COVID-19 Primary Care bulletin

6 August 2020

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

Dear colleagues,

On 31 July 2020, we published a letter covering the latest COVID-19 national alert level, priorities for the rest of 2020/21; and outlines the financial arrangements heading into Autumn as agreed with Government.

We absolutely know that you are continuing to work differently and under challenging circumstances. There is a lot in this letter but the objectives, though ambitious, are the right ones for our patients.

Having pulled out all the stops to treat those with COVID-19 over the last few months, we will now need to redouble our focus on the needs of all other patients too. This will continue to require excellent collaboration between clinical teams, providers and clinical commissioning groups (CCGs) operating as part of local ‘systems’ (sustainability and transformation partnership (STPs) and integrated care systems (ICSs)), with local authorities and the voluntary sector, underpinned by a renewed focus on health inequalities, patient communication and partnership working.

The letter details many areas that will affect you and your teams across primary care as we all look to restore services for the patients we serve.

As we all continue to juggle work and home life, we do hope that you are able to take some time to recharge and switch off.

Nikki and Gabi

Annual flu letter

The second annual flu letter was published on 5 August 2020 giving more details about this year’s expanded Flu Programme. This year, as part of our wider planning for winter, we intend to vaccinate more people than ever before in the existing eligible cohorts, and we are also offering the vaccine to:

• household contacts of those on the NHS Shielded Patient List.  (Specifically, individuals who expect to share living accommodation with a shielded person on most days over the winter and therefore for whom continuing close contact is unavoidable).
• children of school Year 7 age in secondary schools (those aged 11 on 31 August 2020).
• health and social care workers employed through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, to deliver domiciliary care to patients and service users.

We aim to further extend the vaccine programme in November and December to include the 50-64 year old age group subject to vaccine supply. This extension is being phased to allow you to prioritise those in at risk groups first.

In light of the risk of flu and COVID-19 co-circulating this winter, the Flu Programme will be absolutely essential to protecting vulnerable people and supporting the resilience of the NHS. We thank you for your support in delivering it.

General practice

COVID-19 general practice support fund

The Government has previously described the intention to create a COVID-19 general practice support fund to assist with the legitimate additional costs of the response borne by GP practices. We are now able to confirm further details and have published guidance on 4 August 2020 setting out how practices can claim for:

• Specific and net additional costs incurred for bank holiday opening across Easter and on 8 May 2020.
• Additional net costs incurred in delivering additional services to care homes, pursuant to our letter of 1 May 2020. This arrangement is in place from 1 May until 30 September 2020.
• COVID-19 related absence cover from day one of absence, where it was required to maintain necessary clinical and non-clinical capacity, staff could not work from home, and the individual received full pay. This will apply from 23 March to 31 July 2020.
• Additional capacity which has been required between 23 March to 31 July 2020 where supported by the commissioner.
• Costs incurred as a result of purchasing other consumables required as a result of COVID-19.

Shielding notifications for people working in areas affected by local shielding guidance

Following publication of the updated guidance for people who are clinically extremely vulnerable to COVID-19, an updated letter for sharing with patients that are newly added to the Shielded Patient List (SPL) will be available via GP practice systems shortly and can be download.

As noted in last week’s bulletin, there may be exceptions to lifting the Government’s shielding guidance in parts of the country experiencing community outbreaks.  All individuals considered clinically extremely vulnerable (on the SPL) are advised not to enter an area affected by local shielding guidance, including to go to work.

There may be people who live outside, but work within, an area affected by local shielding guidance. These individuals can request a shielding notification as evidence of their clinically extremely vulnerable status e.g. for Statutory Sick Pay purposes.

The shielding notification will also be made available via GP systems and practices can issue the letter directly to patients flagged as high risk on request. There is no requirement for a GP to confirm that the patient works within an area subject to local shielding guidance, as employers will confirm this upon receipt.

Further guidance for practices on shielding notifications for those working in areas affected by local shielding advice will be provided via practice systems shortly.

Support for recruitment of additional social prescribing link workers

Social prescribing link workers (SPLWs) have been an important part of the response to COVID-19, helping to support people with mental health and social issues and contributing to reducing pressure on general practice. Therefore, we are funding a time-limited support offer to cover recruitment and induction costs for additional Network DES funded SPLWs. 

This offer will be available only until 31 January 2021. All primary care networks (PCNs) which are interested in expanding the number of DES funded SPLWs are encouraged to submit an Expression of Interest no later than 24 August 2020. For enquiries relating to this offer please contact: england.linkworkerrecruitment@nhs.net.

Roll out of Electronic Prescription Service (EPS) Phase 4

To help you prepare for winter, we are accelerating deployment of EPS Phase 4 which allows EPS to be used for patients without a pharmacy nomination. All GP practices using EPS with TPP SystmOne and EMIS Web will be live with Phase 4 by mid-September.

Phase 4 significantly reduces the need to hand sign prescriptions and deal with lost prescriptions. GP practices and pharmacies will also be able to track the status of more prescriptions using the EPS Prescription Tracker. 

Using EPS with a nomination is still the preferred and most efficient option, especially during the coronavirus (COVID-19) pandemic, so please continue to encourage your patients to nominate.

GP practices: Phase 4 functionality will be enabled automatically for all TPP SystmOne and EMIS Web practices that use EPS (including dispensing practices) from 7 September 2020. EPS Phase 4 is not currently available in the Vision or Microtest systems.

To ensure a smooth transition, it is recommended that practices enable Phase 4 before this date. This will give teams more time to access support from their clinical commissioning group (CCG) EPS lead if necessary. Practices can contact their CCG to arrange a go-live date. For most practices the move requires minimal action, but teams should consult the support materials and readiness checklist.

Pharmacies: As more practices go live with Phase 4 over the coming weeks, pharmacies and other dispensers will see the majority of hand-signed FP10s replaced by Phase 4 tokens.

Online consultations and video consultations – implementation and clinical safety

The roll out and use of online consultation systems across general practice has rapidly increased as part of the response to COVID-19. Effective implementation of these systems is crucial to getting benefits from them for both patients and staff.

We have produced templates and resources (login required) to help practices and commissioners safely implement and optimise use of online and video consultation systems more easily and share learning. Clinical safety risk management is a joint responsibility of commissioning and deploying organisations, and the resources provided give advice on how clinical commissioning groups (CCGs) and practices should work together to mitigate risk. Alongside these we have also produced a Q&A document which covering procurement, contractual issues and funding arrangements.

To ensure practices and primary care networks (PCNs) are fully supported with digital first pathways and the associated process change, tailored implementation support and hands on capacity is available and can be accessed by contacting your CCG or your NHS England and NHS Improvement regional team via england.digitalfirstprimarycare@nhs.net

Government plan for cycling and walking

The plan published by the Department of Transport on 28 July 2020 has been widely covered in the media, including a reference to ‘bikes on prescription’ from GP practices. This will not be widely rolled out immediately. The next stage is expected to be a series of pilot programmes in areas with poor health and low physical activity rates. The Government is now working with stakeholders in healthcare, local authorities and communities to develop the pilots. The funding is coming from money previously announced for Active Travel in May, and is part of the Government’s broader approach to preventing poor mental and physical health as outlined in the Prevention Green Paper published in 2019.

EMIS Web practices: new electronic notifications for the urgent supply of medicines

You will soon be able to receive electronic notifications from pharmacies about the urgent supply of medicines made as part of the NHS Community Pharmacist Consultation Service (CPCS). This will inform you that a patient registered with your practice has received an urgent supply of medicine from a community pharmacy.

EMIS Web practices will have the new functionality enabled this month. EMIS will inform you of your specific switch on date.

The notifications arrive as a workflow task within the EMIS Web system, prompting you to add the information to a patient’s record.

Please note, if you use a third-party product such as Docman for your patient document management you will need to configure your Document Management task settings in Workflow Manager.

You should still continue however to check for notifications received via NHSmail, fax or post.

System guidance is available from EMIS. Information is also available on the NHS Digital website.

Dispensing Services Quality Scheme (DSQS) – update for dispensing practices only

Our letter dated 9 July 2020 confirmed that the DSQS would be reinstated from 1 August 2020, and that dispensing practices wishing to participate in the Scheme this year would need to inform their commissioner.

Following further discussions with the British Medical Association (BMA), we are planning to revise the Scheme’s requirement in relation to patient medication reviews this year.

The Scheme currently requires dispensing practices to deliver medication reviews for at least 10% of their dispensing patients. This requirement will be reduced to 7.5% this year in light of the current circumstances. Practices are asked to prioritise patients who they consider to be higher-risk or would benefit most from a review. Practices will also be able to undertake these reviews remotely if they so wish and it is clinically appropriate. The Statement of Financial Entitlements (SFE) will be amended to reflect this.

The other requirements of DSQS will remain the same – please refer to the SFE for further details. A letter will be sent to dispensing practices soon confirming the position. 

Community pharmacy

Roll out of Electronic Prescription Service (EPS) Phase 4

To help you prepare for winter, we are accelerating deployment of EPS Phase 4 which allows EPS to be used for patients without a pharmacy nomination. All GP practices using EPS with TPP SystmOne and EMIS Web will be live with Phase 4 by mid-September.

As more GP practices go live with Phase 4 over the coming weeks, pharmacies and other dispensers will see the majority of hand-signed FP10s replaced by Phase 4 tokens.

See full article in the General Practice section.

PPE orders for community pharmacies

From Wednesday 5 August 2020, the Department of Health and Social Care (DHSC) will be emailing community pharmacies, inviting them to register with the PPE portal. The portal has been developed by DHSC in partnership with eBay UK, NHS Supply Chain, the Army, Clipper and Royal Mail.

Emails will come from PPE Dedicated Supply Channel (please note this email address does not accept incoming emails): ppe.dedicated.supply.channel@notifications.service.gov.uk. Please ensure that you are regularly checking your NHS email accounts in order to ensure that the invitation is received and actioned.

Pharmacies are encouraged to register promptly, to ensure they can order emergency personal protective equipment (PPE) from a central inventory. This is to supplement (not replace) the wholesale supply route that already operates. New users will initially have small order limits, but these are under review.

Orders through the portal should arrive within 48 hours if placed before 1pm. Orders placed after 1pm will be subject to an additional 24-hours.  Information on what items are available for your sector and size will be made available from Monday 3 August on the DHSC Guidance webpage.

If providers have any queries or have not received an email invite by close of play Monday 10 August, please contact the PPE portal customer services at: 0800 876 6802.

Further detailed information is also available on the NHS Business Services Authority website.

Optometry

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

Dentistry

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

Additional information

Urgent PPE support from NSDR moving to Monday – Friday only

Due to a significant decrease in emergency orders of Personal Protective Equipment (PPE) during weekends, the National Supply and Distribution Response (NSDR) service will start to reduce its weekend support for emergency orders of PPE and will operate during weekdays only, from 7am on Monday to 10pm on Friday.

Should you experience a shortage of PPE over the weekend, please seek mutual aid with another provider, or for organisations who have registered on the PPE portal, please submit your request via that route.

If your organisation has exhausted all other PPE supply routes, you can still phone the National Supply Distribution Response (NSDR) 24 hours a day, seven days a week on 0800 915 9964. Your case will be logged but PPE requests will only be addressed during the above operational hours.

If required by a significant incident, an emergency weekend service would look to be stood up again at short notice.

Aftercare for COVID-19 patients

We have updated our guidance on the aftercare needs of inpatients recovering from the virus, to reflect the NHS’s move to the third phase of its response to COVID-19, and the increasing evidence base about the ongoing needs of some patients.

Reforms to initial education and training of pharmacists

The UK Pharmacy regulators and the four Chief Pharmacists published a letter on 28 July 2020 updating on major reforms to the five year initial education and training programme for pharmacists, being taken forward across the UK.

The reforms will ensure pharmacists are equipped with the necessary skills to take on extended clinical roles and work flexibly across sectors and in collaboration with other healthcare professionals, to help meet changing demands in healthcare and pharmacy practice.

Once the standards for independent education and training are finalised, there will be a phased approach to implementation. The reforms will start in July 2021 for those beginning their fifth year of education and training, as the current pre-registration year develops into a foundation period – announced jointly with Health Education England on 23 July 2020.

Download our #LookingAfterYouToo poster and share our coaching offer with colleagues

We recognise that our frontline primary care colleagues are facing unprecedented challenges looking after others, which is why we want to look after you too.

#LookingAfterYouToo is free coaching support available to all primary care staff, both in clinical and non-clinical roles, available 7 days a week, 7:15am – 10pm by phone or video. 

We’ve seen over 2,000 people benefit from dedicated sessions with experienced coaches. One GP said they were thinking of quitting after the pandemic but said “the session was a huge relief and felt like magic.” 

We’d like to promote this fantastic offer and reach as many people as possible. You can help us by downloading this poster to send round to colleagues, or to print out and display in your workplace.

This week's case study

Implementing weekly ‘care rounds’ in care homes

Having tried to work more collaboratively to deliver a more proactive service to care homes, Barrow and Millom Primary Care Network (PCN) in Morecambe Bay finally found a way with PGP Quick Start.

They piloted a standard weekly 'care round' in care homes approach and process, to be rolled out across the PCN. The pilot demonstrated an increase in the number of residents the GPs see by 36% per month, whilst reducing travel and admin time by 30%. 

Read the full story.

Dates for your diary

Thursday 6 August, 5 - 6pm – GP webinar with Nikki Kanani and Gabi Darby

Digital Primary Care online presence – accessibility compliance

Public sector organisations have a legal duty to make sure websites and apps meet accessibility requirements. The accessibility regulations aim to help make sure online public services are accessible to all users, including those with disabilities.

CCGs and GP practices are invited to attend one of two webinars and learn more about meeting the W3C accessibility standards before the deadline of 23 September 2020.

Wednesday 19 August, 5 – 6pm – book now

NHS Volunteer Responder programme updates – new webinars

Fortnightly webinars are being held to provide regular updates on the NHS Volunteer Responder programme. The webinars are for referrers and colleagues working across health and care, including: primary care; social care; local authorities; government departments; voluntary sector organisations; STPs and ICSs; and NHS England and Improvement regional teams.

These webinars 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 20 August, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 3 September, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 17 September, 11am - 12pm - Join Microsoft Teams Meeting
• Thursday 1 October, 11am - 12pm - Join Microsoft Teams Meeting

Nikki and Ed's link of the day 

Care Quality Commission: Registration: flu vaccination arrangements