Primary Care Bulletin - this week's round-up

22 December 2021

Dear colleagues,

Outbreak, capacity and staff sickness reporting  

We recently reminded of the requirement and importance of reporting COVID-19 outbreaks and ensuring the NHS 111 Directory of Services (DoS) is updated with accurate opening hours over the Christmas and New Year period. 

We cannot stress enough the need for providers to inform their local commissioner when the delivery of services is compromised by staff absences, whether attributed to a Covid-19 outbreak or not, in line with local reporting and escalation processes in order to support service continuity and resilience plans. 

Local systems recognise and support the consequences of reduced staffing in primary care services and if they are not already collecting information on the extent and impact of staff absences through their locally agreed processes this winter, we request this is put in place. 

Where service capacity is significantly compromised, for example, short terms closures or restrictions on new appointment requests being agreed with your commissioner, these capacity changes should also be updated on the DoS to ensure patients are appropriately signposted to available services. Providers can request these changes via their local DoS lead if they do not update their own profile directly.

Equally, where local systems are managing significant capacity issues in primary care, we remind commissioners to inform their Regional Incident Coordination Centres (ICC) without delay to consider appropriate business continuity measures or mutual aid, Regional ICC will notify the National ICC.

COVID Oximetry @home and Virtual Wards

Given the intense and growing pressure on hospital beds, we have asked all ICSs, to ensure immediately that comprehensive coverage is available through COVID Oximetry @home (CO@h), and COVID Virtual Ward (CVW) pathways to meet potential demand and mitigate pressures on services and workforce.

The use of Covid Virtual Wards is part of a wider adoption by the NHS of Virtual Ward and Hospital at Home models, as set out in Amanda Pritchard and Stephen Powis’ letter of 13 December. This includes the rapid expansion of Acute Respiratory Infection Virtual Wards for patients suspected with acute respiratory tract infections including COVID-19. Further details are outlined in this guidance. Further guidance has also been made available on Frailty virtual ward (Hospital at Home for those living with frailty).

Workload prioritisation

Following our letter outlining next steps for the NHS COVID-19 vaccine deployment the RCGP and BMA have published some guidance on workload prioritisation for general practice. We hope this will help practices along with the additional measures NHS England and NHS Improvement have worked with DHSC to agree with various government departments including extending the fit note period and suspending DVLA health checks. See the Primary Care Bulletin from 17 December for more details.

The RCGP and BMA prioritisation guidance makes clear, that whatever steps are taken to manage workload, we must reassure the public that general practice remains open and that patients will be seen face to face where it is clinically appropriate. We must continue to encourage patients with potentially serious symptoms to contact their surgery to enable an assessment. Where a face-to-face consultation is required, appropriate personal protective equipment should be worn in line with current government and IPC guidance.

Stay safe,

Nikki and Ed

COVID-19 updates

Generating local demand for Covid-19 vaccination

We know that some sites are reporting reduced public demand for Covid-19 vaccination in the run up to Christmas and between Christmas and New Year. Given the increasing spread and impact of the Omicron variant we are asking that sites take action to drive local demand in their area. We have published ten top tips for PCN-led LVS sites to generate local demand and deliver the maximum available vaccinations to ensure that your populations receive protection of the booster vaccines. Please do explore these activities before taking any steps to reduce capacity.

Vaccinating the housebound

It is vital we reach housebound patients as quickly as possible with the COVID-vaccine booster. We have asked all PCN Local Vaccination Sites to confirm their progress on reaching this patient group. The survey is available on Foundry so please complete it as soon as possible if you haven’t already done so. If you have any questions or technical issues, please email england.pccovidvaccine@nhs.net. 

Severely immunosuppressed people COVID-19 vaccinations – update walk-ins

On 17 December we issued updated guidance about the making of walk-in services easier to use for people who have been severely immunosuppressed at the time of their first or second dose. People who believe they may be eligible for a third primary dose can now get a third primary dose without a referral letter from their clinician at a vaccination walk-in site that has 'third dose availability' flagged on their walk-in coronavirus (COVID-19) vaccination site finder site profile, on presentation of relevant evidence. Please refer to latest updates.

Toolkit to increase staff engagement in boosters and vaccinations

New resources are available to help local organisations encourage their staff to take up the evergreen COVID-19 vaccine offer and get their booster. Hosted on NHS CommsLink, these include staff facing key messages, FAQs and template assets and complement existing materials.  Please continue to remind your colleagues that our national health and wellbeing resources are here when they are needed. There is also a new resource on winter workforce preparedness for line managers, which provides practical guidance on how to ensure our NHS people are all well supported.  If you have any queries, please contact the people plan team.

Volunteers on stand-by to help COVID-19 vaccination sites across the country

We have had an overwhelming response from the public as part of the latest national NHS Voluntary Responders (NHSVR) volunteer campaign, resulting in over 46k steward volunteers coming forward, with 36k now ready to be deployed across the country. We also know that many vaccination sites are dealing with an unprecedented demand from the public and we wanted to remind you that our national NHSVR Steward Volunteer workforce is here, ready to go and able to help.

Steward Volunteers form an important part of the COVID-19 vaccination workforce and are available to help sites manage the flow of people and support social distancing. All NHSVR steward volunteers are ID checked and provided appropriate guidance for the role. They are co-ordinated via the GoodSAM app. All sites are strongly encouraged to draw down from this national pool so contact your lead employer today to access the available NHSVR Steward Volunteers in your area. More details are available on Future NHS.

Using and interpreting SARS-CoV-2 antibody tests

The UK Health Security Agency have published extended information for medical professionals and researchers on using and interpreting SARS-CoV-2 antibody tests. The guidance provides additional information for medical professionals and researchers. 

The guidance complements the existing key Information, which has been updated as of December 2021, and the UK Standards for Microbiology Investigations Serology Guidance. SARS-CoV-2 antibody test results flow directly to patients’ GP records. The results will be given as either positive, negative or unknown. 

COVID-19 Vaccination Programme – workspace

General practice

Network Contract Directed Enhanced Service (DES) Specification

On 20 December 2021 we published a revised Network Contract Directed Enhanced Service (DES) Specification with updated contract guidance and Investment and Impact Fund (IIF) implementation guidance. This DES variation implements the measures taken to support the COVID-19 vaccination programme as announced in our letter of 7 December.

DES Practices already signed up in 2021/22 will automatically participate in the updated 2021/22 DES. PCNs with changes must notify the commissioner by 19 January 2022 to seek approval of those changes, and if a practice wishes to sign up to, or opt out of, the DES, it must inform its commissioner by 19 January 2022. Please contact the GP contracts team with any queries. 

CQRS service for Seasonal Influenza and COVID-19 Vaccination Recording 2021/22

From 21 December, the Calculating Quality Reporting Service (CQRS) includes a new service to support the 2021/22 Flu ES requirement for practices to report on the number of flu vaccinations administered to primary care staff; and request voluntary information on the flu and COVID-19 vaccination status of general practice staff employed or otherwise deployed in general practice. 

This data will inform planning to encourage vaccine uptake amongst the workforce, and for COVID-19 support ongoing planning around capacity and service provision due to new regulations coming into effect from 1 April 2022.

General practice - latest updates

Dentistry

Contractual updates for NHS dentistry

Key steps in 2022 to deliver for patients in NHS dentistry sets out the latest contractual requirements for dental contractors for Q4 and 2022/2023. Further information and updates can be found in the latest dentistry and oral health update.

Primary care

Update to the national guidance for lipid management
The clinical pathway for lipid management has now been updated to include bempedoic acid to primary prevention and inclisiran into the secondary prevention pathway. This pathway unifies multiple NICE guidance and technology appraisals into a single document to support clinical decision making on lipid management, supporting the NHS Long Term Plan’s ambitions for cardiovascular disease prevention and to improve patient outcomes.

Upcoming events and webinars

January – March 2022 (multiple dates). CPCS workshops with RPS & RCGP

5 January, 1pm – 2.30pm. National Social Prescribing Link Worker Webinar Series: Looking after yourself and accepting and responding to change

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

Professor Jonathan Van-Tam explain various COVID-19 treatments