24 September 2020

Dear colleagues,

As we face a second wave of the pandemic, we will increase the frequency of these bulletins to twice a week from the first week of October, in order to make sure we can share information in a timely and supportive way.

Free PPE extended to primary care

Through our conversations with the Department for Health and Social Care (DHSC) the department have notified the NHS that the forthcoming arrangements for providing free personal protective equipment (PPE) to social care will be extended to primary care.

DHSC will publish their PPE strategy next week, which will provide full details of the arrangements for primary care.

In preparation, we encourage all NHS primary care providers, including community pharmacy, to ensure they have registered on the PPE portal in order to receive PPE supplies free of charge. Further information on the portal supply can be found on the DHSC guidance page. If providers have any queries or have not received an email invitation, please contact the DHSC PPE portal customer services at: 0800 876 6802.

The Government advice on shielding guidance

We’re aware of some confusion regarding the current status of the Government shielding guidance. Specifically, queries from the public about whether shielding guidance is currently in place in their area are increasing.

To confirm:

• People who were identified as clinically extremely vulnerable (CEV) to coronavirus were advised to ‘shield’ during the first wave of the pandemic.
• Shielding advice was lifted in most parts of the country on 1 August 2020.  This means the vast majority of people considered CEV are no longer being advised to shield.
• There are two specific exceptions to this in Leicester City and North East Blackburn. Shielding advice is still in place in these areas but will be lifted from 5 October. 
• Therefore, unless Government policy changes again, from 5 October no-one in England will be advised to shield.
• Areas that are subject to local lockdown restrictions are not automatically subject to shielding guidance; the decision to introduce shielding advice is currently made on a case by case basis by the UK Deputy Chief Medical Officer (DCMO) alongside the local Director of Public Health (DPH).
• If shielding guidance is re-introduced in a particular area, people considered clinically extremely vulnerable, as well as local health system colleagues, will be informed of the changes.

Keep safe,

Nikki and Ed

Primary care

GP Referral to Community Pharmacist Consultation Service to be made available across England

GP practices across England will be able to refer patients with minor illnesses asking for a GP appointment for a same day consultation with a community pharmacist, as part of a new referral pathway to the NHS Community Pharmacist Consultation Service (CPCS). Findings from a pilot in the Bristol, North Somerset and South Gloucestershire area saw thousands of patients using the service.

Dr James Case, GP at Concord Medical Centre, Bristol, says: “The community pharmacist consultation service is a real opportunity to help practices reduce our daily demand and manage our more complex patients, which is very valuable for us.”

The NHS CPCS service specification and toolkit will be refreshed to include GP referrals and will be published in due course. PCNs are encouraged to implement the service as part of the Structured Medication and Medicines Optimisation Service Specification and we will commission this service from pharmacies from across England from November. General practice and pharmacy teams should work together on local arrangements for referral of minor illnesses to pharmacy.

NICE says people approaching the end of life should be supported in a timely and effective way

NICE has published an impact report on end of life care in which we highlight NICE guidance and standards which have contributed to improvements in end of life care for adults. Our recommendations say near the end of a person’s life, we expect them and those near to them to be provided with personalised care, support and effective planning of the highest quality. NICE’s acting director of health and social care has published a blog discussing her thoughts, in the National Health Executive.

New primary care resources for CVD prevention and better respiratory care

In response to the COVID-19 pandemic primary care teams have had to change ways of working to keep patients and staff safe. UCLPartners have designed a series of resources to help clinicians deliver their care for patients with cardiovascular and respiratory conditions in a world where a lot of care is delivered virtually. Resources are now available for high blood pressure, asthma and COPD. Resources include:

• Search tools to risk stratify and prioritise patients
• Pathways and protocols to deliver care at home and use of the wider workforce
• Digital resources to support remote management and self-management
• Training that includes motivational interviewing and health coaching

Be Clear on Cancer – awareness campaign evaluation results and materials 

The National Cancer Registration and Analysis Service (NCRAS) has published the final evaluation report for ‘Be Clear on Cancer: local, regional and first, second and third national Blood in Pee’ on their website.

The ‘Blood in Pee’ campaign was introduced to educate and encourage people to present early with symptoms suggestive of bladder or kidney cancer to help promote early diagnosis. The number of newly diagnosed bladder cancers increased following all campaigns. This suggests awareness campaigns encouraging people with blood in pee to visit their doctor can help ensure more people are diagnosed at an earlier stage, potentially reducing the need for late stage treatments and any related side effects. ‘Be Clear on Cancer’ campaign materials can be downloaded here.

BMJ Best Practice – an award-winning resource now free to all NHS staff

BMJ Best Practice is a clinical decision-making resource providing the latest evidence-based information to use at the point of care. Funded by Health Education England, it is free for NHS professionals in England.

Rated as one of the best support tools worldwide, it includes guidance on diagnosis, prognosis, treatment and prevention, medical calculators, patient information and more. Content comprises expertise from over 1,600 international authors and 2,500 peer reviewers providing up to date references at your fingertips, anywhere, any time of day or night.

Click here and register via NHS OpenAthens (instructions here). Once registered you can download the app.

Continuing to make our website better for you

We are continually working to improve our online services, listening to what our users tell us to provide the best possible customer experience. We have developed some new prototype designs for our website that we’d like to share with a test audience. If you are interested in participating, please use our short form to register your details. Appreciating the pressures you’re under, we’ll ensure we take up as little of your time as possible.

Please share this request with colleagues - fresh voices and insights are always welcome.

COVID-19 guidance

Clinical Prioritisation of Elective Waiting Lists

This week we wrote to systems regarding the Clinical Prioritisation programme which is needed to support the prioritisation of waiting lists. We have asked systems to clinically review all patients on an admitted patient care pathway by 23 October 2020. Further guidance will be issued with regards to the requirements to clinically prioritise patients on waiting lists for diagnostics and outpatients’ appointments. The project is about making the best mutually agreed decisions with patients and is not an exercise to reduce numbers on waiting lists. The various stages to the programme are outlined in the letter and the patient’s GP will be notified of the outcomes of discussions regarding their procedure. We will keep you updated on the programme as it progresses.

Urgent actions to address health inequalities in NHS provision and outcomes - Health Inequalities Frequently Asked Questions (FAQs) September 2020

Following the publication of the guidance on implementing the Phase 3 letter, Action required to tackle health inequalities in latest phase of COVID-19 response and recovery, we have developed a set of FAQs to respond to the questions and feedback we have received across the health care system. We will continue to update and build on the FAQs over the next coming months.

This space is aimed at supporting heath care systems to share good practice on each of the eight actions. If you require access to the NHS Futures site, or have any queries or resources to share please email england.eandhi@nhs.net. 

New COVID-19 e-learning on recovery and rehabilitation

As the COVID-19 pandemic continues it is recognised that those who recover from the virus often continue to display a range of physical and psychological symptoms that require therapy and support. This new interactive COVID-19 recovery and rehabilitation e-learning programme from Health Education England aims to provide health and care staff with strategies and techniques to manage key symptoms experienced by people recovering from COVID-19. Four 20-minute e-learning sessions cover breathlessness, exercise, cough and fatigue.

The programme is included in the continuing professional development (CPD) portfolio for health and care staff and is useful learning in the lead up to the launch of the second phase of the Your COVID Recovery rehabilitation platform in the autumn. This second phase will require referral and face to face assessment from a healthcare professional, so that it is available to those patients who are able to benefit from the programme. Please do continue to share and signpost to Phase 1, live at the above link.

NICE sets out resources for rebuilding capacity in non-COVID services

The National Institute for Health and Care Excellence (NICE) has set out an array of support as the NHS seeks to return to pre-COVID levels of service provision. The guidelines, resources and briefings cover GP practices, care homes, immunisation, learning disabilities and digital therapies, among other services. More details and advice can be found in NICE’s blog.

NHS COVID-19 app launches today

The new NHS COVID-19 app launches to the public today. It is the fastest way to see if you are at risk from coronavirus. Because the faster you know, the quicker you can alert and protect your loved ones and community. It has a number of tools to protect you, including contact tracing, local area alerts, and QR venue check-in. The app does this while protecting a user’s anonymity. Nobody, including the government, will know who or where a particular user is. The NHS COVID-19 app is the official contact tracing app for England and Wales and it is free.

Reminder: Availability of pulse oximeters for use with people at home and in care homes    

We have purchased a limited supply of pulse oximeters that can be transferred to local areas (via clinical commissioning groups) free of charge, where there is an urgent local need such as increased infection rate of COVID-19 or care homes with insufficient oximeters (each care home is recommended to have one oximeter per 25 beds, with a minimum of two per home).  Primary care colleagues should contact their CCG if they feel there is 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 primary care networks (PCNs). CCGs will need to provide assurance that oximeters will be used under general practice supervision, and that people at greatest risk of COVID-19 will be prioritised.

Guidance is available on the use of pulse oximetry to detect early deterioration of patients with COVID-19 in primary and community care settings. For more information and to submit a request, please email england.home@nhs.net. 

General practice

High impact intervention guides on Advice & Guidance (A&G)

The Elective Care Recovery & Transformation programme has recently published high impact intervention guides on Advice & Guidance (A&G) to support the recovery of elective services.

A&G services provide a digital communication channel between primary and secondary care. This enables closer collaboration between GPs and consultants around the needs of patients, enhances shared decision making, and ensures patients see the right person, in the right place, every time.

These guides set out steps colleagues working across systems may take to establish and strengthen A&G services. By offering rapid access to specialist clinical advice on investigations, interventions and potential referrals, A&G supports GPs and enables system approaches to managing patients needing non-urgent care. 

Online consultations in general practice – changing products

The general practice response to the pandemic has been remarkable. Almost all practices now have access to an online consultation system to support total triage and use of these systems has been steadily increasing. However, we recognise some practices are finding that the product chosen in their area doesn’t meet their needs. Where practices are considering using a different system to the one currently in place, they are strongly encouraged to speak to their commissioner first before moving to a new product - even if a practice plans to fund a product themselves or where a product is being offered on a trial/pilot basis. This is to support a collaborative approach to digitisation and benefits of at scale working.

For further information read our Q&A on procurement, funding and assurance, templates on clinical safety management and practice and commissioner responsibilities depending on the route of procurement.

New functionality matrix for online consultation suppliers

We recently invited suppliers currently on the dynamic purchasing system (DPS) and GP IT Futures frameworks to share information on their online and video consultation products in order to compile a functionality matrix. This sets out the different functions and capabilities that different products offer. We hope this will support practices and commissioners in understanding the different options that are available on the market, but it does not replace any of the procurement arrangements that are in place for these products.

The functionality matrix covers information on:  

• Interoperability with clinical systems
• Triage mechanisms
• Video consultation capabilities
• Implementation and tech support

For more information, please email england.digitalfirstprimarycare@nhs.net.

Community pharmacy

Pharmacy Quality Scheme Part 2 2020/21 published

Guidance to support contractors taking part in Part 2 of the Pharmacy Quality Scheme (PQS) sets out how community pharmacy can be rewarded for providing high quality care and better health outcomes for patients as part of primary care networks.

This year’s PQS has been developed to incentivise quality improvement in areas that support the COVID-19 response including collaborating across primary care networks (PCNs) on flu vaccination of over-65s and business continuity plans, training staff in infection prevention and control, and carrying out individual COVID-19 risk assessments for all staff members.

Key prevention measures, such as recognising patients with red flag conditions such as sepsis or those at risk from suicide, are also included, as well as supporting patients to manage their weight.

Contractors are asked to complete the Part 1 checklist of the PQS as soon as possible, ensuring adaptations have been implemented to ensure the pharmacy is COVID-19 secure and patients and staff are protected. This is a gateway requirement for Part 2.

Video consultations given the go ahead

We recently announced that community pharmacies now need to obtain a patient’s verbal consent and keep a record, for carrying out flu vaccinations, Medicines Use Reviews (MUR), the New Medicine Service (NMS) and Appliance Use Reviews (AUR). In addition, MURs, the NMS and AURs (where suitable) may now be provided by phone or video consultation, without having to seek prior approval from NHS England and NHS Improvement. This should only happen where it is clinically appropriate and where the conversation cannot be overheard by others. We’re also working on possible further flexibilities such as enabling provision of remote consultations from other premises.

Medicines delivery service commissioned in local outbreak areas

To support patients who have been advised to continue to follow previous government shielding advice in specific local COVID-19 outbreak areas, the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service has been commissioned from 24 September 2020, for patients who live in the following local outbreak areas:

• Eight wards within North East Blackburn outlined here until 5 October.
• Leicester City as outlined here until 5 October.

Dentistry

Sign up: NHS dentistry and oral health bulletin

This October, we are launching a new NHS dentistry and oral health bulletin, which will include a roundup of all the latest news and important resources for anyone working in NHS dental services. We will still share important content in this bulletin. Sign up here.

Flu reminders and updates

Medicine and Healthcare Products Regulatory Agency (MHRA) guidelines for movement of flu vaccine

Revised guidelines for the movement of flu vaccines has now been approved by MHRA. These guidelines enable clinical commissioning groups (CCGs), primary care networks (PCNs), general practitioners and NHS trusts to move local flu vaccine stock between NHS providers as necessary. This is a very short interim measure to help with this year’s expanded flu programme as a consultation exercise is currently being conducted on this issue. Any sharing arrangements should ensure that vaccines are kept and transferred correctly. 

Flu vaccine for people with a medical condition

Further to the flu immunisation programme update sent to practices and local systems on 5 August; this is a reminder that people with long term respiratory conditions such as asthma (that requires an inhaled or tablet steroid treatment, or has led to hospital admission in the past) , Chronic Obstructive Pulmonary Disease (COPD), emphysema or bronchitis should be offered the flu vaccine.  Respiratory diseases are a major factor in winter pressures.  It is imperative this cohort of patients undertake prevention activities to reduce the risk of flu and deterioration of their respiratory condition as soon as possible. Details were outlined in the national flu immunisation programme letter of 5 August 2020.

Dates for your diary

Friday 25 September, 3pm - 6pm. Clinical Pharmacy Congress 2020

Wednesday 30 September, 12pm - 1:30pm. Musculoskeletal (MSK) First Contact Physiotherapists: webinar and Q&A session.

Wednesday 30 September, 4pm - 5pm. Digital Primary Care - Flu Campaign 2020.

Wednesday 30 September, 10am - 12pm. New PCN health and wellbeing coaches webinar.

Thursday 1 October, 11am - 12pm. NHS Volunteer Responder programme - webinar (Microsoft Teams link).

Thursday 1 October, 4pm - 5pm. Maximising your money – hints, tips and tools for all NHS staff

Thursday 1 October 2020, 5 – 6:30pm: General Practice webinar

The next General Practice webinar with Nikki Kanani and Ed Waller will include a focus on the national flu programme. This is a closed webinar for those working in or with general practice. Please ensure you register by 12pm on 30 September 2020.

Thursday 8 October, 12pm - 1:30pm. New PCN care coordinators webinar.

 8 - 9 October. UK Annual Social Prescribing Link Worker Day Awards and Conference. A virtual awards ceremony and conference is set to mark the day.