COVID-19 Primary Care bulletin

7 April 2020

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

Dear primary care colleagues,

In this fast moving environment, we are grateful for the way everyone across primary care is adapting and supporting our communities through this very difficult time.

Today saw the launch of the NHS Volunteer Responders service where over 750,000 people have volunteered their time to drive patients to appointments, collect medicines from pharmacies and making regular phone calls to check on people isolating at home. We strongly encourage all of you to make full early use of the volunteer responders for your patients. Further details on how you can make use of this resource are available here. 

Below we have outlined arrangement for the forthcoming Bank holiday weekend. We are sorry to be sending this information so close the bank holiday weekend but hope the details below will help you to finalise your arrangements.

On personal protective equipment:

• Work continues to increase distribution of PPE equipment, with a further nationally coordinated push of supplies this week for GPs, pharmacy and urgent dental services.
• Additional PPE equipment has also been released to established wholesalers to ensure primary care can get hold of supplies through business as usual routes.
• Over 30 million items of PPE are being delivered across Local Resilience Forums in England and will provide further support in maintaining access to supplies at a local community level, including GPs.
•  Any primary care providers who continue to experience problems getting hold of PPE equipment, who are in need of urgent or emergency supplies can still contact the NSDR.  
• We continue to keep arrangements under review to ensure all healthcare providers who have a clinical need for PPE are able to access the necessary equipment.

Our next webinar for primary care will be on Thursday 5-6pm

Nikki and Gabi

Bank holiday preparations – access to primary care services

COVID-19 demands are anticipated to be at their highest so far in many areas, with increasing care needs for our population and impact on staff. We have previously asked for primary care to align with the rest of the NHS, and to treat the Easter bank holiday as a normal working day. This will be no normal weekend, as you will have anticipated. Local Resilience Forums (LRFs) are working to maximise capacity right across the system. Thank you in advance for your support.

GP Services
Necessary changes to GP contract regulations now mean Friday 10 April (Good Friday) and Monday 13 April (Easter Monday) are defined as core hours, meaning they are normal working days for general practice, as they are for the whole NHS system.

Patients with COVID-19 symptoms will continue to be advised to use NHS 111 online as the first port of call. Our expectations for general practice services on these days are that:

1.  all GP practices will be open (available) in line with core hours. The exception to this is when alternative arrangements have been agreed in advance with your clinical commissioning group (CCG) e.g. where a primary care network (PCN) ensures availability to meet anticipated demand within core hours. Transferring calls to NHS 111 will not be an option.
2. remote triage will be available for delivering care and treatment wherever possible and appropriate.
3. patients identified at highest risk from COVID-19 and who have been advised to shield will continue to receive proactive clinical management support.
4. any essential face-to-face services (including home visits) that may be required will need to be delivered in line with the GP Standard Operating Procedures.

We recognise that this short notice change presents challenges for you and your staff (including childcare difficulties, although you may wish to check if schools/nurseries for key workers in your areas are available as usual). Practices should discuss with their local CCG the level of service required on the bank holiday, and agree what staff cover is needed. 

CCGs, working with their LRFs, will need to take a system wide view of available services, particularly when considering the need for any alternative arrangements (e.g. cover by a PCN member practice) and the reciprocal impact on Extended access hub/Integrated Urgent Care/Out of Hours services that had otherwise been planned. Planned in-hours cover may be adjusted to reflect these services. The Directory of Services should be updated with the practice availability.

National patient facing communications will confirm the availability of GP services on these days but we are asking you and CCGs to use your usual channels to alert patients to the changes locally so they know how they can contact your (or a nearby) practice on these days where appropriate.

Community Pharmacy and Urgent Dental Care
The changes for general practice also naturally impact community pharmacy as it is important patients have confidence in their ability to access pharmaceutical services on these days. We are requiring pharmacies in England to open from 2pm to 5pm on 10 April 2020 and 13 April 2020.

Any pharmacy that was planning to open longer hours should still to do so to support access for patients through the day.  Where pharmacies had been directed to open by regional teams (RT) as part of the Easter planning activity before the COVID-19 pandemic these arrangements and payment stand unless agreed otherwise between the contractor and NHSE&I regional team.

The NHS England and NHS Improvement regional office should be contacted if:

• a pharmacy is unable to open for reasons beyond the control of the contractor
•  the pharmacy wishes to seek exemption from the requirement to open e.g. if a pharmacy is in an area where there is minimal demand due to the Government’s social distancing policy (e.g. large shopping malls)
• there are circumstances where it makes more sense for local communities if the opening hours are outside of 2-5pm.

NHS England and NHS Improvement regional teams will consider exceptions and the local flexibility needed based on the needs of patients in the areas served and in view of the challenges for pharmacy staff. Contact details of NHS England and NHS improvement regional pharmacy commissioning teams can be found at:  https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-contract-teams/  

Pharmacy 111 DoS profiles have been updated to reflect the 2-5pm opening hours.  Pharmacies with different opening hours or pharmacies that are closed should ensure their NHS 111 DoS Profiles entries reflect their opening hours over the bank holiday weekend.   (DoS Profile Updater is available at https://dos-profile.service.nhs.uk and the emergency change number is 0300 0200 363). 

To support patient access pharmacies will also need to ensure their NHS Website entries reflect their opening hours.

Urgent dental services will also be available.

We are asking that CCGs signpost GP practices to available services and their opening hours on these days and again the Directory of Services should be updated.

In summary the commissioning model for Good Friday and Easter Monday is as follows:

Financial arrangements
Pharmacy contractors will be able to claim a payment for opening for directed hours. The detail of this payment is being negotiated with the Pharmaceutical Services Negotiating Committee. 

GP practices open on Good Friday or Easter Monday will be able to seek reimbursement for additional staffing costs. Further costs incurred as a result of the pandemic will be addressed in due course. 

Practices should discuss with their local CCG the level of service required on bank holidays, based on the need for care and local capacity and agree in advance what additional staffing will be reimbursed.  CCGs are responsible for reimbursing practices and will be reimbursed themselves at standard national rates, which will be confirmed this week.

General practice

Secure messaging available in the NHS App
The EMIS and TPP systems enable patients to send non-urgent secure messages to their practices. Practice staff receive and respond to these in the clinical system. Around 900 practices currently use this feature.

Patients registered with EMIS practices can now use the NHS App to send and receive these messages. If a practice has already enabled messaging then patients will be able to use the app and the practice doesn't need to do anything. If an EMIS practice wants to start using this feature then they will need to enable it in the EMIS system. This feature will be enabled for patients at TPP practices in the coming weeks.

Instructions on how to set up and manage this feature in EMIS is available at https://digital.nhs.uk/appstaff

Community pharmacy

The Royal Pharmaceutical Society and the General Pharmaceutical Council have produced a letter for community pharmacists in support of the legitimate movement of pharmacy employees between their home and place of work. 

We will be hosting a COVID-19 webinar for community pharmacists and pharmacy technicians on Wednesday 8 April. Join Keith Ridge Chief Pharmaceutical Officer, from 7pm via MS Teams bit.ly/3bOqSwq.

Dates for your diary

Wednesday 8 April 3pm – 4pm 

Webinar: Group video consultations and video consultations in care homes

Video consultation has huge potential for supporting group consultations, virtual pods to support patient-led/clinician-guided observations and also virtual ward rounds in care homes and other residential settings. Join us for this webinar to hear about experience of using video consultation with patient groups in Lancashire and how they can help patients support one another and also create efficiencies for staff. We will also cover how to establish virtual ward rounds in care homes, virtual pods and what to consider when doing video consultations in these settings.

Wednesday 8 April, 7pm - 8pm

Webinar: Professor Keith Ridge, Chief Pharmaceutical Officer

This is a fortnightly webinar for community pharmacists and pharmacy technicians. This week’s guest is Dr Susan Hopkins, Public Health England’s National Incident Director for COVID-19.

Thursday 9 April 12pm - 1pm

Webinar: Keeping focused, safe and legal – running your CCG during the COVID-19 crisis

This webinar from NHS Clinical Commissioners, Browne Jacobson LLP and the Good Governance Institute will cover everything you need to know and answer any burning questions you may have about operating as a CCG in the current COVID-19 crisis.

These, and other webinars, are on primary care webinar page.

Nikki and Gabi's Link of the Day

RCGP learning: Ethical Guidance on COVID-19 and Primary Care