Primary Care Bulletin - today's round-up

8 April 2021

Dear colleagues,

Following yesterday’s update from the Medicines and Healthcare product Regulatory Agency (MHRA) and the independent Joint Committee on Vaccination and Immunisation (JCVI) guidance in relation to the use of the AstraZeneca vaccine, we have published the next steps and actions for all vaccination sites. MHRA and JCVI have made clear the balance of risk is still very much in favour of vaccination. It is therefore critical that we implement their direction in a similarly balanced and operationally robust manner so that we continue to deliver our life-saving programme. Thank you for your continued efforts and, as ever, we are hugely grateful for everything that you are doing to make the NHS-delivery of this programme the success that it is.

New NICE guideline on assessment and management of chronic pain published

A new guideline on the assessment and management of people with chronic primary and secondary pain, setting out the range of treatments people should be offered, has been published by NICE.

The guideline emphasises the need for shared decision making, putting patients at the centre of care, and the importance of healthcare professionals gaining an understanding of how a person’s life affects their pain and how pain affects their life.

It also recommends that a care and support plan should be developed based on the effects of pain on day-to-day activities, as well as a person’s preferences, abilities and goals. Any medicines prescribed should be reviewed regularly for effectiveness, adverse effects and to confirm that the benefits continue to outweigh the risks and the patient’s treatment goal is being met by the medicine(s) in question.

Kiren and Ali

COVID-19 updates and guidance

Government extends free COVID-19 PPE scheme until the end of March 2022

The Government is extending the provision of free COVID-19 PPE to health and social care providers until the end of March 2022. Following the previous announcement of free PPE provision until the end of June 2021, the scheme will now be extended to the end of March 2022 as the expectation of clinical experts is that usage will remain high throughout the next financial year. 

This will ensure that General Practice, dentists, community pharmacy and opticians can continue to access rigorously tested and high-quality PPE. Providers should continue to access COVID-19 PPE via their current distribution channels.

Pulse oximetry for people with darker skin

There have been some reports on the accuracy of pulse oximeters for people with darker skin. Medicines and Healthcare products Regulatory Agency (MHRA) guidance published on 26 March notes that it is possible that patients with lighter skin may have small differences in the result reported when compared to those with darker skin (along with other well-known factors), however, they are not aware of any incidents where skin colour has had an adverse effect on the use of pulse oximeters when providing effective clinical care.  

Existing guidance on COVID Oximetry @home and COVID virtual wards takes this potential factor into account by recommending recording of baseline readings and monitoring trends, as well as using clinical judgement to remain vigilant for other signs of deterioration. Therefore, it remains important that everyone who could benefit has access and support to use pulse oximetry effectively at home to identify silent hypoxia. Please contact england.home@nhs.net with any queries about remote monitoring using pulse oximetry.

COVID-19 has fundamentally changed the way health & social care services are delivered at a time where self-care has also revealed itself as the critical answer to tackling the pandemic. Self-care praxis remains largely understudied, and in particular how the attitudes of health & social care staff may have changed with respect to embedding good health-seeking self-care behaviours in the clients they serve in the new setting.

Imperial College London Self-Care Academic Unit (SCARU) is conducting a qualitative research study to explore this further. Please take a moment to review the Participant Information Sheet of this study which also has ethical approvals in place.

Usage of lateral flow devices for asymptomatic staff testing

On 30 March, the revised Standard operating procedure: Usage of lateral flow devices for asymptomatic staff testing at vaccination sites document was published.

Achievements and developments during 2020/21 flu season
On 1 April 2021, a letter from Professor Stephen Powis was sent out to primary and secondary care colleagues, including all GP practices and all community pharmacies commending the achievements and developments made with regards to the NHS Annual Influenza Vaccination Programme during 2020/2021, referred to as ‘the most successful in the history of the programme’, especially considering the roll out took place during a pandemic.

COVID-19 Vaccination Programme – workspace

General practice

Extension of temporary changes to GP contract under the pandemic regulations

The following temporary changes to the GP contract in England will continue under the pandemic regulations until 30 June 2021:

• A suspension of the requirement that practices report to commissioners about the Friends and Family Test returns
• A temporary suspension of the requirement for individual patient consent in certain circumstances, in order to encourage increased use of electronic repeat dispensing (eRD)
• A continuation of the temporary increase in the number of appointment slots that practices must make available for direct booking by 111 to 1 slot per 500 patients per day.

GP contract legislative changes

The APMS directions reflecting GMS and PMS contract changes that came into force from 1 April 2021 along with the Directed Enhanced Service Directions and the Statement of Financial Entitlements Directions have now been published.

Contractors should note that the revised Influenza Immunisation Scheme is not currently included in this set of DES Directions, but the details of the scheme will be confirmed as soon as possible. We know that practices have already ordered their flu vaccines and they should continue to plan for the 2021/22 flu programme to be delivered by practices as normal.  

National video consultation contract – transition period

We’re pleased to announce that the transition arrangements for the national call off contract for video consultation for general practice have been agreed. Costs will be paid centrally but will be offset against each CCG’s Digital First Primary Care funding. The arrangements will ensure continuity and ensure no practices lose access to a service before it can be procured locally.

We expect the new Digital First Online Consultation and Video Consultation procurement framework to launch later this month. It will provide a range of video consultation products for commissioners and practices to consider, which have been through central assurance. There’s no tie into the national contract and so CCG areas or practices can transition to local contracts at any time. Read more in this blog by Mary Hudson, Assistant Director of Digital First Primary Care.  

Community pharmacy

Community Pharmacy COVID-19 Lateral Flow Device Distribution Service – Register to provide the service

In order to improve access to testing for asymptomatic people, identify positive cases in the community and break the chain of transmission, the Community Pharmacy COVID-19 Lateral Flow Device Distribution Service has been commissioned until 30 June 2021 (inclusive).

NHS Test and Trace is making lateral flow devices (LFD) available through this service for collection from a community pharmacy. Tests will be administered away from the pharmacy. Patients who have symptoms of COVID will not be asked to attend a pharmacy.

The service will work alongside existing NHS Test and Trace COVID-19 testing routes. Community pharmacy contractors can review the service specification here with details of how to register to provide this service. Resources are now available to download to promote the service in your sites.

Pharmaceutical Needs Assessments requirement deferred until October 2022

Pharmaceutical Needs Assessments are due to be renewed and published by Local Authority Health and Wellbeing Boards in April 2022. Due to ongoing pressures across all sectors in response to the COVID-19 pandemic, the requirement to publish renewed Pharmaceutical Needs Assessments will be suspended until October 2022. Local Authority Health and Well Being Boards will retain the ability to issue supplementary statements to respond to local changes and pharmaceutical needs during this time.

Updated Pharmaceutical Needs Assessments guidance will be published this summer. The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 will be updated to reflect this change in due course.

Optometry

General ophthalmic service fees and voucher values from April 2021

A letter and directions setting out the general ophthalmic services fees from April 2021 has been published online. The letter provides guidance for all staff dealing with general ophthalmic services, the hospital eye service, optometrists and ophthalmic medical practitioners.

Primary care

Quickly signpost patients with NHS Service Finder

Improvements have been made to NHS Service Finder, which gives health and care staff access to accurate information when signposting patients to other local services. The latest release makes searching for services faster and simpler, search results are now easier to navigate, and there are also more options for filtering by service type and opening times.

Creating an account is quick and easy, and open to anyone working in health or social care. Register with your NHSmail email address for immediate access from your computer, smartphone or tablet. For more information, visit the NHS Digital website or email service.finder@nhs.net. 

Reminder for self-isolating patients and household contacts not to go to pharmacies

Primary care prescribing colleagues are asked to remind patients advised to self-isolate by Track and Trace, or a household contact of a COVID-19 positive patient, that they should not go to a pharmacy, but arrange for prescriptions to be delivered to them instead.

Patients should:

• ask family, friends or a carer, provided they too have not been advised to self-isolate;
• contact the NHS Volunteer Responders Programme which can support all shielding, self-isolating and/or otherwise vulnerable patients by calling 0808 196 3646; or
• ask their pharmacy or dispensing doctor to arrange delivery where neither of the above are possible.

Home Delivery Services during the COVID-19 outbreak are commissioned throughout England from community pharmacies (and from dispensing doctors) to ensure delivery of medicines to eligible patients who should not present in the pharmacy. Current details of eligible patients are available online.

Dementia and older people’s mental health: guidance for primary care networks and care homes

A new guidance document has been published by the South East Clinical Network on the topic of Dementia and OPMH: Guidance for Primary Care Networks and Care Homes. This document aims to equip members of staff working in care homes and primary care with understanding of dementia and mental health conditions due to the prevalence of both disorders in care home populations.

Evaluation of clinical Advice and Guidance (A&G) services

NHS England & NHS Improvement have commissioned NHS North of England Commissioning Support (NECS) to undertake an evaluation of primary care and commissioner perspectives on clinical A&G services. Findings will help shape future planning and national support for the role of A&G. If you work in primary care and have experience of using A&G services, please take this 10 minute survey by 16 April.  

If you work in primary care or commissioning and would like to be interviewed about your experience of using or managing A&G services, please express an interest via the survey, or email the evaluation team at necsu.reteam@nhs.net. Interviews will last 30-40 minutes via telephone or Microsoft Teams.

Multiple long-term conditions (multimorbidity): making sense of the evidence

One in four adults in England lives with multiple health conditions, and they encounter many common problems with healthcare. How can the system adapt to meet their needs? The National Institute for Health Research has developed a collection of research on multiple long-term conditions (multimorbidity) Which explores the impact of multiple conditions both on people’s lives and on the healthcare service.

Improving the health of deprived communities

The King’s Fund spoke with Stephen Rosenthal, Senior Vice President for Population Health Management at Montefiore, New York, about improving the health of deprived communities. The video of the conversation can be viewed online and is part of their work on integrated care systems, working with NHS England and NHS Improvement. More video interviews with health and care leaders from around the world will be published over the next couple of months.

BLOG: So where does social prescribing go from here?

In this new blog Tim Anfilogoff, Head of Community Resilience at Herts Valleys CCG, and NHS England and NHS Improvement’s Social Prescribing Regional Facilitator for the East of England looks at the crucial role of social prescribing in responding to COVID-19 and the lessons learnt for the future

Dates for your diary

Monday 12 April, 1.30pm - 2.45pm. Roma communities in the UK: from myths and facts to increasing engagement

Tuesday 13 April, 5pm – 6.15pm. Digital Playbooks Dermatology webinar

 Tuesday 20 April, 10am - 11am. 10 Steps to working with people and communities: a case study of culture change

Tuesday 20 April, 12.15pm - 1.30pm An Introduction to working with People & Communities

Tuesday 20 April, 2.30pm - 4:30 pm. Blood Pressure @home: Steps to success webinar

Wednesday 21 April, 5pm – 6pm. Digital innovation in cardiology

Thursday 22 April 2021, 1pm - 2pm. Learning from co-production - using better engagement to address health inequalities

Wednesday 28 April, 5.30pm – 7pm. Primary care networks webinar: A focus on additional roles reimbursement scheme and recruitment

Link of the day

BLOG: ‘I don’t want to mourn another life lost unnecessarily to Covid-19’