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Primary Care Bulletin - this week's round-up
17 December 2021
Dear colleagues,
The UK has recorded the highest number of daily COVID-19 cases since the beginning of the pandemic, and so we are incredibly grateful for all the work going across primary care to keep patients safe.
In response the rapidly changing situation, the government has updated its COVID-19: management of staff and exposed patients or residents in health and social care guidance to reflect self-isolation changes when in contact with a confirmed or suspected Omicron variant case. Notably, by next week Omicron will very likely be the dominant strain in most of the UK.
This letter provides an update to reflect the latest guidelines and applies to all staff including substantive clinical and non-clinical roles, bank staff, contractors and suppliers; students working in all facilities, settings and organisations delivering NHS care and volunteers working in settings with patients.
The rapid expansion of the vaccine programme and the role general practice will play in this has been recognised by departments across government and a number of changes have been agreed with DHSC to help free up general practice teams which are detailed below in the bulletin.
Primary care access over the Christmas and New Year Bank Holiday Weekends
Local systems winter plans will have existing plans for appropriate levels of cover over the coming bank holiday weekends, including access to community pharmacy (further details below), extended GP access services and out of hours GP access through integrated urgent care pathways. We are asking all systems to keep those plans updated as the next week develops.
Vaccine capacity is now being increased, funded through the COVID programme. We encourage regions and systems to continue work to use the Winter Access Fund (WAF) to support the ongoing access to general practice for those who need it, in line with the existing principles of the Fund. The WAF may be used to fund contingency cover for bank holiday weekends over and above what has been previously planned. It cannot be used to fund vaccination capacity given alternative arrangements to support that.
It is also important that primary care providers update their NHS 111 Directory of Services (DoS) entry with accurate opening hours for the Christmas and New Year period (as detailed below).
Stay safe,
Nikki and Ed
Dr Nikki Kanani
GP and Medical Director for Primary Care,
Deputy SRO, COVID-19 Vaccination Deployment Programme
NHS England and NHS Improvement
Ed Waller
Director for Primary Care, NHS England and NHS Improvement
COVID-19 updates
COVID-19 vaccination programme: additional financial supplements
In our 7 December operational note, we announced an increase to the Item of Service (IoS) fee to £15 per COVID-19 vaccination (administered on weekdays and Saturdays from 1 December 2021 to 31 January 2022), and an increase to £20 per COVID-19 vaccination (administered on a Sunday or Bank Holidays) over the same period.
In light of the further vaccination effort required in response to the Omicron variant, we are now extending the IoS fee to £20 per COVID-19 vaccination administered between 25 December 2021 to 3 January 2022 inclusive. This is to support PCN and CP sites to set up additional clinics during this period.
The IoS fee will continue to be £20 per COVID-19 vaccination administered on Sundays in December 2021 and Sundays in January 2022 as previously announced. The ES and LES will shortly be updated to reflect this.
Vaccination of social care staff and residents
The JCVI were clear that in response to the Omicron variant those at greatest risk must be prioritised for booster vaccination, including those residing and working in care homes. We know that over 9 in 10 care homes have already received visits to offer vaccination, but we are asking that further visits are undertaken where necessary. Additionally, we have stood up hospital hubs to vaccinate social care workers and asked vaccination sites to establish priority lines for those with valid ID.
Yesterday, Dr Nikki Kanani and Dr Adrian Hayter wrote to PCN clinical leads for care homes asking them to ensure that additional visits are undertaken, that conversations are held with hesitant residents and staff, and sharing a template letter to support these discussions with care home staff. We also wrote to care homes themselves earlier this week alongside DHSC colleagues emphasising their role in getting their residents and staff vaccinated and protected. Please take all steps to ensure this population receive the protection of a booster vaccination.
NHS COVID passes
It is now mandatory for adults (over 18 years old) to demonstrate their COVID-19 status before entering certain venues and events. This means demonstrating that they have received a full course of an approved vaccine, have completed a negative PCR or lateral flow test within the past 48 hours, or are exempt from both testing and vaccination. The NHS COVID Pass can be used to demonstrate COVID-19 status at these venues.
Children aged 12-15 year old who have had a full course of COVID-19 vaccination are eligible for an NHS COVID Pass letter for travel, which includes an internationally recognised 2D barcode. The letter service can be accessed by calling 119 or via www.NHS.uk.
The medical exemptions service will continue to run, and individuals will still be able to request an application form by calling the NHS COVID Pass Service on 119 and then sending this onto a clinician for review. However, to ensure a national effort to maximise booster rollout, the timeframe for processing a medical exemption request will be at the professional discretion of the practice. DHSC will update all the relevant public guidance to reflect this change.
Pulse oximetry over the Christmas period
COVID Oximetry @home can support people to manage their condition at home, help with earlier detection of silent hypoxia and ensure timely NHS treatment if needed. Where suitable, a full self-monitoring and escalation pathway is available, which can help with effective use of clinical time. The COVID Virtual Ward can support early and safe discharge of COVID inpatients.
A national supply of pulse oximeters continues to be available for people on these pathways. We continue to advise that all patients take a baseline oxygen saturation, consider trends and remain alert to other symptoms. To support patients and carers, a patient diary, instructional videos in a range of languages and example guidance for the full self-monitoring and self-escalation pathway are available. Safety netting guidance also includes guidance on when and how to seek clinical advice.
CCGs, trusts and ambulance services can continue to request oximeters free of charge from england.home@nhs.net. We recommend placing orders by Monday 20 December to avoid any delays in delivery services over the holiday period.
Occupational therapy Long COVID guides
The Royal College of Occupational Therapists (RCOT) has published two new quick guides about occupational therapy and Long Covid. The guides outline the unique role of occupational therapists in supporting adults, children and young people to manage and recover from Long Covid.
They have been developed in collaboration with occupational therapists supporting people with Long Covid across a range of settings, as well as with occupational therapists with lived experience of Long Covid, and members of Long Covid peer support groups.
Recent publications
These recent publications have been updated to support those delivering vaccination services.
General practice
Fit Note extension period
The Department of Work and Pensions are making legislative changes meaning that from Friday 17 December 2021 self-certification for sickness will be extended from 7 to 28 days for people accessing Statutory Sick Pay, and there will be no requirement for a fit note to access other benefits. This time limited change will end on 26 January 2022. Further guidance on this is available. Whilst we expect this to cover the vast majority of fit note requests, GPs may continue to receive some for access to occupational sick pay depending on individual contractual arrangements.
Prescription charge medical exemption certification
The Department of Health and Social Care will temporarily suspend the re-certification requirement for existing prescription charge medical exemptions but retain this requirement for newly diagnosed patients. NHS Business Services Authority (BSA) will contact patients with existing medical exemptions that are due to expire between 16 December and 26 January and supply a new certificate extending their exemption for a further six months. Some people requiring renewals may have already received a reminder and have arranged with their GP surgery for this form to be signed. If this has not yet been done, no action needs to be taken.
Firearms licenses
The Home Office has written to the main shooting organisations to request where possible, that firearms certificate applicants who are about to submit a request wait until January before requesting the relevant medical information from their GP or from an independent doctor. We anticipate the vast majority of applicants (for example new applications for non-work purposes) will be able to wait.
The Home Office would be grateful, if a person has a particularly urgent application, for example, because of work commitments or the imminent expiry of their certificate, if practices could still consider providing the information.
DVLA checks
The Driver and Vehicle Licencing Agency (DVLA) has suspended requests for medical information for the provision of drivers licences until the 12 January (excluding essential workers e.g. bus and lorry drivers).
Full Rollout Approval for GP Connect: Send Document
EMIS and TPP have full roll-out approval for the send and receive elements of GP connect send document. Enabled users will be able to create and send a PDF consultation summary of care encounters held outside the registered GP practice to replace time consuming methods like printed letters, NHS mail or fax.
Users will also be able to transfer consultation summaries across secure infrastructure into the patient's registered practice system, for addition to the patient record. Rollout is restricted to sites who have expressed an interest. To discuss using the service, contact the GP connect team.
Clarification regarding administration of Shingrix® vaccine for shingles and adjuvanted seasonal flu vaccine
Within a previous primary care bulletin, we advised that shingles and PPV vaccinations can be offered alongside flu vaccine. Whilst this is the case for most people eligible for the shingles vaccine receiving Zostavax®, for those who are immunocompromised and in receipt of Shingrix®, the Green Book advises a gap of at least seven days between Shingrix® and an adjuvanted flu vaccine.
This is due to a lack of data on co-administration of these vaccines and to avoid incorrect attribution of potential adverse events. This will be the case where Shingrix® is advised and aQIV is the available vaccine.
Where individuals attend requiring both vaccines, however, and require rapid protection or are considered likely to be lost to follow up, co-administration may be considered. Scheduling of a second vaccination appointment to administer the outstanding vaccine is advisable.
Apply for the 2019/20 Pension Annual Allowance Charge Compensation Policy
The second window for GP applications for the 2019/20 Pensions Annual Allowance Charge Compensation Policy opened on the PCSE portal on 13 December 2021. This window will remain open until 11 February 2022.
Further details can be found on our website and on PCSE’s website. To qualify for the policy you must first submit a scheme pays election (SPE2) form for 2019/20 to NHSBSA.
Community pharmacy
Pharmacy Christmas and New Year opening hours
We would like to thank pharmacies who will be providing pharmaceutical services over the Christmas period. Pharmacies with contracted hours on Sunday 26 December and Saturday 1 January which are not bank holidays are required to open for their normal contracted hours. Regional teams will have ensured there is adequate cover for the bank holidays on Monday 27 and Tuesday 28 December 2021 and for Monday 3 January 2022.
If any extra general practice/out of hours capacity is being stood up at late notice arrangements will be made by regional Teams locally to ensure adequate access to pharmaceutical services to support this. It is vital that we maintain access to pharmaceutical services for people over this time and we would like to thank Regional Teams, LPCs and contractors who are working together on pragmatic solutions to ensure this happens.
Primary care
Reminder to update the NHS 111 Directory of Services with Christmas and New Year opening hours
It is important that primary care providers update their NHS 111 Directory of Services (DoS) entry with accurate opening hours for the Christmas and New Year period. Community pharmacy can use the DoS Profile Updater to update the DoS, entering opening times for the Christmas and New Year bank holidays (25, 27, 28 December 2021 and 3 January 2022). Sunday 26 December 2021 and Saturday 1 January 2022 are defined as normal working days and any exceptions to the normal working pattern for this specific Sunday and Saturday must be entered as additional dates.
General practice and dentistry should contact their local DoS Lead to update the DoS. Contact details for DoS Leads can be accessed via the DoS Provider and Commissioner Helpline 0300 0200 363. Providers should update their DoS entry as soon as possible.
BLOG: Dr Sarah Jarvis - Community pharmacy, primary care and the Omicron fightback
In Dr Sarah Jarvis’ her latest blog, she shares an innovative way that general practice can work with local community pharmacies to help relieve pressures on primary care.
The Centre for Advancing Practice ePortfolio (supported) Route – applications now open
The Centre for Advancing Practice ePortfolio (supported) Route is designed to enable Practitioners to evidence that they meet the advance practitioner requirements described in the Multi-professional framework for advanced clinical practice in England (MPF).
The process includes an application stage where individuals are asked identify any gaps in how closely they currently map to the MPF. Successful candidates will then be allocated to an education provider and will complete a Learning Needs Analysis and the ePortfolio itself.
NHS Pension Response
The People Directorate’s Reward Team have launched their new ‘we are recognised and rewarded’ webpage dedicated to highlighting the benefits and value of the NHS Pension Scheme and what this means for staff and their loved ones. The aim is to encourage staff to think about the benefits of working longer, by increasing their understanding about how the Pension Scheme works and how it can support flexible working, as well as explain how Pensions Tax works, and the support available through ‘Scheme Pays’.
The examples shown have been developed for officer members of the NHS Pensions Scheme, and will be relevant to many salaried members of the primary care team. Additional advice for practitioner members, including GPs and partners, can be accessed via the NHS Business Services Authority website.
Accessible campaign resources for communicating to patents on accessing general practice
Accessible resources, including a large print, BSL, audio and Braille (on request) version have been created to help communicate to patients the routes to access general practice. You can download the GP assets now on the CRC website. An easy read version will be uploaded in the coming weeks.
Upcoming events and webinars
January – March 2022 (multiple dates). CPCS workshops with RPS & RCGP
13 January, 5pm – 6pm. General Practice webinar
18 January, 10am – 11.30am. Personal health budget community of practice
19 January, 1.30pm – 2.30pm. Social Prescribing Link Worker Learning and Development Webinar Series: Tackling Health Inequalities
Link of the Week
