COVID-19 Primary Care bulletin

31 July 2020

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

Dear colleagues,

On Thursday 30 July, NHS England and NHS Improvement, and Health Education England published the next part of the NHS People Plan. We are the NHS: People Plan for 2020/21 - action for us all sets out what our NHS people can expect from leaders and each other. The plan is practical but ambitious and sets out the action needed to look after and support our NHS people in 20/21, recognising the pressure we have all been under during the COVID-19 response.

Published alongside the plan was Our NHS People Promise, which challenges us all to make the NHS a better place to work. Over the next four years, we will work together to make the ambitions within it a reality for everyone.

We’re keen to hear your thoughts on the plan, so please do get in touch or join the conversation on Twitter using #WeAreTheNHS and #OurNHSPeople.

Staying safe during Eid Al-Adha

‘Do good deeds properly, sincerely and moderately…’ Sahih Bukhari, vol. 8, hadith 471

Last night marked the beginning of Eid Al-Adha for our Muslim colleagues and we would like to wish you and your loved ones Eid Mubarak. This online video session from the Muslim Council of Britain is tailored for mosque leaders on how best to prepare for Eid safely, covering key lessons learned from congregational prayers across the UK thus far and health and safety advice. Public Health England have also written a blog around staying safe for Eid Al-Adha. Please do share these resources in your communities.

Self-isolation of health and care workers from high risk countries

From today (31 July), registered health and care professionals travelling to the UK from high risk countries will lawfully be required to self-isolate for 14 days. They will no longer be exempt. The move will bring health and care professionals in line with the general public and further protects the NHS and social care system from the spread of coronavirus from overseas, as signs of second waves begin to show in other countries.

The regulations are laid out by the Department for Transport (DfT). The current list of countries exempt from self-isolation measures is available on GOV UK. Health and care professionals returning from a country which has a travel corridor to the UK will not be required to self-isolate on return. Information on air corridors can be found here. This amendment to the regulations will ensure consistency with wider quarantine measures and continue to protect public health. 

Nikki and Ali

General practice

Updates to shielding guidance

From 1 August, shielding advice to those who have been identified as clinically extremely vulnerable is being relaxed and the national shielding programme is being paused. The updated guidance will be published on 1 August on GOV.UK and further details will be communicated in next week’s bulletin.

Individuals considered clinically extremely vulnerable will not receive another letter from the government to confirm these changes. The relaxation of shielding measures was communicated to everyone on the Shielded Patient List (SPL) in a letter from the government on 22 June, or more recently via their shielding letter if identified as clinically extremely vulnerable since then.

There may be exceptions to lifting the shielding guidance in parts of the country experiencing community outbreaks. Where specific local measures are in place, the local guidance should be followed. Individuals living in these areas will be informed by the government shielding service.

As per the letter to the NHS on 8 July, the Shielded Patient List will still be maintained while the shielding programme is paused, as the government may advise people to shield again if there is an increase in transmission of coronavirus in the community. Clinicians should continue to identify people who may be considered clinically extremely vulnerable based on the existing criteria and add them to the SPL. An updated template letter for notifying people identified as clinically extremely vulnerable will be distributed to practices and trusts and will be made available on the NHS Digital website.

As set out in annex 3 of the letter of 8 July practices should support the process of reviewing and, where appropriate, removing children and young people previously identified as clinically extremely vulnerable from the SPL in line with new advice from RCPCH. The actions required must take place before the start of the new school term in September 2020.

It is essential that everyone who needs to access health services is supported to do so as services are restored. Individuals who have been shielding may be particularly anxious about attending health settings, and this should be taken into account in care planning and in communications about attending appointments and visiting NHS sites.

Measures should be put in place to support safe service restoration and provide environments where the risk of infection is managed for all patients. Individuals’ care should be reviewed as necessary to identify any potential deterioration of existing conditions during shielding and need for rehabilitation or support in resuming daily activities.  

Face covering exemptions 

With face coverings now mandatory in many public places, we understand practices have had patients contacting them seeking verification of exemptions from their GPs. There is no requirement for an individual to prove that they have a valid case for exemption if they cannot wear a face covering, therefore, GPs are not expected to provide verification of exemptions.

It is not a legal requirement in health care settings for people to wear a face covering. Government advice says you should wear a face covering in enclosed spaces if you can, including places such as primary care services. However, a patient should not be refused entry to a premises or access to care if they are unable to, or refuse to, wear a covering. This should be clearly communicated to all patients.

Some people may feel more comfortable showing something that says they do not have to wear a face covering. This is a personal choice, and is not necessary in law, verbal communication of this is good enough. Template exemption cards are available for patients to print or download.

Carer funding available to qualified GPs on the Induction and Refresher Scheme returning to practice

Funding has now been agreed to provide financial help towards the cost of childcare and caring responsibilities for GPs on the NHS GP Induction and Refresher Scheme. We have reached agreement with the British Medical Association General Practice Committee (BMA GPC) that the support will also be available to those GPs with other caring responsibilities. Up to £2,000 will be available to claim for the cost of childcare for each child whilst on the scheme and those with caring responsibilities. The funding is in addition to the £3,500 per month bursary and other funding that GPs on the scheme can claim.

The funding will be available from 1 April 2020 until 31 March 2022.

SystmOne practices: new electronic notifications for the urgent supply of medicines

You can now receive electronic notifications from pharmacies about the urgent supply of medicines made as part of the NHS Community Pharmacy Consultation Service (CPCS). This informs you that a patient registered with your practice has received an urgent supply of medicine from a community pharmacy.

The notifications arrive as a workflow task and include ‘structured’ information, which means you can add the information directly to a patient’s record without having to transcribe it manually. Not all pharmacies can send the electronic notifications yet, so you should continue to check for notifications received via NHSmail, fax or post.

More information, including user guidance and training materials, is available on the NHS Digital website.

Pulse oximeters for use with people at home and in care homes  

Pulse oximetry used under clinical supervision can help identify ‘silent hypoxia’ and rapid patient deterioration for patients with COVID-19 living at home including in care homes. 

We’ve purchased a limited supply of pulse oximeters that can be transferred to CCGs free of charge for their local areas when there is an urgent need such as increased local infection rate, existing intention to purchase pulse oximeters, or care homes with insufficient oximeters (each care home is recommended to have around one oximeter per 25 beds, depending on the type and configuration of the home and with a minimum of two per home).  

CCGs will need to provide assurance that:

• oximeters will be used under general practice supervision
• people at greatest risk from COVID-19 will be prioritised and supported
• reasonable efforts will be made to safely reallocate oximeters if required, for example, because of evolving COVID-19 infection profiles and clinical pathways
• reasonable efforts will be made to supply relevant information on oximeter use to inform future use of oximetry for COVID-19 patients.

It is recommended that primary care networks (PCNs) contact their CCG if they feel they have an urgent requirement of which their CCG is not already aware. Oximeters will be transferred to CCGs so there is no VAT liability for practices or PCNs. Guidance is available on the use of pulse oximetry to detect early deterioration of patients with COVID-19 in primary and community care settings.

Access to repeat prescriptions

During the COVID-19 pandemic many practices have adopted new ways of working and have encouraged patients to request repeat prescriptions online, where appropriate. Online ordering of repeat prescriptions has many benefits for practices and patients, but it isn’t suitable for everyone. Following some recent enquiries, we wanted to clarify that practices must still have systems in place to enable patients to request repeat prescriptions by telephone or in person. 

Supporting Learning from Deaths Reviews (LeDeR) for people with a learning disability

Practices are asked to support Learning from Deaths Reviews for people with a learning disability and release case notes to reviewers as quickly as possible (ideally within a week of a request being made using the secure LeDeR web-based portal).

If preferred, a GP can have a direct discussion with a LeDeR reviewer. Click here for further information.

Patient Group Directions – Written instruction for the administration of seasonal flu vaccination 2020/21

Please note: this item was included in the ‘community pharmacy’ section in last week’s edition, however the following information is intended for general practice. 

Specialist Pharmacy Services were made aware of issues being encountered on the use of Patient Group Directions (PGDs) within healthcare organisations and occupational health services with regards to offering employees and peer to peer seasonal flu vaccinations. 

Specialist Pharmacy Service in conjunction with Care Quality Commission, Medicines and Healthcare products Regulation Authority, Royal College of Nursing, Public Health England, British Medical Association Occupational Health Committee and representatives from the NHS and independent sectors have developed written instructions for the administration of seasonal influenza vaccination for 2020/21.

The written instruction template and a factsheet will support the use of the written instruction and includes additional advice specific to GP practices in the use of PGDs and the administration of seasonal flu vaccinations.

Community pharmacy

GPhC guidance on COVID-19 rapid antibody tests

The General Pharmaceutical Council (GPhC) issued a letter to community pharmacy owners and superintendent pharmacists on 21 July to highlight its position concerning the provision and sale of COVID-19 rapid antibody tests from community pharmacies.

It states that in the light of current public health advice, it is not appropriate for them to be sold in community pharmacies or recommended by pharmacy professionals at this point in time.

Interim Foundation Pharmacist Programme

Health Education England and NHS England and Improvement have written to employers about the new Interim Foundation Pharmacist Programme to help provisionally registered pharmacists transition to full General Pharmaceutical Council (GPhC) registration and beyond.

This new programme forms the first phase of pharmacist education and reform and is designed to build support around the current cohort of pre-registration pharmacists who will become provisionally registered pharmacists in August 2020.

The COVID-19 pandemic has affected the training of the current cohort of pre-registration pharmacists, who have not had the full experience necessary for registration. The GPhC has decided to provisionally register this cohort, with the final assessment likely to take place later this year, with full registration to follow for those successful in the exam.

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

Home delivery of medicines and appliances in impacted areas during August 

The NHS Home Delivery Service will be commissioned from both community pharmacies and dispensing doctors from 1 until 31 August 2020, to ensure access to prescription medicines for clinically extremely vulnerable patients who continue to need to shield if they live in the impacted areas of Leicester, Blackburn with Darwen and Luton. The provision of this service throughout August will give patients in those areas, who have been advised to shield until 17 August, time to make alternative arrangements for access to their prescription medications once the service ceases. The announcement and further details can be found here. 

Your Covid Recovery – new website to support people with ongoing symptoms on their road to recovery

Evidence shows that a significant proportion of post COVID-19 patients are likely to have significant ongoing health problems, notably breathing difficulties, tiredness and cough, reduced muscle function, reduced ability to undertake physical activity and psychological symptoms such as PTSD and reduced mood status.

Your Covid Recovery is a new NHS website designed to help people recover from the long-term effects of COVID-19 and support them to manage their recovery. It includes information from rehabilitation experts about how to manage ongoing symptoms and health needs at home, and signposts to sources of support.

Please include the site in your conversations with post-covid patients and their families/carers.

Flu programme 2020

The Government has announced that the most comprehensive flu programme in the UK’s history will be rolled out this winter.

The plan is to vaccinate up to 30 million people, including: 

• people who are on the shielded patient list and members of their household
• children in the first year of secondary school
• people over 50-64 who will be invited later in the season for a flu jab depending on availability of the vaccine. 

This year personal assistants who are employed using personal health budgets will also be eligible. Campaign materials to encourage all health care workers to have a free flu jab will be available to NHS organisations next month.

Although the flu jab is not mandated for health and social care workers this year there is an expectation that all staff will be vaccinated and all NHS organisations should have a plan to ensure as many staff as possible are protected against the flu.

The expanded programme is part of plans to ready the NHS – both for the risk of a second peak of coronavirus cases, and to relieve winter pressures on A&E and urgent care. The next flu letter is due shortly.

Clarification regarding corticosteroid injections for GPs, First Contact and Community Physiotherapists

Corticosteroid injections (intraarticular and intramuscular) may be used where clinically indicated and the benefits outweigh the risks. An individual risk analysis must take place on a case by case basis and the lowest possible dose of corticosteroid must be used.

A corticosteroid injection must not be performed if the patient has an infection or suspected infection, including possible COVID-19 infection, being mindful that the incubation period for COVID-19 can be up to 14 days.

Patients must be aware of the potential increased risk and lack of clear evidence related to the risk of corticosteroid injections during the COVID-19 pandemic. Informed consent must be obtained and documented prior to proceeding with the injection.

Please see the full guidance which contains more details including caveats.

Cancer Research UK publish early diagnosis of cancer support guide

GPs play a pivotal role in diagnosing cancer earlier and supporting the NHS Long Term Plan ambition to diagnose 75% of cancers at stage 1 or 2 by 2028. Cancer Research UK has published new guidance to support GP practices and primary care networks to deliver the Network DES service requirements for the early diagnosis of cancer. This material should be viewed alongside the NHSEI guidance for delivery of the Early Cancer Diagnosis service.

Type 2 diabetes – get with the programme

Type 2 diabetes is one of the biggest healthcare challenges of our time. The free Healthier You programme provides guidance on how it can be prevented or delayed and is currently being offered over telephone, group video conference, or online through apps and websites.

Eligible participants can sign themselves up to the programme online – as well as being referred by a healthcare professional. Expanded access to the programme follows recent analysis that those living with diabetes face a significantly higher risk of dying with COVID-19.

People can also use the Diabetes UK risk tool to find out if they at risk of developing the disease. If identified as moderate or high risk, they will be invited to sign up to their local Healthier You service.

Primary Care and General Practice Nursing Career and Core Capabilities Framework

A draft of the Primary Care and General Practice Nursing Career and Core Capabilities Framework is now available. You are invited to review the draft framework and provide your comments and feedback by completing an online survey.

This will be particularly relevant to employers such as PCN Clinical Directors, GPs and Practice Managers, commissioners, (e.g. for workforce planning), education providers (e.g. to inform the design and delivery of curricula) and to patients, nurses and colleagues in multi-disciplinary teams.

Please submit your completed survey by 4pm Friday 7 August 2020.

Dates for your diary

Monday 3 August, 2 - 3pm – National Population Health Management webinar. The next in the series will explore national and local perspectives on health inequalities highlighted by COVID-19 and how Population Health Management can be used to address these health inequalities.  

Thursday 6 August, 5 - 6pm – GP webinar with Nikki Kanani.  

Wednesday 19 August, 5 - 6pm – Digital Primary Care Online presence – accessibility compliance webinar. Public sector organisations have a legal duty to make sure websites and apps meet accessibility requirements. CCGs and GP practices are invited to attend and learn more about meeting the standards before the deadline of 23 September 2020.

NHS Volunteer Responder programme updates

Fortnightly webinars are being held to provide regular updates on the NHS Volunteer Responder programme. The webinars are for referrers and colleagues working across health and care, including: primary care; social care; local authorities; government departments; voluntary sector organisations; STPs and ICSs; and NHS England and Improvement regional teams.

These webinars 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 6 August, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 20 August, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 3 September, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 17 September, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 1 October, 11am - 12pm - Join Microsoft Teams Meeting

Nikki and Ali's link of the day 

Recognising risk and protecting our workforce: how Greater Manchester made rapid progress in tackling risk assessments in general practice.