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In this Bulletin:
- COVID-19 Alert Level
- Latest Guidance on Shielding
- Latest Guidance on Social Distancing
- Working Safely – Actions for Practices
A) COVID-19 Alert Level
The COVID-19 alert level has been downgraded from Level 4 (A COVID-19 epidemic is in general circulation; transmission is high or rising exponentially) to Level 3 (A COVID-19 epidemic is in general circulation). This relates to an alert level, not an incident level and it does not mean that the pandemic is over, so for now the NHS continues to operate under a Level 4 incident. The virus is still in general circulation, and localised outbreaks are likely to occur. Therefore, we need to continue to follow the guidelines carefully to ensure this progress continues.
B) Guidance on Shielding and Protecting People Who are Clinically Extremely Vulnerable from COVID-19
The Government has updated its guidance for people who are shielding, considering that coronavirus COVID-19 infection rates have decreased significantly over the last few weeks. This guidance remains advisory. People who are shielding remain vulnerable and should continue to take precautions but may now choose to leave their home if they are able to maintain strict social distancing.
The guidance for the clinically extremely vulnerable group remains advisory, and the
Government has set out the plans for people who are clinically extremely vulnerable, outlining a phased easing of the advice. The Government will write to everyone who has been advised to shield (c.2.2M people) to make them aware of the updated guidance.
Unless there is a significant rise in cases, the shielding programme is expected to be paused on 31 July 2020. Therefore, from 1 August 2020 the Government will be advising that shielding will be paused, which means that this group of people:
- Can go to work (if they cannot work from home, the business must be COVID-safe)
- Can go outside to buy food, to places of worship and for exercise, but they should maintain strict social distancing
- Should remain cautious as they are still at risk of severe illness if they catch coronavirus. The advice is to stay at home where possible, and if they do go out, they must follow strict social distancing
- Children who are clinically extremely vulnerable can return to their education settings if they are eligible and in line with their peers. Where possible, children should practise frequent hand washing and social distancing
The NHS will continue to maintain the Shielded Patient List, allowing NHS England to continue to provide targeted advice and support for this cohort and to change advice and support if the incidence were to rise significantly.
People in the clinically extremely vulnerable group should continue to access the NHS services they need during this time. This may be delivered in a different way or in a different place than they are used to (for example, via an online consultation) but if they do need to go to hospital or attend another health facility for planned care, extra planning and protection will be put in place.
More detailed advice will be updated in this guidance as the changes in advice come into effect on 6 July 2020 and 1 August 2020.
C) Social Distancing
Further changes to lockdown measures have been set out and the two-metre social distancing rule will change from 4 July 2020. Following a review, the advice is that where it is not possible to stay two metres apart, guidance will allow people to keep a social distance of ‘one metre plus’. This means staying one metre apart, plus mitigations which reduce the risk of transmission.
D) Working Safely
All these changes will impact on primary care and the key points for Practices to be aware of and actions to be taken to continue to follow to keep staff and Patients safe are:
- Carry out risk assessments and review them regularly to ensure the workplace is ‘COVID secure’
- To keep employees safe, you should:
- Minimise the number of people in the Practice
- Make sure employees wear face coverings safely
- Make sure employees can spot symptoms
- Ensure that staff wear PPE when in direct contact with Patients
- Ensure that staff wash their hands and clothes after helping someone in an emergency
- Tell staff with symptoms to quarantine immediately
- Tell staff they must follow the instructions from Test and Trace
- Explain the new procedures and provide training where necessary
- To support employees working remotely, you should:
- Provide the right equipment for people to work from home
- Keep remote and on-site employees connected
- Send updates to employees when the situation changes
- Make sure disabled workers and new and expectant mothers can do their work from home, where practicable, to prevent discrimination at work
- Look after people’s mental wellbeing
- To establish social distancing, you should:
- Ensure that where it is possible to keep 2 metres apart, people should
- Ensure that signs are displayed to remind people to social distance
- Control the use of corridors, lifts, and similar areas (for example, with markings on the floor)
- Put up signs to use the stairs instead of lifts whenever possible
- Where it is not possible to keep 2 metres apart (‘one metre plus’ from 4 July 2020) Practices must take mitigations to reduce the risk of exposure and transmission. These include:
- Staff
- Should only work together for up to 15 minutes at a time
- Should wash hands and clean surfaces regularly
- Use protective screens and barriers to separate people where possible
- Should work side-by-side or back-to-back, rather than face-to-face
- Avoid sharing workstations, for example by assigning employees to one role
- Avoid people passing objects by having drop-off stations
- Changing shift patterns so that staff work in set teams
- Improving ventilation
- Using face coverings
- Providing hand sanitiser
- Closing non-essential social spaces, e.g. staff rooms – use freed up space from people working remotely to create break areas, and arrange seating in break areas 2 meters apart
- Ask people to store only essential personal items in lockers if possible, or store non-essential items in their own vehicles
- Have social distancing floor markings where people queue – for example; toilets, changing rooms and other common areas
- Stagger break times and, if possible, have breaks outdoors
- Only have meetings in person if you cannot meet remotely, stay 2 meters apart, and have hand sanitiser available
- Do not share objects like pens
- Staff
- Patients
- Staggering arrival and departure times
- Opening more entrances and exits to the Practice
- Marking a one-way flow where possible
- Make sure it is safe to queue and not in the way of traffic by putting up barriers
- Using screens in reception areas
- Providing hand washing facilities or hand sanitiser
- Make sure people touch things as little as possible, for example deactivate hand operated door systems
- Avoiding face-to-face seating by changing the waiting room layout
- Reducing the number of people in enclosed spaces
- Improving ventilation
- Encouraging Patients to use face coverings
- Closing non-essential social spaces
People should follow guidance on social contact, and the fewer social contacts people have, the safer they will be.