible. Through research a vital understanding of COVID-19 has been built, findings that have helped people in the UK and across the world.

To coincide with the announcement of one million participants, the NIHR and NHS jointly launched the #ResearchVsCovid ‘thank you’ campaign to celebrate the efforts of participants, researchers and healthcare professionals. People are encouraged to join in with their own thank you to anyone they know who has been involved in COVID-19 research.

COVID-19 Vaccination Programme – workspace

General practice

How to conduct written online consultations with patients in primary care

Our colleague, Dr Minal Bakhai, GP and Clinical Director in the Digital First Primary Care team, recently shared some practice pointers on conducting an effective written online consultation with patients. We are now seeing over 2 million online consultation requests per month. The article offers evidence-based guidance to help clinicians, particularly those working in primary care.

Blog: Tackling the mental health tsunami: joint working between PCNs and mental health providers

It is an open secret that one of the biggest impacts of the COVID-19 pandemic is the large rise in mental health problems in our communities, writes Dr Tayo Kufeji, clinical director of The Bridge MK PCN, as he explains how his GP practice has been tackling the rising need.

General practice – latest updates

Primary care

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 Wednesday 31 March, covering changes between 1 January and 31 March. Practices and PCNs should review their records and make any updates, including recording GP locums (practices) or new ARRS staff (PCNs), before then. This is a contractual requirement and is 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.

Guidance on care home visiting

The Department of Health and Social Care has published revised guidance on visiting professionals to care homes. The guidance strengthens the existing approach for testing professional visitors to care homes in order to reduce risks from visits from professionals.

GPHC confirms Summer and Autumn 2021 pharmacist registration assessment dates

The General Pharmaceutical Council (GPhC) has announced dates for the Summer and Autumn 2021 registration assessments. The Summer assessment sittings will take place on 27, 28 and 29 July 2021 and the Autumn assessment sitting will take place on 16 November 2021. Assessments will be delivered through Pearson VUE, mainly at test centres in Great Britain. 

The provisional registration of pharmacists will be extended to January 2022, to enable trainees from the 2020/21 cohort to apply to join the provisional register once their training is satisfactorily completed, so that they can take up offers of employment at the same time as they usually would, from 1 August 2021.

Staff insight needed for new digital weight management programme

The NHS is developing a new digital weight management programme as part of the NHS Long Term Plan, which will include a self-referral offer for NHS staff to support them to achieve a healthier weight. We are organising some one-to-one interviews and a focus group to gather insights from a range of NHS staff across all roles, taking place w/c 22 March. This will support the development of the access route and registration process of a self-referral pathway. We would value your input, so if you would like to take part please contact england.wmp-prevention@nhs.net by 21 March.

Making sure your digital health technology meets our national standards

If you’re trialling, procuring or promoting a new digital health technology (including apps) in your organisation, you will first need to make sure it passes the Digital Technology Assessment Criteria (DTAC) - the new national standard. NHSX has launched the DTAC to help give staff, patients and citizens confidence that the digital health tools they use meet our clinical safety, data protection, cyber security, interoperability and accessibility requirements. You can find out more and download the DTAC question set on the NHSX website. You can also sign up to an upcoming information session.

Dates for your diary

Wednesday 17 March, 9.30am – 11am. Supporting your team to work flexibly

Wednesday 17 March, 1.30pm – 2.30pm. Supporting people with long COVID

Wednesday 17 March, 3.30pm – 5pm. Inclusion health self-assessment tool live demonstration

Thursday 18 March, 1pm – 2pm. Learning from co-production – using better engagement to address health inequalities

Thursday 18 March, 2pm – 3.30pm. Workforce recruitment and retention in PCNs

Thursday 18 March, 8pm – 9pm. The role of the PCN/GP practice pharmacist in implementing the GP referral pathway to the Community Pharmacist Consultation Service (CPCS)

Monday 22 March, 1pm – 2pm. Public Health England: CVD Prevention Packs update

Tuesday 23 March, 10am – 11am. An Introduction to Working with People and Communities

Tuesday 23 March, 2pm – 3pm. ICSs and patient empowerment – how can we work, at place, to effectively give people better control over their own health and care?

Wednesday 24 March, 10am – 11am. Connecting with our local community to deliver the COVID vaccine programme

Wednesday 24 March, 12pm – 1pm. PCN webinar: Mental health practitioner

Thursday 25 March, 9.30am – 11am. Flexible working: how to ask

Thursday 25 March, 10.30am – 11.30 am. Building and developing trusted connections with communities

Wednesday 28 April, 5.30pm – 7pm. Primary care networks webinar: A focus on additional roles reimbursement scheme and recruitment

Link of the day

Remote working toolkit for general practices and primary care networks