GP Weekly Roundup (Last Update: 04.06.21) | QCS

GP Weekly Roundup (Last Update: 04.06.21)

Dementia Care
June 4, 2021

GP COVID-19 SOP Update

On 20 May 2021, version 4.3 of the Guidance and standard operating procedures (SOP) for General practice in the context of coronavirus (COVID-19) was updated. It was first published on 19 March 2020 at the beginning of the pandemic and was last updated on 12 April 2021.

It is guidance and not policy, however NHS England hopes clinical judgement will be used when applying this guidance. It applies to general practices operating under an NHS England contract and providers that operate outside core GP contract hours.

We’ve put together an update on the latest guidance to save you time reading through the whole of the 27-page document.

Looking after you too

Staff at increased risk from COVID-19

  • Guidance for pregnant employees is available and they should be referred to an occupational health professional for further advice and support if required

Backlog of care

  • The current demands on general practice are well known, and the 2021/22 priorities and operational planning guidance sets the priorities for the year ahead, such as:
    • Supporting the health and wellbeing of staff and taking action on recruitment and retention
    • Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19
    • Accelerating the restoration of elective and cancer care and manage the increasing demand on mental health services
    • Expanding primary care capacity to improve access, local health outcomes and address health inequalities
    • Preventing inappropriate attendance at A&E, improve timely admission to hospital for emergency patients and reduce length of stay
  • As capacity allows, GPs and PCNs should continue to deliver face to face appointments as well as the option of online consultations, reach out to patients whose health needs may have increased, developed or gone unmet during the pandemic, support patients with self-care and self-management, and support staff wellbeing and recuperation

Access to general practice

  • In a change to previous guidance, all GP practices should offer a blended approach of both face to face and remote appointments, when clinically appropriate
  • The guidance says both patients and clinicians have a choice of consultation mode, and input from patients should be sought to respect preferences for face to face or remote care, unless the patient has COVID symptoms
  • Practices should triage patients consistently and continue to prioritise patient care based on need, and with an appropriate healthcare professional
  • Although patients should be able to either go online or walk into practice reception areas for triage, as well as care, queues and crowded waiting rooms should be avoided by using triage and patient navigation
  • Online consultation systems should be in place for patients to request and ask for support. The guidance says this should be available via an online system at any time, and by switching off online consultation systems out of hours is likely to be less convenient for patients and reduce patient satisfaction. However, practices are not expected to respond to these requests outside of core hours
  • Practices should ask for support from their CCG if they need to, including how to establish a remote ‘total triage’ model in general practice using online consultations
  • Patients should be able to book appointments directly online wherever possible, but Practice reception areas should be open to patients who don’t have easy access to phones or online services, so that they’re not disadvantaged
  • Practices should consistently engage with patients about appointment access models, and adapt processes as needed in response to patient feedback
  • Due to the impact on health inequalities and inclusion groups, patients with specific needs (e.g. people living in deprived areas and those with long-term health conditions) should be given extra support to access remote consultations (e.g. access to phone/IT)
  • Practices should collaborate with local community pharmacies receiving referrals for minor illness through the new Community Pharmacist Consultation Service

Communications to patients

  • Practices should keep websites up to date with information about
    • How to contact the practice to book an appointment and ask for help
    • How the practice’s triage model works including the option of walking into practice reception areas
    • How face to face or walk-in services can be accessed
  • Patients’ mobile phone numbers and email addresses should be kept up to date for easy and regular communication

Communications to patients

  • Consider the impact of face masks during communication with patients who rely on lipreading and think about how online messaging and/or video consultation solutions can support interpreter-led, type-based and lip-read communications

Patient registration

  • Practices should continue to register new patients where capacity allows, including those with no fixed address, asylum seekers, refugees and people leaving custody. ID is not required for registration

Specialty referral pathways

  • Practices should take account of national guidance on high quality referrals, and stream patients to the correct services, avoiding unnecessary outpatient activity

Information and support for patients and the public

NHS 111, Clinical Assessment Service (CAS) and GP interface

  • Patients who contact NHS 111 will be assessed and triaged to determine whether they require urgent hospital admission, advice on self-help/isolation at home or a referral into a clinical assessment service (CAS) or other service
  • A CAS may also refer patients into general practice for further management
  • GP practices should make nominal appointment sessions available for NHS 111 / CAS and ensure that patients are picked up and assessed
  • Practices and IUC providers should review the NHS 111 / CAS assessment information, and prioritise patients accordingly

The COVID Oximetry @home pathway

  • COVID Oximetry @home should be available to people who are
    • Diagnosed with COVID-19: either clinically or positive test result AND
    • Symptomatic AND EITHER
      • Aged 65 years or older OR
      • Under 65 years and clinically extremely vulnerable to COVID or where clinical judgement applies, taking into account multiple additional COVID risk factors

Suspected or diagnosed cancers, including ongoing cancer treatment

  • Identifying, diagnosing and treating cancer is a priority in 2021/22, so there is a critical role for primary care to play in the identification and rapid referral of this group of patients
  • Referral numbers for some cancers remain lower, including for lung, urological, upper gastro-intestinal, prostate, and skin cancers including melanoma, so GPs should be particularly alert to the risk of cancer in patients with symptoms suggestive of these tumour types
  • Practices are encouraged to contact their local Cancer Alliance for further advice and guidance, including on cancer diagnostic services
  • Patients who still wish to defer referral/treatment must be appropriately safety-netted using the appropriate SNOMED code and monitored if this is the case