COVID-19 Primary Care bulletin

1 May 2020

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

Dear primary care colleagues,

Following the letter published this week outlining the second phase of NHS response to COVID-19, we will continue to share information in the coming days on how this will impact primary care services.

In particular, we have published a letter asking primary care and community health services to help provide the best possible care for our care home residents at this difficult time.

We would like CCGs, working with primary care and community providers to ensure:

• timely access to clinical advice for care home staff and residents;
• proactive support for people living in care homes; and
• care home residents with suspected or confirmed COVID-19 are supported through remote monitoring – and face to face assessment where clinically appropriate – by a multidisciplinary team.

We will shortly share details of webinars and further support offers to enable all areas to offer this if they do not already.

8 May Bank Holiday Opening

Last Friday’s bulletin described an outline expectation for opening on the Early May Bank Holiday. We can now confirm our position.

• GP Practices may need to open as part of providing appropriate access on 8 May; any decision not to open must be agreed with their CCG in advance on the basis of the service and level of staff cover required. Network level cover may be agreed as an alternative in view of anticipated demand. We expect the level of demand to be lower than over Easter. Reimbursement of staff costs will be at the same rates as Easter – see financial arrangements below.
• Planned bank holiday cover (OOH/IUC/EA) to be adjusted as needed in response to GP practice opening and in view of demand.
• We are requiring all community pharmacies in England to open 2-5pm with exceptions or a variation to those hours, based on the likely demand and local needs, agreed in advance with the NHSE/I regional team. These three hours will be remunerated at a rate of £250/hour.Further information will follow regarding how to claim.
• Planned community pharmacy and urgent dental care bank holiday cover to proceed unless otherwise agreed with NHSEI regional team.
• All opening arrangements and any exceptions to be settled on by Thursday 7 May and the NHS Directory of Services updated accordingly.

We continue to recognise that this is another bank holiday we are asking at least some primary care staff to give up. Many of our Muslim colleagues may have the additional challenge of fasting during this holy month of Ramadan and may have been looking for the support of an additional rest day. Childcare difficulties may also be present for many, but staff should check locally if schools/nurseries for key workers in your areas are available as usual. However, we hope the additional flexibility to better match staffing levels for this bank holiday means some of you can still enjoy a well-earned rest.

Nikki and Ed

General practice 

Financial arrangements for 8 May Bank Holiday Opening 

Where it is determined that a GP practice must open on Friday 8 May they will be able to seek reimbursement for costs incurred in line with the respective rates below for all staff cover agreed in advance with their CCG. The rates are:

• 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;
• GP Partners up to two additional sessions 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.

CCGs are responsible for reimbursing practices and will be reimbursed themselves at these standard national rates. Further costs incurred as a result of the pandemic will be confirmed in due course as part of the details for the General Practice COVID support fund. 

Remote total triage in general practice

As part of Health Education England (HEE) e-learning programme for COVID-19 a remote total triage in general practice resource has been developed by the Digital First Primary Care Team at NHSE/I and HEE to support all GP practices in England with the rapid implementation of a ‘total triage’ model.

This model enables practices to use an online consultation system to gather clinically relevant information from patients in their own time and triage patient contacts, responding using the most appropriate modality to meet the patient’s needs such as via telephone, video, text or online messaging. Non-digital users are taken through the same process by administrative staff over the telephone.

Total triage is important to reduce avoidable footfall into practices and protect patients and staff from the risks of infection. It enables practices to manage work more efficiently, whilst supporting continuity of care and equity of access.

Notification of COVID-19

COVID-19 is a notifiable disease; guidance on reporting notifiable diseases is available on the GOV.UK website. Suspected COVID-19 cases should be notified by general practice. Test confirmed cases will be notified by the laboratory. The GOV.UK website provides guidance on which cases should be reported to local health protection teams.

Community pharmacy

Amendments to the Misuse of Drugs Regulations (MDR) 2001 Regulations

Amendments to the MDR 2001 Regulations were laid on 29 April. These enable the Secretary of State to make an announcement at a time of pandemic that would then, following that announcement, permit the following for NHS services:

• The supply of schedule 2 and 3 CDs under a Serious Shortage Protocol (HMR Regulation 226A).
• The emergency supply of Schedule 2 and 3 CDs during a pandemic (HMR Regulation 226).
• The ability of a pharmacist to change the interval on an instalment prescription in consultation with the prescriber (HMR Regulation 15).

There is no change in practice until the flexibility introduced by the legislation is activated by an announcement from the Department of Health and Social Care.

Market Entry

Further to the statement on suspension of market entry activity in the letter from Keith Ridge and Ed Waller dated 31 March 2020, NHS England and Improvement and Primary Care Support England (PCSE) are working to progress applications where there is a pressing reason for doing so. PCSE has contacted applicants to advise them on what to do if they wish to ask for their application to be progressed. Where a decision has been made and notified to the applicant and interested parties then the usual timescales apply. For more information please see the PSNC website.

Dentistry 

Antibiotic Prescribing

For oral health professionals seeking guidance on the prescription of antibiotics for urgent dental care during sustained transmission of COVID-19, a note has been published by Public Health England, Royal College of Surgeons FDS, Faculty of General Dental Practice (UK) and the British Dental Association which seeks to clarify the appropriate approach to this.

Optometry

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

Additional information

Bereavement support for #OurNHSPeople

On 28 April we observed a minute's silence to honour colleagues in health and care who have lost their lives to COVID19. It is an incredibly tough time for many of us at the moment, and we may need to reach out for support. NHS England and NHS Improvement have put together a suite of bereavement resources that aim to help you access support during what will be a difficult time for our staff, given the restrictions and changes to normal grieving patterns and processes for staff who come from diverse backgrounds. In recognition of this, you can find a selection of resources that will support you during a bereavement, be that practical next steps to take as a line manager or confidential bereavement support staffed by a team of specialists.

You can access the bereavement support online or you can call the confidential bereavement support line, operated by Hospice UK, on 0300 303 4434. This is free to access from 8am – 8pm, seven days a week.

Primary care wellbeing survey

We would like to understand the current wellbeing of the primary care workforce, and invite you to take part in a short survey undertaken by the Institute for Employment Studies to support this and to support the wider evaluation of the #lookingafteryoutoo  Primary care coaching offer. The survey will take no longer that 5 minutes to complete and will contribute to our ongoing response to support your wellbeing.

Dates for your diary 

Upcoming webinars

• 6 May, 7-8pm: Community Pharmacy webinar with Keith Ridge and Ed Waller

• 7 May, 11am: Homeless Health webinar

• 7 May, 5-6.30pm: Primary Care webinar with Nikki Kanani and Ed Waller including a Q&A session

​To catch up on previous webinars visit Future NHS

Nikki and Ed's Link of the Day

Prerana and Nikki’s blog on ethnicity and COVID