27 August 2020

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

Dear colleagues,

Last week we shared Public Health England’s updated infection prevention and control (IPC) guidance, helping primary care colleagues to assess appropriate IPC measures. The guidance includes the following information on the use of PPE when administering vaccinations:

In some clinical outpatient settings, such as vaccination/injection clinics, where contact with individuals is minimal, the need for single use PPE items for each encounter, for example, gloves and aprons is not necessary. Gloves and aprons are recommended when there is (anticipated) exposure to blood/body fluids or non-intact skin. Staff administering vaccinations/injections must apply hand hygiene between patients and wear a sessional facemask.

We’d like to take this opportunity to wish you all a safe and happy bank holiday weekend. 

Nikki and Ed

General practice

Shingles vaccination programme for those who missed it during lockdown or were shielding

Individuals become eligible for routine vaccination against shingles when they become 70 years of age and for those in the catch-up cohort, as they become 78 or 79 years of age. All eligible individuals retain eligibility to receive the shingles vaccine until they become 80 years of age.

As lockdown and shielding measures are easing, this a reminder that the shingles vaccine can be offered opportunistically to the cohorts outlined above. Shingles vaccination as part of the routine immunisation programme is covered under the national PHE PGD and may be administered at the same time as the pneumococcal vaccine (Pneumovax 23) and when available, inactivated influenza vaccines.  

Some individuals who were eligible for the shingles (catch-up) vaccination programme may have turned 80 years during the pandemic and missed the opportunity to be vaccinated, either due to lockdown or because they were shielding at home and unable to attend their general practice. This cohort of individuals is likely to be very small and can still be offered shingles vaccine unless contraindicated, up to the 31 December 2020. This temporary offer applies only to those who were eligible and who missed shingles vaccination because they were shielding and who turned 80 years of age during that period. It is only applicable to periods of time when lockdown or shielding was recommended.

Payment for this should be at the same rate as other shingles vaccines and will be managed by local commissioners. As this cohort will not be included in the Shingles PGD, a Patient Specific Direction (PSD) should be used by practices for this specific cohort of patients.

Physician Associate (PA) supervision support programme for GPs

Health Education England has commissioned a Physician Associate (PA) recruitment and supervision support programme for any practices thinking of employing a PA for the first time. It is available for a limited time, at no cost to your practice. Through the programme experts will support:

• understanding the role, scope and benefits of employing a PA
• making sure your PA is seeing patients confidently, effectively, safely and efficiently
• understanding how services to patients can develop
• developing the PA role to benefit you in the long term.

Find more information here, or email info@our-path.co.uk.

Dentistry

Analgesics for dental pain

Based on toxicovigilance assessments during the pandemic, there is the potential for patients with dental problems to take excessive dosages of analgesic medications instead of attending the dentist. Please see the following poster for guidance on dental pain relief.  

Community pharmacy

The most recent guidance letter and standard operating procedure for community pharmacy is available on our website.

Optometry

The most recent guidance letter and standard operating procedure for optical staff is available on our website.

Additional information

First Contact Practitioner workforce modelling tool

First Contact Practitioners (FCPs) provide increased capacity to general practice by offering patients with musculoskeletal (MSK) conditions direct access to advice, assessment and self-management options across the MSK pathway. FCPs also help reduce unwarranted variation in secondary care referrals and imaging requests.

The NHS Long Term Plan sets out a commitment to ensure all patients have direct access to FCPs by 2022/23. To deliver this ambition, and support systems with their mobilisation planning, the South, Central and West Commissioning Support Unit has developed a FCP workforce modelling tool (join the workspace if you do not have access). Primary care networks (PCNs) can use this tool to identify FCP workforce capacity at a system level, including potential gaps and areas of opportunity. For more information on FCPs or the workforce modelling tool, please contact england.fcpmsk@nhs.net.

Hospital discharge publications

The Department of Health and Social Care have published new documents to support hospital discharge processes; these take account of the learning gleaned from the pandemic and support the discharge to assess principles on which the COVID-19 Hospital Discharge Service Requirements were based.

The documents aim to reinforce appropriate and timely discharge, ensuring individuals have the best possible outcomes when they return home from hospital. The policy and operating model outlines the national policy for discharge across health and social care, and action cards provide role-based specifications which highlight the important elements of work for key groups of staff involved in discharging patients. 

Reintroduction of NHS Continuing Healthcare (NHS CHC) guidance

New guidance has been published to support the reintroduction of NHS Continuing Healthcare assessments by Clinical Commissioning Groups (CCGs) and Local Authorities from 1 September 2020. The new guidance document sets out how CCGs, working with local authorities, reintroduce NHS CHC assessment processes and how this aligns to the introduction of a maximum of 6 weeks of funded health and care recovery and support services after discharge from hospital. It also addresses the deferred assessments from the period of 19 March – 31 August 2020.  

Patient Safety Specialists

As part of the NHS Patient Safety Strategy, NHS organisations in England have been asked to begin the process of identifying one or more person as their designated Patient Safety Specialist(s) to lead on patient safety across their organisation. NHS trusts, foundation trusts and CCGs are required to identify one or more person as their Patient Safety Specialist(s) by the end of November 2020. However, any other organisations that feel they are in a position to introduce a Patient Safety Specialist(s), should contact our patient safety team by emailing patientsafety.enquiries@nhs.net. 

COVID-19 Crisis Counselling Support Service

As we continue to respond to the impact of COVID-19 on health and social care staff, we are delighted that so many colleagues have taken up one or more of the various elements of the national support offer through the NHS People website.

In addition to those services we have commissioned, we have now added a free service developed and funded by the Association of Christian Counsellors, who are offering up to 10 online or telephone counselling sessions to people working within the NHS who are directly impacted by COVID-19; people working in residential care homes who have been impacted by caring for those with Covid-19; and anyone who has been bereaved during this time. The confidential service is open to people of all beliefs and none, and you can ask to be matched on ethnicity. You can call them on 0247 644 9694.

Clinical entrepreneur training programme - helping bring innovations into the NHS

The latest round of NHS England and Improvement’s clinical entrepreneur programme is open and welcoming applications from a diverse range of clinical and non-clinical healthcare professionals. The clinical entrepreneur programme is the biggest entrepreneurial workforce development programme of its kind, aiming to provide the commercial skills, knowledge and experience needed to successfully develop and spread innovative solutions to the challenges facing the NHS. If you (or someone you know) might be interested in applying, find out more here. Contact england.cep@nhs.net if you have any questions.

Share your experience of remote diabetes consultations

Have you delivered remote diabetes consultations with your patients living with diabetes during the pandemic? If so, Diabetes UK want to hear from you. They have created surveys for both healthcare professionals and people living with diabetes to provide an opportunity to share their experiences of remote diabetes consultations during the pandemic. They hope to improve their understanding of these experiences to inform future work. Find out more and have your say before 6 September 2020 by visiting their website. Please share widely with your colleagues and patients living with diabetes.

Dates for your diary

Tuesday 1 September, 2pm - 3pm - Phase 3 of COVID-19 and Population Health Management

This session will cover the national update on Phase 3 and how the Population Health Management (PHM) approach can support; local updates on PHM work to support COVID-19 response and recovery. The event is aimed at PCN, Place and System teams – clinicians, managers and commissioners and anyone with an interest in PHM.

Thursday 3 September, 12pm - 1.30pm - ‘Tackling Health Inequalities: Tackling CVD’ for leaders in primary care

Throughout the pandemic, health inequalities across the UK became apparent. For Cardiovascular Disease (CVD), health inequalities are prominent and accounts for more than a quarter of deaths in England. Professor Chris Bentley shares evidence and solutions of what works to reduce health inequalities, incorporating both place-based and evidence-based approaches. For more information, please email england.clinicalpolicy@nhs.net.

Thursday 3 September, 5pm - 6pm - General Practice webinar

The next General Practice webinar with Nikki Kanani and Ed Waller will include a focus on remote consultations and include a guest speaker from National Voices. This is a closed webinar for those working in or with general practice. To attend please ensure you register in advance.

Tuesday 8 September, 11.30am - 12.45pm - Building back from COVID-19: tackling health inequality in partnership.

The second in a series of NHSEI Integrated Care Webinars - run in collaboration with SCIE - will look at tackling health inequalities in partnership; how systems can work together and plan for action at both system and place level.

NHS Volunteer Responder programme updates

Webinars are being held to provide regular updates on the NHS Volunteer Responder programme for referrers and colleagues working across health and care. They 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 3 September, 11am - 12pm
• Thursday 17 September, 11am - 12pm
• Thursday 1 October, 11am - 12pm

Online workshops on remote monitoring

During the COVID-19 outbreak, some NHS organisations used technology to support people with COVID-19 at home. Join this webinar series to hear from the clinicians involved about how this worked, what they did and what the benefits were.

• Tuesday 8 September, 10am - 11am. Tech-enabled Virtual Ward Model - the West Herts experience
• Tuesday 22 September, 10am - 11am. The primary care hot hub - the West London experience

Please contact InnovationCollaborative@future.nhs.uk for more information.

Nikki and Ed's link of the day 

The Burden of Disease in England compared with 22 peer countries: executive summary