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COVID-19 Primary Care update 18 March 2020
We recognise that we are in a challenging, changing period and the Civil Contingency Act gives us the opportunity to act rapidly in response to Covid-19. We have already had a number of suggestions regarding the management of Covid-19 from practices across Sussex, which are being considered. If you have further proposals can you please forward in writing email@example.com. We have repurposed CCG managers to provide additional support to PCNs and practices and they should support in any proposal preparation. The CCG Managers will be in contact with CCG Clinical Directors within the next 24 hours.
Important and Urgent Next Steps Letter from Simon Stevens
Yesterday evening the CCG received a letter from Simon Stevens and Amanda Pritchard (attached). The letter sets out important actions for every part of the NHS to put in place. These are:
- Free-up the maximum possible inpatient and critical care capacity.
- Prepare for, and respond to, the anticipated large numbers of COVID-19 patients who will need respiratory support.
- Support staff, and maximise their availability.
- Play our part in the wider population measures newly announced by Government.
- Stress-test operational readiness
- Remove routine burdens, so as to facilitate the above.
Guidelines on the advice GPs should be giving to patients contacting surgeries with suspected COVID-19 infection
There has been some confusion due to the daily changing situation about what advice surgeries should give to patients contacting them with symptoms suggestive of Covid-19 infection. At this point in time, this is the current advice:
Stay at home and self -medicate if needed with paracetamol. Do not ring NHS111. If you wish to get more information then you can go on line to the NHS111 website – 111.nhs.uk/service/COVID-19/ which has a lot of useful information and links. You should isolate at home for 7 days . If your symptoms worsen and you feel your breathing is deteriorating or if at the end of 7 days your symptoms have not abated then and only then should you contact NHS111. Initial contact should be online, where there are links to appropriate services. If you do not have access to the internet or do not find the information you need then use the NHS 111 phone line. As safety netting we would suggest you also give the patient the option of ringing the surgery back.
We suggest the above advice is given as standard as general practice has an important role to play in reducing anxiety and preventing the collapse of an already stretched system.
Digital Update from Tim Caroe
Today there are people opening boxes, getting out new laptops and getting the necessary software onto them. We are running as fast as we can to get them into your hands. I know we all wanted them yesterday, but we are doing everything we can.
With VPNs, I am still concerned that we are going to face a dropping out if we don’t use it wisely. Last week your GP IT Manager sent you a list of people that currently have licenses. I know this is an impossible ask, but please can you identify if possible people who ‘must’ have access and those who ‘ideally’ need access (including anyone you’ve asked for in the meantime). If we reach the point where everything is about to break for everybody, we will prioritise the ‘must’ over the ‘ideally’. Thank you – this is a temporary solution until the significant upgrade hopefully before the end of March. I sincerely hope we don’t reach the tipping point but we need measures in case. Please return the categorised list to your GP IT Manager – thank you.
I know that a lot of you have had trouble remoting in. I am told that ‘an emergency setting change’ is being done to try and solve that. Please keep letting the IT helpdesk know if you can’t make it work.
Some of you will be using your smartcards over VPN. And some of you won’t. There is a configuration which allows users to have a smart card reader at home (which if you don’t have one you can just buy from amazon and invoice us or wait until we can get some to you which we are trying to source in bulk) and sign scripts. This configuration has been done for all recent VPNs, but not for those issued licenses a while back. We are in the process of reconfiguring this for everybody and I hope that this will work within the next 48 hours.
In terms of licenses, many people have asked for quite a few. We are now at the stage that we need to ensure that there is an even distribution and so you may not get all that you have asked for yet. When we have the new bandwidth, this will change.
I am also pleased to announce that Microsoft Teams has been activated for everyone to help with keeping in touch through remote working (I am using this now as I self-isolate). Please go to https://support.nhs.net/ to find out more.
Finally, another big thank you. I know personally that the front line is a really tough place to be and you are all on it. I want to assure you that the digital team is doing everything it can to support you.
BMJ COVID-19 Flowchart
We have been made aware that the above flow chart sent to practices earlier today was not up to date and we apologise for this. Due to the fast moving situation we are in guidance is being updated daily and we will endeavour to get the most up to date versions out to practices. The most up to date version can be found at the following link https://www.bmj.com/content/368/bmj.m800
Sussex CCGs’ COVID-19 GP Toolkit
The most up-to-date Sussex CCGs’ COVID-19 GP Toolkit available onlinehere. It will be updated when the national guidance changes, with updated versions available on the same link. The latest information since the last version is highlighted in Green.
Cancelling Electives from 15 April
The NHSE Chief Medical Officer has stated, NHS services are likely to come under intense pressure as the coronavirus spreads, and we need to ensure that we have as many beds available as possible to care for patients with severe respiratory problems when the number of infections peaks.
Therefore, in line with well-established plans for situations like this, every hospital in England has now been asked to suspend all non-urgent elective operations from 15 April for at least three months, with some other procedures likely to be rescheduled before then so we can train our staff and adapt certain areas.
Urgent and emergency cases and cancer treatments will be carrying on as normal, but we know many people waiting for treatment will be disappointed or worried, and we will be contacting everyone affected as soon as possible.
Visitors Guidance for Hospitals/Care Homes
The most up-to-date visitors guidance is here. The public are being asked to limit visiting and to consider other ways of keeping in touch, like phone calls.
Visitors must be immediate family members or carers. We are asking people to limit to one person, per patient unless:
- the patient is receiving end-of-life care
- the visitor needs to be accompanied – accompanying visitors should not stay in patient, ward or communal areas, and this applies to inpatient and outpatient settings
- they are a partner and birthing partner accompanying a woman in labour.
Hospitals and other health and care settings will restrict visiting to one hour per day at designated visiting times. Slightly different rules apply to paediatrics and neonates – two visitors are allowed and this may include a child under 12. Paediatric trusts can use their own discretion on visiting hours.
If you need to contact the Primary Care Team you can:
- Call: 0300 131 4380 – if you are unable to get through, please leave a message and we will respond as soon as possible
- Email: firstname.lastname@example.org
Important & urgent next steps in NHS response to COVID-19
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IMPORTANT UPDATE – PLEASE READ – You may have received previous versions of the linked documents – we have updated these to include the latest guidance.Covid 19 guidance summary updated
Primary Care has now been advised to move to Total Triage.
This means that only essential activity will be seen face to face:
- Face to Face examination only to exclude life-threatening of life-shortening illness where this cannot be done over telephone or video link
- 2 week wait referrals – mostly can be done over telephone or video link – please see example scenarios
- Long-term condition monitoring for unstable at risk patients – consider doing by telephone or video link
- All above based on case by case individual clinical decision and risk assessment
As with other patients all contacts to go through clinical triage.
Consider managing by telephone or video where possible. Use decision aid tools, such FeverPain, Centor when appropriate.
It is recognised that most clinicians will have lower threshold for face to face review of younger children, but this is a matter for individual clinical judgement
If require face to face and have been triaged to be low risk of Covid 19, consider a separate children only environment that can easily cleaned or dedicated time slot for paediatric reviews.
Please see attached COVID-19 Guidance Summary and BMJ Visual Guide
Implications for EHS
Within EHS this means that we will be reducing face to face capacity and the only patients booked for Face to Face must have had a triage from a GP or ANP prior to being booked based on the total triage criteria.
We will also have some telephone capacity from host sites for now for practices to book into.
Currently we are seeking assurance from host site practice managers that they are fulfilling the criteria laid out in the attached Practice COVID-19 Plan.
Please do take the time to look at the section on Protect Staff I have included here the information for us as individual clinicians.
- Jewellery and watches removed – bare below elbow policy.
- Avoid looking at phone as much as possible, use computer of clock to check time.
- Mobile phone usage kept to absolute minimum (emergencies only).
- No handshakes.
- No lanyards or neck ties.
Moving forwards we are endeavouring to identify other ways that we can support the local healthcare system possibly to support 111 in order to keep you working. Please be aware however we may need to cancel shifts.
Work at the BSUH UTC continues as normal for the time being and there are shifts available if you do have shifts cancelled. Please let us know if you haven’t worked there before and we can arrange an induction.
Thank you for bearing with us, obviously things are changing by the hour but we are doing all we can to ensure that you are safe and can continue working.
Dr Simon Hincks
Clinical Lead Improving Access to General Practice Services
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Click here to download the latest advice – version 1.4
Click here to view or download the BMJ infographic