Please find our GP weekly summary below, which include updates on the COVID-19 General Case Definition Change and more.
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A) Primary Care Emails and Webinars
Primary Care email bulletins will be twice weekly from next week.
Primary Care webinars will be every two weeks, the next will be on Thursday 4 June.
B) COVID-19 General Case Definition Change – Update to Coronavirus Symptoms
- Following a statement by the UK Chief Medical Offers, the general clinical case definition for COVID-19 has been updated to include loss of or change in smell or taste (anosmia)
- It is now: New continuous cough OR fever OR loss of or change in smell or taste
- Everyone, including health and social care workers, should self-isolate if they develop a new continuous cough or fever or loss of or change in smell or taste. The individual’s household should also self-isolate for 14 days as per the current guidelines and the individual should stay at home for 7 days, or longer if they still have symptoms other than cough or loss of sense of smell or taste
C) Referring Patients For COVID-19 Tests
- Testing is open to any member of the public with COVID-19 symptoms by visiting uk/coronavirus
- Patients in England and Wales who do not have access to or cannot use the internet can call 119, which can be used to book a test if no other options are available
- Patients should not be directed to request tests via NHS 111, as the service is not able to do this for them
D) NHS 111 Referring into General Practice – Clarification
When practices receive a referral from 111 services, including the COVID-19 Clinical Assessment Service (CCAS), they should assume clinical responsibility for the patient
- This means practices should take ownership of the patient and onward decisions about the acre they require, to ensure they are not passed back to 111 services
- This does not mean that GPs will be liable for the assessment and decisions made by 111 services before the patient is referred to general practice
E) GP contraceptive services for patients during COVID-19 pandemic
- GP practices are reminded that those contraceptive services provided to patients as part of the GP contract essential services should continue to be provided during the current COVID-19 pandemic
- In case some women are not getting access to the contraception they need during COVID-19, NHS England wants to draw your attention to new information on sexual and reproductive health for patients and some further information for professionals on the FSRH website
- These include adapted guidance for the provision of emergency and routine contraception and abortion during the COVID-19 pandemic
F) Legionella Risks During the Coronavirus Outbreak
- There is the risk of legionella and pseudomonas proliferation in little used water systems, this can lead to disease transmission through aerosol from taps and showers. This particularly likely where rooms or building have remined dormant (during lockdown)
- This is especially the case when ambient temperatures are above 20 degrees, as has been the case in the UK over recent months
- Please make yourself aware of HSE Guidance on this issue and Health Technical Memorandum – Safe Water in Healthcare
- These links provide information on your duties and how to manage legionella and pseudomonas proliferation through temperature controls; flushing outlets; and chlorination of systems. Please pay attention to how to bring little used outlets back into use without causing harm to yourself or others
G) New Dedicated Yellow Card Reporting Site for Medicines and Medical Devices
A new Coronavirus (COVID-19): new dedicated Yellow Card reporting site for medicines and medical devices has been set up to enable the MHRA to rapidly identify new and emerging side effects and medical device incidents in COVID-19 treatment, including side effects for medicines taken by patients to manage long-term or pre-existing conditions.
H) Implementing and Managing Support for Care Homes
The NHS previously outlined that it is committed to introducing a “package of support to care homes drawing on key components of the Enhanced Care in Care Homes service”.
The NHS further wrote to CCGs / GPs / community health service providers to set out the following service expectations:
- Continued NHS testing of all patients prior to discharge to care homes
- CCG Directors of Nursing assisting Local Authorities in infection prevention and control
- Supporting different staff groups to take up opportunities in care homes, where workforce has been depleted due to COVID-19
- Requesting primary care and community health services help, building on what practices are already doing, to support care homes
Clinical Services model evidence based including Clinical lead and weekly check in with service enablers through CCGs for in and out of hours care as well as support from secondary care providers. By 17 May 100% of operational CQC-registered care homes had an identified clinical lead.
Named Clinical Lead Role is not medically responsible and accountable for the care of individual care home residents, this remains the registered GP and NHS England does not expect residents to be re-registered. A clinical lead can be a GP Geriatrician, a suitably qualified AHP or Nurse.
Weekly Check-In should ideally be an MDT endeavour including Primary and Community Care can include AHPs, Nurses, Geriatrician with support for medication reviews by a Pharmacist where possible. The time spent on weekly check-ins will vary according to the size of the home and the clinical stability of residents.
NHS clinical support has been stepped up and Mutual Aid to care homes includes:
- Timely access to clinical advice for care home staff and residents including a clinical lead for every care home and weekly check-ins
- Proactive support including personalised care and support planning
- Support for care home residents with suspected COVID-19 through remote monitoring
- Sensitive and collaborative decision around hospital admissions for care home residents if they are likely to benefit
Infection Control Training for care homes will continue to be supported by the local authority and CCG.
Digital Support for care homes is ongoing with shared generic NHS mailboxes, portable devices for video calls, and free connection to broadband or free 4G connectivity for as much as 6 months to support them at this critical time. Digital Social Care has launched a helpline for care providers available 9am – 5pm Monday to Friday – 0208 133 3430 or they can email [email protected].
Pharmacy and Medicines Support to Care Homes involves Medicine Optimisation through a new operational model to implement the guidance. It describes the medicines and pharmacy contribution to the work and sets out how teams should collaborate across the NHS system and provides practical advice and resources and a model of service to help local systems reduce the risk of harm during the COVID-19 period.
Key areas where pharmacy professionals will support care homes includes:
- Medicines supply
- Clinical review (e.g. deteriorating patients)
- Information and advice around medicines
- Structured Medication Reviews (e.g. complex polypharmacy, discharged or new residents)
Further information is available from the Specialist Pharmacy Service Care Home Resource Hub.
I) Remote Working in Primary Care
When the coronavirus pandemic was announced in March the NHS produced an appendix to the primary care digital services operating model to provide guidance and support Remote Working in Primary Care for GP Practices during the COVID-19 Emergency Response. It sets out additional guidance for CCGs and their IT delivery partners to help Practices implement remote working and includes remote working options and use of smartcards in a remote working environment. It will remain in force during the COVID-19 emergency response period.
Many Practices have successfully managed to implement remote working for their GPs and staff and, although the Government is easing lockdown restrictions and patients are slowly starting to come back to the surgery, this situation is likely to continue for a little while longer whilst some staff continue to be shielded (until 30 June) or are self-isolating. To date 22,411 laptops have been delivered to local IT service providers for deployment to general Practices.
Practices are reminded about information governance security procedures regarding remote working, especially since the number of cyber-attacks has increased so it is important to get data security right.
The options for remote working, in order of priority and security, are:
- NHS provided laptop – with all required software necessary for the role together with a token for secure VPN access and, where needed, a smartcard reader
- Virtualised desktop service (VDS) – which enables access to critical systems and services from corporate and personal devices. All functions on the host machine can be accessed, including those requiring smartcard access
- Personal PC / laptop i.e. bring your own device (BYOD) – with all necessary software applications installed and connectivity to HSCN network. A smartcard reader will be necessary for certain applications
- Personal device with desktop sharing over Remote Desktop Protocol (RDP) – allowing a remote device to ‘take over’ a host machine – normally a desktop PC in the Practice
Where options 1 and 2 are not available, options 3 and 4 should be considered for users that have equipment with the necessary specifications and can assess and implement the security requirements, and only used in emergency situations and in the absence of any alternatives. Practices must check the information governance and security of the devices for options 3 and 4 i.e. up to date with anti-virus software.
Funding for the equipment to allow primary care clinicians to work remotely during COVID-19 has been allocated to CCGs and regional teams across the country. If you are having trouble accessing funding to
pay for this equipment and your CCG and regional teams are unable to help please email [email protected].
Further developments in the pipeline for remote working include the use of Microsoft Teams for MDT meetings and video group patient consultations for people with the same condition. It would be advantageous for Practices who are interested in doing this to start engaging potential patients and liaise with social prescribers.
J) Trainee Doctor Rotations to Restart in August
Planned rotations for doctors in training had been cancelled because of the COVID-19 pandemic. Health Education England (HEE) has confirmed that all trainees in foundation and core posts will rotate as usual at the start of August, while rotations for various speciality programmes would be pushed back to later in the year. HEE said employers and trainees would be given notice of placements no later than eight weeks before the start date.