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In this Bulletin:
- Update on Social Distancing Guidelines
- Shielding Letters for the NHS and Patients
- GP Standard Operating Procedure (SOP) Updated
- Occupational Health Assessments for Staff
- Postnatal Checks
- Electronic Prescription Service (EPS)
- Next COVID-19 Primary Care GP Webinar – 2 July
- Health and Care Video Library Available Free to NHS
- Latest CQC Mythbusters – Spirometry and Liquid Nitrogen
A) Update on Social Distancing Guidelines
Last week the Government announced the change in the guidance on social distancing. From 4 July, the guidance will change from ‘Stay 2 metres apart’ to ‘Where it is possible to keep 2 metres apart, people should’. It advises people to keep a social distance of ‘one metre plus’, meaning they should remain at a minimum one metre apart, while also taking physical steps to reduce the risk of transmission.
Practices have been working hard to restore those services that had to be paused to deal with the first COVID-19 peak and have been doing this within social distancing guidelines, following infection control procedures to protect patients and staff. NHS England and Improvement are working urgently to consider the implications of the change of Government guidance on the service. If any change in the guidance for health services is agreed, based on clinical advice, new guidance will be issued. The priority will be to enable those running services to see as many patients as possible, while keeping staff and patients safe.
In the meantime, it is essential that those running and planning services maintain social distancing at 2 metres and, even with new guidance effective from 4 July, the Government’s Chief Medical Officer said: “the advice to stay at 2m when you can stay at 2m remains”. Therefore, QCS Ltd will not be making any changes to the 2-metre guidance in its policies or other resources at this stage in order to help practices keep staff and patients safe.
B) Shielding Letters for the NHS and Patients
As announced last week, millions of people who have been shielding from COVID-19 will soon be advised of the plans to ease guidance. The Government shielding support package will remain in place until the end of July. Letters for both the NHS and patients have been added to the NHS England website which explains the Government
will further relax its shielding advice in two stages on 6 July and 1 August.
RCGP Learning has also updated its guidance around shielding.
C) GP Standard Operating Procedure Updated
Two new sections have been added to the GP Standard Operating Procedure (SOP) with some additional information and links for ease of access as follows:
- Outbreak management in the context of COVID-19 – with a recommendation to review business continuity plans (page 8)
- Suspected or diagnosed cancers, including ongoing cancer treatment – information on referral into secondary care (page 18)
D) Occupational Health Assessments for Staff
All primary care organisations remain legally responsible for securing appropriate occupational health (OH) assessments (including staff risk assessments) for their employees. Access to OH services, based on the NHS England National Primary Care Occupational Health Service Specification published in 2016, has been commissioned by NHS England and NHS Improvement and may be via a local NHS trust OH department or an independent OH provider. Practices must ensure they know how to access support from their OH provider, and CCGs are to ensure that this is happening comprehensively and speedily in their areas.
E) Postnatal Checks
All women must be provided with a postnatal GP check at 6-8 weeks. COVID-19 has increased anxiety generally in the population and pregnant women and new parents may be under additional stress due to social isolation, decreased social support, bereavements, financial stresses, changes to healthcare services and limitations on their usual coping strategies. The risks for pregnant women with pre-existing mental health problems will be higher still.
Since 1 April, the maternal postnatal check has been part of essential services. The continuation of postnatal checks, new baby checks and childhood vaccinations have been identified as high priority in BMA and RCGP guidance and should continue regardless of the prevalence of COVID-19 for the duration of the pandemic.
Where the maternal check can be delivered safely on a face-to-face basis, this should continue. Where a check cannot be delivered safely face-to-face, or where the woman has medical conditions that require her to shield or socially isolate, the review could be conducted remotely either by video or phone. If there are outstanding issues after this, a face-to-face appointment could be offered at the same visit to the practice as the infant vaccination appointment. A postnatal check must be offered to mothers who have experienced stillbirth or neonatal death.
F) Electronic Prescription Service (EPS)
During the coronavirus (COVID-19) pandemic, EPS has supported clinicians and patients to observe social distancing as it helps to reduce the need for face-to-face contact and unnecessary journeys, especially when nomination is used. Use of EPS has been expanded into GP Access/virtual hubs, walk-in centres and out of hours settings.
Prescriptions processed using the Electronic Prescription Service (EPS) now make up over 85% of all prescriptions dispensed within primary care in England.
One-off nomination is now available in many GP practices and other care settings, allowing prescriptions to be sent to an alternative pharmacy without affecting patients’ existing nominations and avoiding the need for paper. One-off nomination will also be available in more prescribing solutions soon.
Latest figures show that 51% of GP practices are now using Phase 4, which allows EPS to be used for patients without a nominated pharmacy and allows prescriptions to be downloaded using the unique prescription ID.
G) COVID-19 Primary Care GP Webinar
The next GP webinar with Nikki and Ed will be on Thursday 2 July, 5-6pm.
H) Health and Care Video Library Available Free to NHS
As part of the response to COVID-19, NHSX has secured a 6-month national licence for NHS clinicians to access a health and care video library of over 600 patient information videos free of charge. The videos have been developed and written by NHS clinicians to use within a wide range of care pathways including maternity, physiotherapy, rheumatology and podiatry. The library platform and the videos have been professionally produced by Health and Care Innovations (HCI).
Join the 30-minute onboarding webinars to get the most out of this resource on Thursday 9th July, 3pm or Friday 10th July, 11am.
I) Latest CQC Mythbusters
The latest Nigel’s Surgery mythbusters have been updated, some of which include information about the coronavirus (COVID-19) emergency.
Nigel’s surgery 83: Spirometry in general practice – 23 June 2020
- Spirometry is classed as an aerosol generating process and has been paused. The Association of Respiratory Technology & Physiology (ARTP) COVID Group have produced guidance documents about respiratory function testing and sleep services during COVID-19
- Those performing or interpreting diagnostic spirometry in general practice must be able demonstrate their competency. Being on the Association of Respiratory Technology & Physiology (ARTP) national register is one way to evidence quality and consistency
- The CQC expects practices to be able to demonstrate:
- How they ensure spirometry equipment is cleaned and maintained according to the manufacturer’s guidance (KLOE S3 – reliable systems, processes, and practices)
- That all staff who perform spirometry tests or interpret results are competent (KLOE E3 – staff skills, knowledge, and experience)
Nigel’s surgery 86: Storing liquid nitrogen – 23 June 2020
- Providers must carry out a risk assessment. This is to protect staff and the public from potential hazards of using liquid nitrogen. In CQC inspections they consider this under key line of enquiry 10 – Do the maintenance and use of equipment keep people safe?
- Control of Substances Hazardous to Health (COSHH) regulations 2002 were amended in 2004. They now include nitrogen as a substance hazardous to health.
- The CQC will expect to see a risk assessment to cover:
- The risks from liquid nitrogen
- Safe storage of liquid nitrogen
- Safety audit and training
You can find your QCS risk assessment within your QCS Management system.