GP Weekly Update (Last update 09.06.20) | QCS

GP Weekly Update (Last update 09.06.20)

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GP Weekly Update (Last update 09.06.20)

June 9, 2020

Our GP Weekly Update which includes updates on the COVID-19 GP Preparedness Webinar, Test and Trace, National Testing Programme and more. Download it now for free here. 

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Alternatively, read the summary here:

A) COVID-19 GP Preparedness Webinar

The latest Primary Care webinar on 4 June gave an update on the following:

1) Updated GP SOP Published

 Up-to-date advice and guidance for IPC, PPE, testing (PCR and antibody), staff wellbeing support, and other relevant government, public health and regulatory advice can be found In the GP Standard Operating Procedure (SOP).

New content which may be helpful for practices to consider in the context of COVID-19 is:

  • Identification and monitoring of patients at risk of deterioration from other conditions and, continuing to refer patients into secondary care using the usual pathways (considering clinical urgency and changes to access)
  • Access for patient groups who may find remote consultations more challenging (e.g. those who are deaf or hard of hearing and those requiring translation and interpretation)
  • Marginalised groups disproportionately affected by COVID-19 (e.g. homeless, migrants, and gypsy, roma and traveller communities)
  • Signposting to support that is available for patients including NHS Volunteer Responders, Social Prescribing Link Workers, and medicines home delivery service
  • Signposting to guidance available to consider risk assessments on staff (including BAME)

2) Personal Protective Equipment (PPE) Portal Access

Throughout May and June 2020, the Department of Health and Social Care has been inviting GPs and small social care providers (both residential and domiciliary) to register and order through the PPE portal, in order to help meet their emergency PPE needs, supplementing the default wholesale supply route. Please make sure you regularly check your email accounts registered with the CQC and MHRA to ensure that the email invitation is received and actioned.

3) NHS 111 and General Practice

NHS England is aware that NHS 111 is occasionally sending patients to general practice for testing and has raised this with the NHS 111 Team. They have also received reports that some unwell patients are being redirected to NHS 111 by their GP practice when calling for advice in hours. If patients with symptoms of COVID-19 contact their GP practice, they should be assessed rather than directed to NHS 111. This will prevent unwell patients deteriorating due to delays in accessing medical help.

4) Principles of Safe Video Consulting in General Practice During COVID-19

New guidance aimed at NHS general practice staff who are consulting via video with patients at home has been published. Supported by the RCGP and other key stakeholders as part of the guideline development group, it includes the key principles for safely assessing patients using a video consultation. The guidance is split into two sections:

  1. General information for staff – e.g. information governance, medico-legal and consent
  2. Remote examinations – e.g. intimate examination and a practical, step-by-step guide to starting a remote video consultation

5) Dispensing Doctors – Payments related to COVID-19

 Processes are now in place to ensure that Dispensing Doctors receive payments for the following:

  1. The mandatory element of the Pandemic Delivery Service
  2. The actual delivery of medicines
  3. The £300 towards the cost of screens

Element 1 – will be paid automatically. The period 9 April – 31 May will be paid along with June 2020 dispensing payments. Thereafter, payment will be made monthly for as long as the service is commissioned.

Element 2 – a claim form will need to be submitted for element two. Claims for the period 9 April – 31 May can be submitted along with the FP34D at the end of June 2020. Subsequently, claims should be made at the end of the month for which they relate. Claims should only be submitted for eligible patients.

Element 3 – will be paid automatically as a one-off payment. The payment will be along with June 2020 dispensing payment.

6) Risk Assessments for BAME and Other Staff

NHS Employers have published guidance on risk assessment, particularly for at risk and vulnerable groups within the workforce. This includes staff returning to work for the NHS, and existing team members who are potentially more at risk due to their race and ethnicity, age, weight, underlying health conditions, disability, or pregnancy. NHS Employers have taken an inclusive approach and have described that the guidance is applicable, with appropriate local adaptations, in all healthcare settings. Going forward, NHS Employers will share good practice and examples of risk assessments at the webinars.

QCS Ltd has a risk assessment to help practices carry out risk assessments, especially for staff at risk and in vulnerable groups.

7) Mental Health Apps to Support Children and Young People

A team across NHSX, NHS Digital, NHS England and NHS Improvement are working to identify a few digital tools to support children and young people who are experiencing increased mental health needs because of COVID-19.

The first supplier to complete the process with the team and show how they meet the requirements identified in respect of the children and young people user group is Healios, for its ThinkNinja app. Available through the NHS Apps library, Healios is making its ThinkNinja app available to download free of charge to all 10–18 year olds for the next four months.

The role of the team is not to recommend one tool over another approved tool – ThinkNinja will be joining over 20 existing apps already approved on the Apps library for users to choose from. NHS England will work with Healios to evaluate the impact of the offer at the end of the four-month period. More information about this work is available through the NHSX blog.

8) An Update from the Deputy Chief Medical Officer for England (Dr Jenny Harries)

Dr Harries gave a brief update on the current situation and where we are with the pandemic in the UK. She reiterated that there is still a long way to go, it is a marathon not a sprint.

B) Test and Trace

COVID-19 cases are flattening, with reinforced Public Health messages, e.g. social distancing. The latest Office for National Statistics (ONS) Test and Trace data shows there are about 5,000 cases per day based in the community, excluding hospitals, care homes and prisons. Practices should encourage as many people as possible with symptoms to get tested. However, antibody testing does not confirm immunity.

There are no exceptions for NHS staff, they must all follow the same advice to isolate if they have symptoms or are advised to do so because it is even more important that they are protected from the virus. They key is for people to maintain social distancing and avoid close contact.

The COVID-19 vaccine development programme is progressing and treatments are being explored.

C) Shielding Population Clinically Vulnerable Group

This group is still the highest group with a risk of getting infected. Going forward, as social distancing and lockdown measures are lifted, there is still a risk of a second wave so the previous advice might have to be reinstated if necessary.

It is unlikely there will be any further advice for children in the event of a second wave, since there are 90,000 people on the shielding list which is probably unnecessary.

As lockdown eases, individuals will be supported to ‘get back to normal’.

D) Update on the National Testing Programme

1) Testing

Over the past months, and in response to the global Coronavirus pandemic, the National Testing Programme has enabled a rapid and significant increase in testing capability. In Pillar 1, the NHS and PHE have created a swab testing capacity of 28,000 tests per day for staff.

Testing for active COVID-19 infection for NHS staff, family and patients is available via the NHS and PHE pathology network system (Pillar 1) as well as through the national GOV.UK booking site (Pillar 2).

The results of swab tests completed withing the NHS system are shared with Primary Care via existing patient result sharing infrastructure systems (i.e. EMIS, SystmOne,), with patients receiving their results via locally agreed processes.

Test results are communicated to the patients via text message or email. A system to share their results with GPs is in development and is due to go live shortly.

Testing is also now available to members of the public by DHSC via an online portal.

2) Blood Test for COVID-19 – Serology testing for presence of COVID-19 antibodies

The antibody testing programme will provide information on the prevalence of COVID-19 in different regions of the country and help better understand disease spread. The science is currently uncertain and a positive test result for antibodies only means that an individual has had COVID-19; it does not confirm immunity.

Antibody testing is available to NHS staff including primary care, with rollout being coordinated regionally. The antibody test is available for clinicians to use in their routine management of NHS patients as appropriate. The testing requires a blood draw via venepuncture, not a blood spot test.

Antibody testing requires a record of testing consent in the patient notes.

The Department of Health has produced a useful diagram which explains the differences between Coronavirus (COVID)-19 tests.

E) Questions and Answers

Q: How do we resume services? Is it locally decided, e.g. staff capacity, PPE, staff isolating?

A: Practices need to make a clinically based decision when to resume services, may face a further outbreak so need to be agile about what is required.

Q: The latest version of the SOP tells us that “practices should now be offering routine care as usual, wherever safe, making use of virtual options wherever that is possible”. Since some aspects of routine care (e.g. bloods) cannot be carried out virtually and no face to face work is completely ‘safe’, can we expect any supportive guidance to help us decide what routine work we should start undertaking within our premises?

A: This will vary – based on staff capacity (some areas are already busy again), staff illness/ isolation, PPE, patient need, local prevalence of COVID. NHS England will support practices to use clinical judgement but the RCGP is developing further detail.

Q: What central support will be available to coordinate, run and fund the seasonal flu vaccine programme in GP practices? The usual clinics will be significantly more challenging with social distancing/PPE supplies/shielding etc. assuming these are all still an issue in 3 months’ time which seems a fair assumption.

A: The arrangements for the 2020-21 flu season are something that NHS England is actively planning now.

Q: The updated GP SOP says to continue doing home visits for shielding patients. However, the shielding rules relaxed slightly on 31 May. Can we now invite them into the surgery, or should we still be doing home visits?

A: The SOP/guidance says they can come into the practice if appropriate.

Q: When will the financial package for general practice to accompany the SOP be released?

A: NHS England will clarify as soon as they can agree the financial arrangements around net additional COVID-19 costs.

F) Next COVID-19 GP Webinar

The next webinar will take place on Thursday 18 June at 5pm.

The focus will be on recovery, the ‘new normal’ and managing outbreaks.

G) Social Media YouTube Video Links for Patients

To enable you to inform your patients about the current situation in general practice, and about contacting the practice remotely when they need to, here are a few YouTube video links you could use on your practice website or social media pages, and encourage your staff and patients to share them on local community Facebook pages.