COVID-19 Primary Care bulletin

5 June 2020

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

Dear colleagues,

Earlier this week NHS England and NHS Confederation announced the creation of a new centre to investigate the impact of race and ethnicity on people’s health. The NHS Race and Health Observatory has been created in response to the concerns regarding the impact of the COVID-19 virus on people from black, Asian and ethnic minority (BAME) backgrounds and will identify and tackle the specific health challenges facing them. You may have also seen the Public Health England COVID-19: review of disparities in risks and outcomes which looks at the factors impacting outcomes of COVID-19 including race.

A letter has been sent out to GPs and hospital clincians about the NHS support to people who have been shielding. It confirms the actions for the NHS following the updated guidance published by the Government on 31 May.

We have also sent a letter to GPs and community pharmacists to formally notify you of temporary changes to the need for patient consent to maximise use of the electronic repeat dispensing (eRD) system.

Nikki and Ed

Dentistry

Transition to Recovery SOP

Following the letter dated 28 May which asked that all dental practices commence opening from Monday 8 June for face-to-face care, where practices assess that they have the necessary personal protective equipment (PPE) and infection prevention and control (IPC) in place, the standard operating procedure: transition to recovery for dental services was published yesterday.

This document is designed to provide supporting guidance for the initial transition from recommencing face-to-face care towards the full resumption of dental care services. It should be read in conjunction with the revised standard operating procedures for urgent dental care also published yesterday.

Dental practices obtaining PPE

From 8 June primary care dental services (general dental practices and community dental services) may open to resume face-to-face care (both routine and urgent) for appropriate patient groups once they have appropriate social distancing and other safety measures in place.

PPE for dentists will be available from dental wholesalers for practices to purchase from today (5 June). PPE for dental practices will include equipment necessary for aerosol generating procedures (AGPs) including gowns or coveralls, and FFP2 respirator masks as recommended by the World Health Organisation as well as the Health and Safety Executive (HSE) and UK Government PPE guidance.

The HSE website has advice and training materials on fit testing respirator masks. Practitioners and staff involved in conducting AGPs can also book free fit test training via an independent Respiratory Protective Equipment (RPE) fit testing company. Contact their helpline if you are experiencing fit testing issues from 8am – 8pm seven days per week on 07947 968972 or 07947 968922. You will also be able to book on to online training courses for fit-testing via these phonelines (subject to availability).

Fit testing of PPE may be performed by dental staff with appropriate training, or third party contractors that specialise in such services. Dental contractors should inform their employers liability (EL) insurer that all staff undertaking aerosol generating procedures are required to be fit tested for appropriate PPE, to ensure their EL insurance cover is sufficient. In addition, contractors should also notify their insurers if they are performing the fit testing for their own staff or that of other local dental contractors, again to ensure EL cover is adequate. 

Further PPE advice including on donning and doffing PPE is available on the Public Health England website. The Department of Health and Social Care’s PPE plan sets out the actions being taken by the Government to secure and supply PPE.

General Practice

COVID-19 National Testing: Flowing results to GP records

PCR swab testing is now routinely available to members of the public by visiting nhs.uk/coronavirus or calling 119.

Test results will soon be sent to GP records. Within the next two weeks, when a patient receives their test result from the national COVID-19 PCR swab testing, this will also be sent to GP systems and appear in the patient’s record as a laboratory test result. Results from tests previously undertaken through the same route will also shortly be sent to GP systems – with the exception of a small number of cases where there was insufficient information to identify the patient’s NHS number.

The test results will have the Requesting GP as G9999981 and Requesting GP Surname of COVIDpillar2; this will ensure they are clearly distinguishable from other test results. Bulk upload of test results into GP records will take place without any manual patient by patient process. GP practices will shortly receive further guidance by their own system supplier about how this will work in their own system of choice, as well as details on how results will be filed in the system.

There will be no action required from the practice on receipt of these results. In particular:

• There will be no need to communicate results to patients, as these will have already been sent to them by text and email;
• No clinical action will be necessary, as patients will have also received links to national guidance in their text and email, such as requirements on isolation or what to do if symptoms worsen;
• The results will not need to be notified to Public Health England under the notifiable diseases requirements, as this will have already been done.

Results from the test will be communicated as one of the following three options: negative, positive or unclear. They will appear in patients’ records as “SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) RNA (ribonucleic acid) detection result negative / positive / unknown”. When a result is “unknown” it means this was unclear and the patient will be advised to be tested again through the original route they use to request a test.

The Rapid Deployment of Online and Video Consultations across London

The challenges presented by COVID-19 have seen an acceleration of transformation projects in general practice, particularly the use of technology and a move to a digital infrastructure. This podcast from London, brings a clinical, project and programme perspective on a successful transition to online and video consultations as well as the NHS App. From triage and the creation of a digital front door to managing rapid deployment, the importance of effective communication and the public response, here is how, in a few short weeks, they have enabled 95% of London practices to offer online consultations and 100% who now have the ability to deliver video consultations to support their patients.

Community pharmacy

PPE update for community pharmacy

There have been sales of Type IIR face masks to community pharmacy wholesalers over the past two weeks. We understand that pharmacy wholesalers now have adequate supplies for pharmacy teams to access supplies of personal protective equipment (PPE) and this remains the most effective route for supplies to community pharmacies. If PPE cannot be accessed via this route it remains the case that pharmacies should contact the Local Resilience Forum and if they cannot help contact the national supply disruption service. We are currently developing a new online system so that pharmacies can report any problems they are having accessing PPE, and this will support future allocations.

Antibody testing

As per the letter from Pauline Philip, National Director for Emergency and Elective Care, and Steve Powis, National Medical Director, on 25 May, antibody testing will be offered to NHS staff who want it, including community pharmacy teams. Each NHS region is coordinating its own specific arrangements to roll out testing to NHS staff and more information will be made available in due course.

Community health services

Restoring CYP Community Health Services - updated guidance released

Following the letter from Sir Simon Stephens and Amanda Pritchard about the second phase of the NHS’ response to COVID19, Community Health Services for children and young people should now review and restore their services in line with local capacity and need. To assist with this, the Restoration of Community Health Services – Guidance for Children and Young People has been published (this is an update to the prioritisation guidance). Please note that guidance about restoring adult services will follow shortly.

Optometry

The most recent guidance letter for optical staff is available on our website.

Additional information

NHS Volunteer Responders - supporting patients in primary care and community health

A new one-page guide sets out the different roles and tasks the NHS Volunteer Responders can do to support your patients. If you work in primary care and community health – including in general practice, community pharmacies and community health services – you can offer your patients the support of an NHS Volunteer Responder. Download the guide for your team and use it to refer patients to the right support now.

#LookingAfterYouToo: individual coaching support for primary care staff

Recognising the challenges currently facing frontline primary care staff, both clinical and non-clinical, the #LookingAfterYouToo individual coaching support service was launched on 24 April, to provide staff with opportunities to process experiences, develop coping skills, deal with difficult conversations and develop strategies for self-management in difficult circumstances.

One month since launch, we wanted to share back with you what people are saying. 611 sessions were delivered in the first month, all coachees said they had felt listened to and supported and more than 99% said they had moved forward. We received more than 150 comments on the service, all of which were positive. We’ll be sharing some of these on social media over the next few days, so keep a look out.

Our baseline survey suggests that the need for this service is as strong as ever as the challenges for primary care staff continue, so we’d like your help in getting the message out so as many people as possible can benefit. Download a poster to display in your place of work and share this offer among your colleagues.

Book your session at a time to suit you. Sessions are available 7 days a week, by video or telephone.

Dates for your diary 

Wednesday 10 June, 1-2pm - Digital Nurse Network webinar focus on Carer's week

Join the Digital Nurse Network's weekly Wednesday webinar from 1-2pm. Nurses Helen Crowther and Ann Gregory will be focusing on the role of nurses in supporting care homes during COVID-19. Discussion will include weekly care home virtual check-ins and proxy access. Book your place now.

Wednesday 10 June, 5-6pm - Digital Primary Care webinar focus on care homes 

Dr Matt Hoghton and Alison Taylor will be discussing the role of GPs in delivering virtual check-ins and proxy access, drawing upon his personal experiences as a GP. Find our more and ask your questions by joining them. Book your place now.

Thursday 11 June, 4.30pm - Webinar on supporting Digitally Excluded Communities: how to support patients with getting online

Join NHSX for a 30 minute webinar on how we can better support patients to get online. This webinar is part of our series to support Digitally Excluded Communities. Aimed primarily at GP practice staff the webinar explores how general practice can make the most of their digital services during the COVID-19 pandemic to protect your staff and patients. The webinar consists of a 10 minute presentation with 20 minutes Q&A panel. Digital nurse champion Ann Gregory will be sharing the digital transformation work she has been doing at her GP practice which cares for patients from one of the most deprived areas of the UK. Find out more and register.

Nikki and Ed's link of the day

Hidden Figures: The Impact of the Covid-19 Pandemic on LGBT Communities