COVID-19 Primary Care bulletin

8 April 2020

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

Dear primary care colleagues,

Today we have launched the #OurNHSPeople Wellbeing Support offer to provide you with the support you need to continue the important work you are doing, including a helpline and free access to a number of apps. Further information on the support available can be found below and we hope you will make use of these as needed.

Good Friday and Easter Monday reimbursement rates

Where it is determined that a practice must open on Good Friday or Easter Monday, practices can seek reimbursement for additional staffing costs incurred on these days, in line with the respective rates as set out below. That includes:

• Sessional GPs: up to a maximum of £250 a session or £500 per day;
• Overtime for salaried GPs in line with the individual’s contractual arrangements;
• Additional capacity from GP Partners to recognise up to two additional sessions on each of Good Friday and Easter Monday at a rate of £289 per session plus applicable employer National Insurance and pension costs;
• Overtime for non-GP practice staff in line with the individual’s contractual arrangements.

Practices should discuss with their local commissioner the level of service required on bank holidays and agree in advance what additional staffing costs will be reimbursed.

Details of the General Practice COVID support fund will soon be shared, and additional expenses will be considered within this.

Nikki and Gabi

General practice

Maintaining standards and quality of care in pressurised circumstances

Yesterday, Chief Nursing Officer, Ruth May sent a letter to practices regarding the standards of care during this time, setting out the importance of striving for the delivery of personalised care and high standards of patient experience even under pressure. The British Medical Association, Care Provider Alliance, Care Quality Commission, and the Royal College of General Practice have recently issued a statement on the role of general practitioners in this regard.

The key principle is that each person is an individual whose needs and preferences must be taken account of individually. By contrast blanket policies are inappropriate whether due to medical condition, disability, or age. This is particularly important in regard to ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders, which should only ever be made on an individual basis and in consultation with the individual or their family.

Update on identifying highest risk patients

On 3 April we wrote to you about the updated process for identifying your patients that are at highest clinical risk and need to shield. Letters for any additional patients that have been identified centrally are now in the post and IT system suppliers are updating patient records to reflect this now. If you cannot already see the flags in your patient records, a letter to confirm how to access your flags will follow this bulletin. So that all highest risk patients are both identified and able to register for government support, please can you complete the review of your patient records by the end of Monday 13 April if you already have the flags in place.

Clinical Trials

Using international evidence and UK expertise the most promising potential treatments for Covid-19, at this stage, have been identified and the UK is running national clinical trials to gather evidence across the whole disease spectrum. We are asking that every effort is made to enrol COVID-19 patients in the three national priority clinical trials in primary care, hospital settings and ICUs listed below:

• PRINCIPLE (higher risk patients in primary care trial)
• RECOVERY (in hospital trial)
• REMAP-CAP (critically ill patient trial)

Other priority studies, including observational studies, are listed here.

These trials are being run as simply as they can to reduce the burden on the NHS, with adaptive designs so further treatments can be added if new promising candidates are identified. The results are essential to the future treatment of UK and global patients. We will ensure important results are disseminated rapidly to improve practice.

The faster that patients are recruited, the sooner we will get reliable results. While it is for every individual clinician to make prescribing decisions, we strongly discourage the use of off-licence treatments outside of a trial, where participation in a trial is possible. Use of treatments outside of a trial, where participation was possible, is a wasted opportunity to create information that will benefit others. The evidence will be used to inform treatment decisions and benefit patients in the immediate future.

Remote Working in Primary Care Guidance for GP Practices

An appendix to the Primary Care (GP) Digital Services Operating Model has been published to support remote working across general practice during the COVID-19 pandemic. It sets out additional guidance for CCGs and their IT delivery partners that will support practices with options for remote working.

SNOMED CT codes

SNOMED CT codes to support COVID-19 related activity have been published and are visible in some GP systems now (search on term text) and all systems should have these shortly. See the codes organised by activity diagram and the clinical description for these codes. Keep up to date as new releases of SNOMED CT codes will be made available on a regular basis to support patient care during the pandemic. Note: this guidance has been developed in collaboration with the professional bodies (via PRSB) and the Faculty of Clinical Informatics.

Home oxygen patients

Last week we contacted users of home oxygen to assure patients currently receiving medical gas that supplies will continue. While plans are underway to support the increased need for oxygen for COVID-19 patients, both in hospital and community settings, we are working closely with suppliers to maintain an effective service for all patients requiring oxygen. In doing so, some oxygen cylinders and concentrators may be required for redistribution to support an expected increase in demand. However, no patient will be left without oxygen.

Community pharmacy

Summary Care Record application (SCRa) Shielded Patient Flag pilot with community pharmacies

A new alert for the people on the Shielded Patient List – the list of people at “high risk” of complications from COVID-19, who should be shielded for at least 12 weeks - has been made available to community pharmacies via the SCRa. Previous communications referred to this as the ‘vulnerability flag’. This has been updated to the Shielded Patient Flag to align with Government terminology.

This alert will initially only be available to community pharmacies. Feedback from this pilot will support the future wider roll-out to other healthcare professional groups.

Dentistry

Redeploying the Clinical Dental Workforce

The dental workforce has a wide range of skills and experience that can be utilised to undertake activities that will help clinical colleagues and the wider workforce during COVID-19. A guidance document has been published which sets out the principles of safe redeployment and healthcare delivery as critical care units prepare and deliver increased activity. Any dental team member wishing to support the NHS can register their interest here. 

Additional information

#OurNHSpeople wellbeing support

Our NHS people are doing extraordinary things in the face of an extraordinary challenge, and so need an extraordinary level of support. This is why the NHS nationally and locally has developed a range of wellbeing support to care for and protect all of our NHS people, whether at the front line or in supporting services.

So, from today, all our people will have access to a range of support (#OurNHSPeople Wellbeing Support) through one point of contact:

• a free wellbeing support helpline 0300 131 7000, available from 7.00 am – 11.00 pm seven days a week, providing confidential listening from trained professionals and specialist advice - including coaching, bereavement care, mental health and financial help
• a 24/7 text alternative to the above helpline - simply text FRONTLINE to 85258
• online peer to peer, team and personal resilience support, including through Silver Cloud, and free mindfulness apps including Unmind,  Headspace Sleepio and Daylight

We encourage NHS teams to take immediate advantage of these services. They can be used in addition to the support available from your own NHS organisations and will develop further in coming days and weeks in line with user feedback.

Dates for your diary

Thursday 9 April, 12 - 1pm: Webinar: Keeping focused, safe and legal – running your CCG during the COVID-19 crisis. This webinar from NHS Clinical Commissioners, Browne Jacobson LLP and the Good Governance Institute will cover everything you need to know and answer any burning questions you may have about operating as a CCG in the current COVID-19 crisis.

Thursday 9 April, 5 – 6pm: Webinar: Covid-19 Primary Care webinar with Nikki Kanani

You can find a full list of upcoming webinars on our primary care webinars page.

Nikki and Gabi's Link of the Day

BMJ Learning: Covid-19 online courses