COVID-19 Primary Care bulletin

4 September 2020

COVID-19: this week's round-up for primary care

Dear colleagues,

In order to support the NHS to deliver the flu vaccination programme, the Department of Health and Social Care have adjusted the order limits for emergency supply of PPE via the PPE Portal. These increased order limits are based on size and type of provider and will enable medium and larger practices to access supplies in line with the predicted increase in activity as a result of the flu programmes. These order limits also reflect the increased need for PPE due to COVID-19. 

More information is available on the DHSC PPE Portal guidance page and the portal customer service team can be reached on 0800 876 6802 for enquiries or registration support.

GP access

Many of you will be aware of reports that some patients are experiencing difficulty in accessing their GP. We know that the vast majority of practices have made significant efforts to remain accessible to patients through the pandemic, and to keep staff and patients safe. It remains critical that information for patients about how they can access services is clear, encourages patients to consult where necessary, and that face to face care always remains available when clinically appropriate, taking the appropriate precautions set out in our standard operating procedure. We are working with professional bodies and will be providing further information to support clear messaging to patients as soon as possible.

Nikki and Ed

General practice

As schools are now returning, practices need to review children and young people on the Shielded Patients List (SPL) – FOR ACTION

In their letter of 8 July 2020, the Chief Medical Officer for England and NHS Medical Director asked clinicians to review all children and young people who had been identified as clinically extremely vulnerable (CEV) to coronavirus and included on the Shielded Patient List (SPL). Children no longer considered CEV according to guidance from the Royal College of Paediatrics and Child Health (RCPCH) should be removed from the SPL following consultation with the individual and their family. The majority of these patients will be under the care of a specialist, however, there are children on the SPL that have been added by primary care and no longer need to be identified as CEV.

As schools are now returning, as soon as possible please review children you have added to the list, so that children and families are clear on what advice they should follow. So far, only a small number of children and young people have been removed from the SPL since July.  

The RCPCH guidance states that the children and young people with conditions including asthma, who are cared for just in primary care, are unlikely to be clinically extremely vulnerable. These patients should therefore be reviewed and, if appropriate, removed from the SPL as soon as possible. Please can practices communicate with the patient/their family to discuss their individual circumstances and remove the high-risk flag from records of anyone who no longer needs to be on the Shielded Patient List.

Seasonal influenza DES specification – updated

The Influenza and Pneumococcal Immunisation Directed Enhanced Service specification has been amended and republished to provide for additional new cohorts of patients to be vaccinated in general practice.

The new cohorts include household contacts of those on the NHS Shielded Patient List or of immunocompromised individuals, and health and social care workers employed through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, to deliver domiciliary care to patients and service users. It also covers a potential cohort of 50-64 year olds later in the flu season, depending on vaccine availability.

In addition, the specification requires that practices must include within at least one written communication to eligible patients offering vaccination, a request that the patient advises the practice of their ethnicity status if they have not previously provided this information to the practice and requires the practice to record this in the patient record.

Roll out of Electronic Prescription Service (EPS) Phase 4 from 7 September

To help you prepare for winter, we are accelerating deployment of EPS Phase 4 which allows EPS to be used for patients without a pharmacy nomination. All GP practices using EPS with TPP SystmOne and EMIS Web will have Phase 4 enabled between Monday 7 and Friday 11 September 2020. Your system supplier will inform you of your specific switch-on date. For most practices, the move requires minimal action, but teams should consult the support materials and readiness checklist.

Phase 4 significantly reduces the need to hand sign prescriptions and deal with lost prescriptions. GP practices and pharmacies will also be able to track the status of more prescriptions using the EPS Prescription Tracker. Using EPS with a nomination is still the preferred and most efficient option, especially during the coronavirus (COVID-19) pandemic, so please continue to encourage your patients to nominate. EPS Phase 4 is not currently available in the Vision or Microtest systems.

COVID-19 and professional standards activities – resumption of appraisal

Medical appraisal was suspended for most doctors in March 2020, to free up clinical time to manage the COVID-19 emergency situation.

Medical Appraisal 2020, developed with partners and stakeholders, describes the restart of appraisals using a rebalanced approach that focuses on the doctor’s professional development and wellbeing, and simplifies expectations around supporting information and pre-appraisal paperwork. It therefore also supports our commitment to do away with unnecessary bureaucracy faced by GPs in England.

This letter from Professor Stephen Powis, National Medical Director, to Responsible Officers and Medical Directors in England describes the flexible approach to the incremental restoration of appraisal across all organisations in England, beginning by 1 October, with a view to resuming normal levels of activity by 1 April 2021.

Further resources to describe and explain this ‘Appraisal 2020’ format, including materials to support appraisers, are hosted on the Academy of Medical Royal Colleges website.

Community pharmacy

Flu service specification published

The Community Pharmacy Seasonal Influenza Vaccination Advanced Service and supporting Patient Group Direction (PGD) have been published on our website. The service became ‘live’ on 1 September and is available until 31 March 2021. Some amendments to the service have been introduced to support greater vaccination rates and to reduce the overall burden to contractors delivering the service during the pandemic. You should ensure you are familiar with the content of these documents and the PGD is appropriately signed before providing any NHS flu vaccinations.

Government consultation on expanded role in vaccinations for pharmacy professionals

The government has published a proposal to expand the scope of Patient Group Directions (PGD) to allow pharmacists to administer unlicensed vaccines, including any COVID-19 vaccine. The consultation on changes to the human medicine regulations, which was published on 28 August 2020, also includes a proposal that pharmacy technicians could become eligible to safely administer a COVID-19 or influenza vaccine. The consultation closes on 18 September 2020.

New development opportunity for community pharmacists

New continuing professional development (CPD) opportunities for pharmacists are available, coordinated by Health Education England (HEE), and funded by the Pharmacy Integration Programme, to help improve the care of patients presenting with minor illness through the NHS Community Pharmacist Consultation Service.

A programme of interactive online workshops and learning is being delivered to support community pharmacists in effective patient-facing consultations and clinical assessments for a range of common minor illnesses. The CPD is being delivered in partnership with the Royal Pharmaceutical Society, Royal College of General Practitioners and the Centre for Pharmacy Postgraduate Education. It will be facilitated by approved medics including GPs and advanced practitioner trainers.

Hepatitis C service specification published

The community pharmacy Hepatitis C Antibody Testing advanced service went live on 1 September 2020. Through this service, people who inject drugs and who are not currently accessing community drug and alcohol treatment services can be tested for the hepatitis C virus at a participating community pharmacy.

Any community pharmacy that meets the prerequisites for service provision detailed in the service specification can register to provide this service via the NHSBSA Manage Your Service platform. Full details of the service can be found in the service specification, which is available from the NHS England and NHS Improvement website.

National COVID-19 Clinical Assessment Service electronic prescriptions

From 1 September 2020, the COVID-19 Clinical Assessment Service (CCAS), hosted by the South Central Ambulance Service, added the functionality for GPs within the service to prescribe, using the electronic prescription service (EPS). This is intended to improve the patient journey and allow the CCAS GPs to complete an episode of care. The scope of prescribing will be for acute prescriptions only and may include controlled drug medicines where clinically appropriate.

EPS prescriptions coming from the CCAS are not restricted to patients in the South East Region as the service manages patient enquiries from across England. Pharmacists and dispensers will be able to use the contact details on the EPS token to telephone the service to contact the prescriber in the event of a query.

Dentistry

Updated standard operating procedures published

Chief Dental Officer for England, Sara Hurley, has written to dental practices with the latest updates for them regarding Covid-19. We have also published an updated standard operating procedure for urgent dental centres and standard operating procedure: transition to recovery for dentistry, which includes updated advice on clinically vulnerable patients.

Optometry

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

Additional information

NHS staff wanted for new TV and print campaigns

We’re casting for GPs, Immunisation Nurses, GP Practice Nurses and Midwives to feature in national campaign activity this winter – on TV, print and social media. Please cascade this to your teams. We’re keen to reflect the diversity in the NHS workforce and encourage people from all backgrounds to apply.

Deadline for expressions of interest is 9am on Monday 7 September. Those interested should be available in London w/c 14 September for filming. Email siri.montague@mcsaatchi.com with your full name, job title, location/place of work, years in the NHS, contact telephone number and a headshot photograph for more information.

Evidence-based interventions (EBI) programme: list 2 engagement final review

The EBI programme runs alongside the NHS England and NHS Clinical Commissioners’ programme, focused on items that should not be routinely prescribed in primary care. Both programmes follow similar principles, while one focuses on medicines and the other on interventions.

Over the last few weeks, the EBI Expert Advisory Committee have been engaging on the second list of procedures for the EBI programme as a follow up to the original guidance. The online questionnaire is now closed but we are holding a post-engagement event which is open to anyone and are encouraging patients, the public, clinicians, commissioners, providers, and anyone with an interest to join the post-engagement event on 22 September from 9am – 12pm to share any further views. Please register your interest here.

Your COVID Recovery – helping patients to understand what to expect as part of their recovery from COVID-19

Your COVID Recovery is an NHS website designed to help people recover from the long-term effects of COVID-19 and support them to manage their recovery. It has information from rehabilitation experts about how to manage ongoing symptoms and health needs at home, and signposts to sources of support. A significant proportion of post COVID-19 patients are likely to have ongoing health problems. How quickly somebody recovers and the problems they have is likely to vary, and this website can help to answer some questions for patients. 

Applications for the NHS Innovation Accelerator are now open

The NHS Innovation Accelerator (NIA) has launched its call for applications representing high impact, evidence-based innovations. It’s open to local, national and international healthcare innovations supported by passionate individuals from any background, including SMEs, clinicians, charity/third sector and academics. Visit the NIA website to learn more and find dates for informational webinars or contact nia@uclpartners.com for further information. Applications are open until midnight on Friday 16 October 2020.

Dates for your diary

Tuesday 8 September, 11.30am - 12.45pm - Building back from COVID-19: tackling health inequality in partnership

The second in a series of NHSEI Integrated Care webinars - run in collaboration with SCIE - will look at tackling health inequalities in partnership; how systems can work together and plan for action at both system and place level.

Thursday 17 September, 5pm – 6.30pm. A focus on primary care networks

This webinar will be the first in a series focusing on primary care networks and the priorities and opportunities for them in the coming months and years. Join Nikki Kanani, Ed Waller and special guest speakers for this online interactive event designed to support PCNs on their development journey. To attend please ensure you register in advance.

NHS Volunteer Responder programme updates

Webinars are being held to provide regular updates on the NHS Volunteer Responder programme for referrers and colleagues working across health and care. They will provide an overview of the programme, including facts, figures and the most recent updates on programme adaptations in response to policy changes and the needs of vulnerable people.

• Thursday 17 September, 11am - 12pm
• Thursday 1 October, 11am - 12pm

Online workshops on remote monitoring

During the COVID-19 outbreak, some NHS organisations used technology to support people with COVID-19 at home. Join this webinar series to hear from the clinicians involved about how this worked, what they did and what the benefits were.

• Tuesday 8 September, 10am - 11am. Tech-enabled Virtual Ward Model - the West Herts experience
• Tuesday 22 September, 10am - 11am. The primary care hot hub - the West London experience

Please contact InnovationCollaborative@future.nhs.uk for more information.

Nikki and Ed's link of the week

The Dr Will Zoom You Now: getting the most out of the virtual health and care experience