COVID-19 Primary Care bulletin

3 April 2020

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

Dear primary care colleagues,

A huge amount of news across primary care in today’s issue but we wanted to particularly share that there have been three important communications published in the last 24 hours – shielding of patients who are at the highest risk, PPE and an ask for help to support NHS 111:

Update on the Government’s shielding policy and implications for general practice

A CAS (Central Alert System) was sent today providing an update on the Government’s shielding policy and implications for general practice. The letter provides an update from Dr Nikki Kanani, and Dr Jenny Harries, Deputy Chief Medical Officer for England following the letter issued via CAS and published on 21 March to GP practices regarding the management and shielding of patients who are at the highest risk of severe morbidity and mortality from COVID-19.

A set of FAQs for clinicians has also been published today following the publication of FAQs for patients published on 1 April 2020.

Updated guidance published on personal protective equipment

Leaders from across medical and nursing royal colleges with Government have published new guidance on personal protective equipment (PPE) use for health and care teams. The guidance simplifies PPE use for staff and reflects the fact that COVID-19 is more widespread among the general population. The guidance is based on the best scientific evidence and the WHO has confirmed it is consistent with what it recommends in circumstances and settings with the highest risk of transmission.

Key points:

• The guidance sets out the recommended PPE for high risk operations and other direct or resident care across different health and care settings.
• Previous guidance had differentiated PPE according to whether a patient was confirmed with or suspected of having COVID-19. Given the greater prevalence in the general population staff can wear PPE where the procedure/contact requires where they are concerned about risk of infection.
• This guidance also notes the settings where masks and eye protection can be worn for an entire session and doesn’t need to be changed between patients, as long as it is safe to do so.
• When carrying out aerosol generating procedures (AGPs) clinicians should wear a higher level of protective equipment, these are listed out in the guidance.

The guidance sets out how the UK is consistent with WHO guidance on PPE.

• Table 2 shows the recommended PPE for primary, outpatient, and community care.
• Table 3 shows the recommended PPE for pharmacists and pharmacy staff.

A new PPE ordering website is being set up for primary care and will be available very soon.

Urgent request for GPs to support NHS 111

We recognise that as GPs you are already working incredibly hard in your own practices to respond to COVID-19, and that many of you won’t have any time to free up. But we’ve also heard some GPs asking what they can do beyond their local setting to support the national response or volunteering to provide additional sessions. We would be hugely grateful to any GPs who are able to provide time to support the new national COVID-19 Clinical Assessment Service (CCAS).

The CCAS has been set up to manage patients who require a discussion with a clinician following their use of NHS 111. Our huge thanks go to doctors who have already returned from retirement or volunteered to support the service.

We urgently need more GPs help to staff this service, especially as COVID-19 cases increase over coming days, because of your expertise and experience. The health service aims to support many patients to care for themselves at home, helping to relieve the burden on practices, as well as managing variability in demand and areas as the pandemic unfolds. We are therefore urgently seeking GPs able to join the CCAS as soon as possible.  Work will either be from doctors’ homes or from their practices, and, if agreed with CCGs, we will be happy for practices to repurpose a proportion of current extended access hours to allow their doctors to support the service in normal hours.  CCGs will wish to ensure there is sufficient capacity locally for the CCAS to book into, for face to face assessment where needed.

We are seeking GPs who are on the Performers List and currently work as salaried or partner GPs who can:

1. make a substantial time commitment to the service (at least two sessions a week over April, subject of course to changes in local needs), working remotely with shifts available 24/7. This could be as a volunteer in your currently contracted NHS time by agreement with your practice, or in addition paid at £200/session, or a combination.  Doctors who are currently working on the service will have pay uplifted to £200/session from today.
2. be willing to undertake (approximately) four hours of paid training to be ready to work on the CCAS, and complete a limited amount of necessary paperwork and IT/telephony set up as quickly as possible to allow them to work from next week.
3. have access either personally or through their employer to a Windows PC or laptop.
4. sign an Honorary Contract with South Central Ambulance Service Foundation Trust to work as part of the CCAS declaring that they are appropriately employed within their practice and have met the usual statutory and mandatory training requirements necessary to fulfil their role.

If you would be happy and able to help, please sign up (link will be fully live from midday tomorrow - 4 April 2020). You will be making an important contribution to the NHS efforts to respond to COVID-19.

Any doctors who are familiar with Adastra software, which is used by NHS 111 would be particularly welcome – though it is by no means a prerequisite and we will provide training to all doctors so that they are ready to work. In particular we need doctors who can help in normal working hours, though all contributions will be valuable.  We are asking in particular for employed (salaried and partner) GPs, because it will allow us to process applications more quickly as per (d) above – we are very grateful to locum GPs who have come forward and are already supporting the service. 

Nikki and Ed

General practice

NHS Volunteer Responders: guidance for primary care professionals

An incredible 750,000 volunteers have signed up for NHS Volunteer Responders since it was launched on 24 March. We have published guidance for health professionals to explain how the programme works and how to refer patients for support. We are encouraging all NHS organisations to start using the service to refer patients for support where the professional considers them to be vulnerable.  This offer is there for primary care in particular who we are sure will really value additional support from these volunteers.

Requests for support for individuals or organisations can be made by any health professional and from local authorities via the NHS Volunteer Responders referrers’ portal. You can also call 0808 196 3382 to refer patients. This guidance will be extended and updated regularly on our website.

Use of Clinical Frailty Scale (CFS) for people with learning disability and autism

Dr Roger Banks, National Clinical Director for Learning Disability and Autism, Claire Murdoch, National Director for Mental Health and Dr Nikita Kanani, Medical Director for Primary Care have co-signed a letter to clarify the use of the Clinical Frailty Scale (CFS) for people with learning disability and autism. It highlights the update to the rapid NICE guidance on admission to hospital and critical care which states that “[t]he CFS should not be used in younger people, people with stable long-term disabilities (for example, cerebral palsy), learning disability or autism. An individualised assessment is recommended in all cases where the CFS is not appropriate”. Decisions regarding appropriateness of admission to hospital and for assessment and treatment for people with a learning disability and / or autism are made on an individual basis and in consultation with their family and /or paid carers, taking into account the person’s usual physical health, the severity of any co-existing conditions and their frailty at the time of examination. It states that treatment decisions should not be made on the basis of the presence of learning disability and / or autism alone.

General practice webinar - 2 April 2020 - recording now available

Over 4,000 people joined the webinar last night. We were joined by Dr Susan Hopkins, National Incident Director for COVID-19 at Public Health England who provided details of the personal protective equipment (PPE) which was published yesterday (see more details below) and Captain Tom Frost Op RESCRIPT who talked through the National Supply Disruption Response for urgent PPE. We talked through the new general practice operating model and GMS regulations. Our Director of Strategy, Emily Hough, briefly spoke about identifying and contacting people at clinically highest risk. Dr Masood Nazir, Director of Digital Primary Care at NHSX talked through digital development in primary care and finally, Dr Nisha Jayatilleke, National Specialty Adviser (Immunisation) stressed the importance of continuing with vaccinations. The full recording is now available on our YouTube channel.

Community pharmacy

Easter opening of pharmacies

We would like to thank each and every member of the community pharmacy teams for their significant contribution in supporting their patients and customers, as a vital part of the NHS response to COVID 19, in what we know have been extremely trying circumstances.  We know that the NHS as a whole is being pushed well beyond what is normally expected, and that community pharmacies are no exception to that.  As part of the very front line of the COVID19 response in the community, we do not underestimate the work that you do, and we know that patients value the support that you are able to provide.

Things are moving quickly, and as you will understand a crucial phase of the pandemic will be ongoing over what is usually the long Easter weekend but for the NHS more widely this is likely to be an extremely busy time. As an important part of the overall NHS response to the pandemic pharmacies at this crucial time will need to be open on Good Friday and Easter Monday.

GPs will be open for business as usual on both Good Friday and Easter Monday.  In support of this we will need access to NHS pharmaceutical services on these days.

Under the National Health Service (Amendments Relating to the Provision of Primary Care Services During a Pandemic etc.) Regulations 2020 and with agreement of the Secretary of State we are requiring pharmacies in England to open from 2pm to 5pm on 10 April 2020 and 13 April 2020.

Any pharmacy that was planning to open longer hours should still to do so to support access for patients through the day.  If you believe your pharmacy is unable to open for reasons beyond the control of the contractor, then you should notify their NHS England and NHS Improvement regional office in the usual way and importantly update the NHS 111 DoS to prevent patients being referred to your pharmacy from NHS 111 when it is not open.  Please make sure NHS website profiles include correct opening hours to support patient access.

Community pharmacies in areas where there is minimal demand due to the Government’s social distancing policy (e.g. large shopping malls) should seek exemption from their NHS England and NHS Improvement Regional team.

Contractors will be able to claim a payment over and above the £2,592 million settlement for opening these hours.  In line with the fact that this will look like a normal working day for the rest of the NHS, the rate will not reflect a bank or public holiday premium.

Nominated pharmacy live in the NHS App

Patients can now view, set and change their electronic prescription service (EPS) pharmacy nomination using the NHS App. Being able to update nominations in the NHS App means patients can easily have their prescriptions sent directly to the pharmacy closest to their home or to a pharmacy that can deliver their medicines, helping to reduce unnecessary travel. Having a pharmacy nomination in EPS removes the need to collect FP10s from GP practices and drop them off at a pharmacy, supporting the public to observe social distancing. This new feature does not apply to dispensing practices or Dispensing Appliance Contractors. To nominate an online-only pharmacy, users must register with the pharmacy through their website or contact them.

GPhC update for community pharmacy

Latest updated on COVID-19 from General Pharmaceutical Council.

Community health services

Enhanced Health in Care Homes framework expanded

In the NHS Long Term Plan, the NHS committed to supporting people who live and work in and around care homes better. The new GP contract requires Primary Care and Community Services to work with their aligned care homes on delivering this objective, through the Enhanced Health in Care Homes framework. To support this, the framework has now been expanded.

Admission and care of residents during COVID-19: Incident in a care home

Guidance has been published for care homes, local health protection teams, local authorities, clinical commissioning groups (CCGs) and registered providers of accommodation for people who need personal or nursing care. This new guidance sets out how to admit and care for residents safely, and protect care home staff.

It also outlines how care homes should be using the capacity tracker to share information on available beds and business continuity during this incident. A series of webinars are being scheduled to support the implementation of the guidance. These will be promoted on our webinar page soon.

Dentistry

Sara Hurley, Chief Dental Officer and Matt Neligan, Director of Primary Care and System Transformation hosted a webinar this afternoon where over 10,000 people joined. The webinar will be available on our website soon and will share the direct link in a future issue of this bulletin.

Nikki and Ed's Link of the Day

A powerful message, compassionately shared by the very brilliant Dr Andy Knox – a must watch.