COVID-19 Primary Care bulletin

10 April 2020

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

Dear primary care colleagues,

As many of us continue to work into the bank holiday weekend, we wanted to say a huge thank you particularly to those involved in opening services over the bank holiday and identifying the highest risk patients.

Identifying highest risk patients – action required

Thank you for your considerable patience as we work to improve the process for identifying individuals at highest clinical risk from COVID-19, following our letters of 21 March and 3 April.  As you know, we are asking this group who are at highest clinical risk of mortality and severe morbidity from COVID-19 to shield, stay at home and avoiding face-to-face contact for a period of at least 12 weeks.  The Government has established a national support offer to make sure they have access to medicines and basic supplies during this time. 

This letter, issued by Central Alert System this morning, now confirms the specific tasks we need GPs to complete in this process, as soon as possible, and where possible by 17:00 Tuesday 14 April. This timeline is to ensure that all relevant patients have been flagged and that they will be able to access the government support offer. There will be a lag between flagging any additional patients, and the information being processed centrally, and if in the meantime any of these patients require urgent additional support they should contact their local authority.

Nikki and Gabi

General practice

COVID-19 staff absence tracker

We know that COVID-19 is putting unprecedented pressure on the NHS workforce. In order to make it easier for you to monitor staff levels and identify any support needed, we have created a tool to make it simple for staff and managers to report COVID-19 related absence.

The new staff absence tracker service has launched and all GPs and practice staff should use it to report their COVID-19 related absence from work and subsequent return to work. It can be accessed from any computer or mobile device, is very easy to use and will provide an invaluable source of national data on the absence rate in general practice that will allow us to better target support.

Staff should register using their NHS email address and if they provide the details of their practice manager or rota manager, they will be automatically informed of the absence. The tracker can be completed by either the member of staff themselves, their line manager, or others such as relatives as a ‘guest’. Reporting should commence from today. 

Right to work verification for returning doctors

Thank you to all the practices who have helped returning GPs to complete their right to work verification so far, your support is greatly appreciated.

Whilst many returning GPs will choose to do their return to work verification virtually, if returning doctors do approach your practice team for help with this, we would be very grateful if teams could:

• check the documents presented and satisfy themselves that they are consistent with the appearance of the individual,
• take a photocopy or a scanned copy of each of the documents presented,
• complete the identification checklist which can be found here along with further information about the process, and
• send scanned copies of the verified documents and the checklist to the GP’s employer at COVID19.CAS@nhs.net from your organisation’s NHS.net account, or another encrypted account if this is not possible.

We know that teams are already exceptionally busy and thank you for your continued help.

Remote working in primary care

Remote working guidance to support practice staff to continue working from home or other care settings during the COVID-19 crisis is available. It includes information on NHS issued IT kits, using your own device, SMART card readers, VPN tokens and more. Please do read the guidance to ensure your remote working solutions are in line with both information governance and data security regulations. If you have any questions, please email pcdt@nhsx.nhs.uk.

General practice webinar

The general practice webinar held on Thursday is now available to view.

Community pharmacy

Easter opening of pharmacies

Thank you to the pharmacists and their teams that are stepping up to provide vital services to their patients and the public over Easter. Our regional teams have been working with pharmacies locally to be flexible regarding this direction to open whilst ensuring access to pharmaceutical services.  We have announced the pharmacies that open will be able to claim a payment of £750 for opening for at least three hours per day on each of 10 and 13 April 2020.

NHS Home Delivery Service

An NHS Home Delivery Service has been commissioned from both community pharmacies and dispensing doctors to ensure delivery of medicines to eligible patients who have been identified as ‘shielded’. More details are in our letter published today.

Patients who meet the ‘shielding’ criteria, are encouraged in the first instance to see if their medicines can be collected from the pharmacy or dispensing practice and delivered by family, friends, a carer or a volunteer.  Where this is not possible the patient’s pharmacy or dispensing doctor team will arrange delivery. 

Confirming pharmacist status

The Pharmacists’ Defence Association has designed a personalised digital ID card to help pharmacists confirm their status. The card may be of particular use for locum pharmacists who may not be able to obtain an employer stamp or endorsement to use with other documentation. The card can be saved on smartphones or mobile devices or printed off.

Personal Protective Equipment 

Updated guidance on Personal Protective Equipment (PPE) was published by Public Health England (PHE) on 2 April 2020. If social distancing of 2 metres from patients attending the pharmacy can be maintained there is no indication for PPE in a pharmacy setting. If this distance cannot be maintained, use of fluid resistant surgical masks (FRSM) is recommended.

Community pharmacies should use the PPE stock that has been delivered to them and when needed order more from their wholesaler. More stocks of fluid resistant surgical masks are being made available to wholesalers to supply to community pharmacies on 9th April 2020. We recognise that some pharmacy staff cannot stay more than 2 metres away from symptomatic people and will need masks. Pharmacy staff working in dispensaries but unable to maintain 2 metres from their work colleagues do not necessarily need to wear masks. It would be extremely helpful, both to protecting longer term supplies to pharmacies and to keeping supplies going to other health professionals, if pharmacies limit the number of staff that have to be within 2 metres of the public to help manage the use of masks and maintain availability.

Temporary closures and changes to pharmacy opening hours on your NHS website profile

With more people using online services due to COVID-19, it is important to keep your NHS website profile up to date and to reflect any temporary closures or changes to your opening hours. Pharmacy profiles editors will receive guidance via email from the NHS website service desk explaining how to do this for both short-term (up to four days) and longer term (five days or more) changes. The step-by-step guide is also available.

Community pharmacy webinar

The recording from last Wednesday's webinar in available to view.

Dentistry

The most recent guidance letter for dental staff and dental redeployment is available on our website.

Optometry

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

Additional information

Anticipatory medicines at the end of life

During the COVID-19 emergency, there have been calls for care homes and individual patients be able to keep anticipatory medicines for end of life care to be used when normal supply might not be possible (e.g. out of hours or at the weekend). The decision to place medicines in care homes as anticipatory stock needs to be balanced with the impact of increased demand on the medicines supply chain. We advise that care homes or individual patients should not routinely hold anticipatory medicines stock and stocks should be centralised as much as possible.

We are aware that some CCGs have already established local hubs to ensure rapid access to anticipatory medicines. Those that do not already have these arrangements in place should consider setting these up as a matter of urgency. These hubs could be community pharmacy, GP practice, community hospital, acute or other settings where palliative medicines (including controlled drugs) can be safely and legally stored and rapidly released when needed. The CCG Chief Pharmacist and their team are central to this action. CCGs should work with providers to ensure rapid access to end of life medicines for patients.

Public facing campaign

Poster for GP practices – accessing services for non-COVID-19 related issues

We have developed a poster for GP practices to use to help explain to patients what they should do if they need to speak to the practice about something not related to COVID-19. It is designed to be used on practice entrances, on their websites and on social media.

Health at Home public campaign 

As recommended by the Government, the general public have been asked to stay at home as much as possible. If people need an NHS service, they should try to do it online from home first (unless it is a serious or life-threatening emergency, they feel very unwell, or to attend ongoing treatment and have been told to do so). The Health at Home campaign - created in collaboration with NHSX, NHS Digital and ourselves - signposts the public to useful information about how to contact their GP, order repeat prescriptions, manage their wellbeing and existing conditions – without leaving their home. Please share the campaign on your public channels and with your staff.

Coronavirus – stay home this bank holiday weekend public campaign

You may well have seen the latest phase of HM Government’s Stay Home, Save Lives Coronavirus campaign Act like you’ve got it, which has now launched across TV, radio, outdoor, social media and print.

The campaign, which communicates the Government’s advice on measures to manage the pandemic, is designed to drive an increased urgency and compliance around key behaviours and are particularly aimed at those who haven’t yet changed their habits. It can be used by a whole range of partners and organisations, including Local Resilience Fora.

There are now also Stay Home resources specifically for: 
•    The Bank Holiday Weekend
•    Social assets for younger people 
•    Alternative formats
•    Translations - Bengali, Gujarati, Punjabi, Polish, Romanian, Russian, Urdu, Romani
 

Dates for your diary

In response to COVID-19 all practices should move to a total triage model and utilise remote consultations wherever possible (online, phone and video) to protect patients and staff and minimise the risk of infection. Total triage means that every patient contacting the GP practice is first triaged before making an appointment. Next week, the Digital First Primary Care team will continue their series of supplier specific webinars on practical steps that practices should take to establish a total triage model.

• 14 April, 10.30 – 11.30am: remote total triage using Footfall
• 15 April, 1.00 – 2.00pm: remote total triage using Engage Health

• 16 April, 4.40 – 5.00pm: COVID-19 giving your patients access to online services remotely

• 17 April, 2.00 – 3.00pm: remote total triage using Sense.ly

You can find a full list of upcoming webinars on our primary care webinars page.

Nikki and Gabi's link of the day

Doctors of the World sharing COVID-19 advice for patients in 44 languages, in partnership with the British Red Cross