COVID-19 – Latest Updates

The government is currently coordinating the national response the outbreak of COVID-19, and Public Health England (PHE) has published a range of COVID-19 guidance for health professionals – including guidance on the assessment and management of suspected UK cases, and specific guidance for social or community care and residential settings. The NHS website also has updated coronavirus pages, bringing guidance for the system and healthcare professionals in one place.At this challenging time it is important that all health and social care providers continue to operate good hygiene and infection control practices, and we would ask that you check and monitor the official guidance from the NHS and PHE as the situation develops.

18th May 2020 – For Cascade: Domestic Abuse letter
18th May 2020 – May Bank Holidays: List of Pharmacies open
18th May 2020 – SWL GPIT and Digital Support Webinar 
15th May 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update
15th May 2020 – Webinar: eRedbook Primary Care Promotional event
15th May 2020 – Please Action: CQRS – GPES Data for Pandemic Planning & Research (COVID-19) service
12th May 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update
7th May 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update
5th May 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update
1st May 2020 – COVID-19 response: Primary care and community health support care home residents
1st May 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update

29th April 2020 – Second Phase of NHS Response to Covid-19
28th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update
27th April 2020 – Exclusive: National alert as ‘coronavirus-related condition may be emerging in children’
24th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 Update
21st April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 Update
21st April 2020 – FAO Practice Nurses: Free PHE immunisation update webinars continue
20th April 2020 – Respiratory Primary Care and Community Resource Pack
17th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update
17th April 2020 – Practice Reimbursements for COVID-19
15th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID19 update 
15th April 2020 – SWL GP TeamNet – New Users – Wandsworth
15th April 2020 – SWL CCG GP TeamNet COVID19 Comms Portal
13th April 2020 – Vulnerable patient lists request
13th April 2020 – At Risk Patient for Action
12th April 2020 – National Testing Programme (NTP) – Home Delivery Testing Service
11th April 2020 – Urgent Dental Care Hubs for London
10th April 2020 – NICE: COVID-19 Update
9th April 2020 – Easter Bank Holiday – Pharmacy opening hours
9th April 2020 – COVID-19 Priamry Care bulletin
9th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 update
9th April 2020 – Optometry Risk Stratification Referral Guidance
9th April 2020 – Emergency oxygen guidance for primary care
9th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 update
8th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 update – Easter
6th April 2020 – Updated GP SOP
6th April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 update – Staff Testing & Easter
4th April 2020 – NICE: COVID-19 Update
3rd April 2020 – FOR INFORMATION: PPE Guidance 
3rd April 2020 – Comms. to GP practices on provision of immunisations during COVID-19
3rd April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 update
2nd April 2020 – ACTION REQUIRED: please complete your Practice SitRep by 10:00am each day
2nd April 2020 – PPE distribution and latest guidance
2nd April 2020 – NHS Volunteer Responders Information for Primary Care Professionals
2nd April 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 update
1st April 2020 – Please complete and return SITREP report by 10.00am daily

30th March 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 update
27th March 2020 – Message from Dr Nicola Jones: SWL Primary Care Cell COVID-19 Update
27th March 2020 – SWL Clinical Leadership Cell – PPE, Staff Testing & SWL Ethics Committee
27th March 2020 – Message from NHSE/I & NHS Digital: QOF year end 19/20 payment update
27th March 2020 – Message from NHSE/I London Region: Londonwide LMC advice on Closed Doors
26th March 2020 – AMENDED EMAIL: IT Remote Access Comms update for Primary Care
24th March 2020 – Message from Dr Nicola Jones: Latest coronavirus information
23rd March 2020 – COVID-19: Round up of national comms.
20th March 2020 – FAQ – FFP3
20th March 2020 – PPE Letter
20th March 2020 – Primary Care COVID letter – Contract payment and contract relaxation
20th March 2020 – Message from Dr Nicola Jones: Latest coronavirus information
20th March 2020 – SWL Clinical Cell Update – Edition 1
13th March 2020 – Message from Dr Nicola Jones: Latest coronavirus information
9th March 2020   – SWL Primary Care – Online Consultation Video Consultation Response
9th March 2020   – Doctorlink Video Consultation Guide
6th March 2020   – Message from Dr Nicola Jones: Latest coronavirus information

Royal Trinity Hospice Community

18th March 2020
Dear Practice Manager/GP Lead,

At Trinity, we are working hard to keep our community services running to continue supporting our very vulnerable patient group and the stakeholders referring to us for our specialist advice.

Due to the Covid – 19 virus we have changed the way that we support patients and will be reducing our face to face contact with patients and have moved to a predominantly telephone assessment and support service.

Face to face contacts will still be possible but visits will only take place as agreed by a senior clinician here and when a patient has a severe or overwhelming problems that cannot be resolved over the telephone.
We will be continuing to accept referrals for patients that meet the criteria for our service and provide a 24 hour service telephone advice service via 0207 787 1062.

Please continue to use us as you always have and do not hesitate to contact me with any questions or concerns.

Many thanks
Helen Brewerton
Head of Community Services 
Royal Trinity Hospice

Pathology Services

30th March 2020

Pathology Services Update: Bulletin 1

Dear colleagues

SWLP is working tirelessly to maintain a comprehensive pathology service to all sites and disciplines. The pandemic is dramatically changing the makeup of the work we receive, including elective work, outpatients and community work.

Our strategy is to target key services and direct resources to the areas these areas, which will have an impact on some levels of service and turnaround times.

We hope you understand why we need to make these changes and appreciate your support.

We will continue to send out bulletins when we have to make changes to our services and have created a dedicated web page which will include all of the service changes in one place. This page can be accessed using the link below:

Covid-19: Changes to SWLP services

Microbiology

 

South West London Pathology (SWLP) Microbiology is now acting as the sole south west London hub laboratory for Covid-19 testing, serving four acute hospital trusts and population of approximately 1.5 million. We have been working very hard to develop testing and test as many samples as we can.

As a part of this we have tested over 4,000 SARS-CoV-2 tests for suspected Covid-19. Given this increase in testing for SARS-CoV-2 we are unfortunately unable to continue our full repertoire of normal tests as we are using the equipment to test for SARS-CoV-2 or staff are needed to run the coronavirus assays.

As such, we have taken the difficult decision that there will be a reduction in services for the following tests:

  • Chlamydia and gonorrhoea NAT testing will be done three times a week instead of Monday to Saturday
  • HIV and hepatitis virus loads will be done twice a week instead of Monday to Friday
  • Viral skin PCR (vesicular rash PCR) will be done once a week
  • Viral eye PCR (for keratoconjunctivitis investigation) will be done once a week.

For all microbial serology (including virology and syphilis) – normal testing will continue however we will be unable to add on tests to samples already tested (note – testing of stored antenatal booking samples is excluded).

There may also be extended turnaround times, reduced storage of previously tested samples, and a restriction in add on testing.

 

Urine microscopy

 

Urine microscopy will now only be performed on the following samples:

  • children under six years old
  • renal transplant patients (where clearly stated on the request)
  • nephrostomy urine (where clearly stated on the request).

Faecal elastase and calprotectin

 

Faecal elastase and calprotectin testing has been suspended for the time being so we can devote resources to more critical aspects of the service, and due to some concerns around health and safety.

Immunology testing

 

There are a number of changes to our immunology services.

Routine analysis of faecal samples for alpha-1 antitrypsin

Routine analysis of faecal samples for alpha-1 antitrypsin, or urine samples for protein electrophoresis is not currently being carried out, due to the most recent advice from PHE about the risk of transmission of coronavirus from these samples. Any requests received will be reported with a standard comment explaining why these tests are not being run.

The faecal samples will be stored indefinitely. The urine samples will be discarded after one month, but we will instead analyse serum free light chains where appropriate, if we have serum sample.

If any of these tests are considered essential for a patient’s care, please call the Immunology Consultants on 020 8725 5106 to discuss whether arrangements can be made to analyse a specific sample.

Tau protein (asialotrasferrin) for suspected CSF leak

The Immunology laboratory is unable to analyse samples for Tau protein (asialotrasferrin) for suspected CSF leak if the sample is taken from the respiratory tract, eg nasal leak, unless the patient is confirmed as being Covid-19 negative. Samples taken from other sites, eg ears or surgical wounds, will be analysed.

Restriction in the collection of cryoprotein samples

Collection of cryoprotein samples at St George’s Hospital is being restricted. If you require collection of a cryoprotein sample, please call the Immunology Consultants on 020 8725 5106 to discuss the case first.

Kind regards
Simon Brewer
Managing Director
SWL Pathology

Health Visiting and School Nursing

1st April 2020

Dear GP Child Safeguarding Leads

I wanted to write to you during these unprecedented times to update you about how Health Visiting, school nursing and social care contingency are progressing with regard to our most vulnerable child patients and to ask you to consider some core duties during your planning for work at your surgeries. We are all working with a great amount of uncertainty and things are changing so rapidly but it is really important that we don’t forget about our vulnerable children and families.

I had a discussion with Abigail Phillipou 0-19 service lead and she has advised that Health Visitors are continuing their face to face visits with high risk under 5s who are subject to child protection and child in need plans and any others identified as high risk. These may potentially be carried out under slightly different time frames than normal but will be taking place. We will be updated of any changes.

Abigail shared a couple of concerns with me. The first is that some families appear to be using covid 19 isolation rules or fears of contagion to delay or put off statutory visits from key professionals such as Health Visitors or Social workers. This may be genuine anxiety around the illness but could also be an excuse and suggest disguised compliance and non-engagement and must be challenged and followed up by the multiagency child safeguarding network. Any concerns will be shared with GPs.

After the initial post birth review with midwives where a weight will be recorded no further baby weighing service will be provided by Health Visiting as there will be no drop in sessions. It is therefore vital that we make sure a weight is done when babies are attending for their immunisations and that we are able to assist parents to accurately record this in the red book, ideally with an accompanying head circumference in order to identify and babies with faltering or abnormal growth.

Practices may have different ideas about how immunisations are to be carried out in the coming weeks and as we know it is an ever evolving situation. I would suggest if possible a video call to combine the 8 week baby check with maternal post-natal check. At our practice we have decided to try to do these proactively at 7 weeks so that we are able to prompt parents to book for immunisations and to explain to them how and where this will take place. If parents have any concerns or the clinician reviewing the baby and mother over the video consultation has any concerns a face to face consultation can be arranged as a ‘cold’ consultation. The location of this may be subject to change as we know over the coming weeks.

Abigail was very keen to reassure you all that referrals will still be followed up and actioned in the same time frames despite the methods possibly being different. Please do email any concerns for health visitors or school nurses to the usual SPA email this is the central point for ALL enquiries and referrals

clcht.0-19wandsworthandrichmondadmin@nhs.net

I would also ask you as leads to take a proactive role in planning how you might follow up your vulnerable families that may not have reached the threshold for child in need or child protection but whom you normally review regularly or keep an eye on. For vulnerable families and those living in Domestic Abuse situations lockdown and social isolation are potentially huge exacerbating factors and may lead to escalation of child abuse and neglect within the home. We need to be hugely mindful of this and I think regular phone review of these families (some of whom may need signposting to ongoing services /may not know what is still available). Please continue to make child safeguarding referrals as appropriate.

Do let me know if you have any questions or queries and I do hope you are all keeping well.

Best wishes
Dr Claire Taylor
Named GP for child safeguarding Wandsworth CCG

For the latest update from CQC please click here

CQC Updated Regulation 16 (death notification) form (14/04/2020)

We would like to understand the numbers of deaths that are occurring due to COVID-19, whether suspected or confirmed. To do this, we have updated the Regulation 16 (death notification) form so you can indicate whether the death was a result of coronavirus (either confirmed or suspected).

Please use this updated form to provide all Regulation 16 notifications from now on. We are aware that providers may have copies of the form saved locally on their computers – please replace these with the updated version of the form.

The information you provide will help us develop a more accurate picture of the number of deaths due to COVID-19, which in turn will help us to work with system partners to mobilise the right level of support. It will also help the inform the government response, so it can put in place appropriate measures to support the health and social care system during this time.

Visit our website to access the updated form.

CQC update on response to COVID-19 (04/03/2020)

Dear colleague,

We are writing to share an update on how we are responding to the outbreak of Covid19, as well as how we plan to approach any future decisions as the situation develops.

We will always act in the best interests of people who use services – so while it’s appropriate to recognise the need for you to focus on delivering care, we will always balance this with our responsibility to check that the safety of service users is maintained.

This is a fast-moving situation which may involve us changing what we do and how we do it. We have, therefore, established three key principles that we will use to make sure services continue to be safe, whilst limiting the impact on you and our own colleagues.

  • We will be focusing our activity where it is needed most to ensure people receive safe care – this means concentrating on those areas where we see that the risk to the quality of care is the highest and where we can make the biggest difference.
  • We will support providers by looking at how we can act flexibly and proportionately to reduce the asks that we make of you – including reducing what you need to do to prepare for inspection and looking at what we can do to limit our need to be on site.
  • We will honour our duty of care to our colleagues at CQC.

We will still be carrying out inspections, but inspection managers will be reviewing inspection plans on an ongoing basis to make sure our activity is aligned with the very latest position. Most inspections will continue as planned in the short term, we will keep the position under review and may decide to postpone an inspection, perhaps with relatively short notice. We will take a pragmatic and flexible approach to how and when we regulate as and when this situation develops and we commit to continuing conversations with providers and their representative organisations.

We will continue to share updates with you through our regular communication channels, such as the provider bulletins, our Twitter feed and our website. The latest general official information coming from the Department of Health and Social Care, NHS England and Public Health England can be found here.

The government is currently coordinating the national response the outbreak of COVID-19 and has published its coronavirus action plan.

Public Health England (PHE) has published a range of COVID-19 guidance for health professionals – including guidance on the assessment and management of suspected UK cases, and specific guidance for social or community care and residential settings. The NHS has also updated its coronavirus webpages, bringing their guidance for social care staff and healthcare professionals into one place.

We continue to monitor the situation and will keep you up to date with any further developments.

Yours sincerely,
Ian Trenholm,
Chief Executive
Care Quality Commission

Dear all

We recognise that you are all going to be working out of your comfort zones at the moment, with a focus on End of Life care that we have not seen before.

To try to support you with this we are circulating some useful resources around having and recording advance care planning conversations.

Attached are some quick pointers around using CMC with the key emphasis on getting the basics around DNACPR, Ceilings of treatment and updated personal / professional contacts in place and then publishing the record so it is available to OOHs / LAS. Anything more than this would be a bonus in the current circumstances but not essential.

There is also an attached script for reference to help in starting ACP conversations.

It would be important to emphasise during these conversations the positive things that we are able to do – ensuring on going care, comfort and support but also being clear around the things that are not likely to be of clinical benefit if your patient’s condition deteriorates.

It may be important to emphasise that this is not a decision made solely on age but on a range of clinical indicators and your own experience.

We are including the GMC’s guidance below which also sets out the need to have these difficult conversations sooner rather than later given the unprecedented circumstances the pandemic has presented us with.

https://www.gmc-uk.org/news/news-archive/coronavirus-information-and-advice/our-guidance-for-doctors?dm_i=OUY,6SP10,GPWVBY,R79RP,

We are expecting to have some additional resources to share with you by the end of the week around management of EOLC symptoms such as breathlessness. As soon as we have them we will share this with you all.

Lastly the links below will take you to the EOLC resource pages on the BHCIC website where there are additional resources that you may find helpful and where we will hold all the resources we are sharing with you over this period for reference.

BHCIC Covid 19 newsletter / EOLC

#1585055357895-30e9ac9e-289a">https://bhcic.co.uk/newsletters/covid-19/#1585055357895-30e9ac9e-289a

 BHCIC End of Life Care Resources

#1560781974217-d83c285e-8b63">https://bhcic.co.uk/pact/end-of-life-information/#1560781974217-d83c285e-8b63

In the meantime if you have any queries, concerns or useful experiences/ resources around EOLC that could be shared please do get in touch with us.

We are happy to try to help to support you via phone / email with any individual issues.

Please could we ask that you share this information with your practice colleagues.

Best wishes

Dr Kate Kandasamy                                       Joanna McIlmurray
Wandsworth EOLC Clinical Lead                    Head of Clinical Services and Governance |     GP Partner Elborough Street Surgery            Battersea Healthcare CIC
176 Upper Richmond Road | SW15 2SH
07974 363071                                            0203 198 9712| : www.bhcic.co.uk

 

Attachments

  1. CMC: Flow chart for guidance
  2. CMC: Top Tips
  3. Suggested script for calling patients to discuss ACP and CMC
  4. Our future health: Talking about dying
  5. CO20 Guidelines: EOLC Symptom Control for Patients with Normal Renal Function (in Wands.)
  6. CO18 Guidelines: EOLC Symptom Control for Patients with Renal Failure (in Wands. and Tri-borough)
  7. Death Certification: info from coroner (26/03/2020) 
  8. Royal Trinity Hospice: Helping you understand and cope with breathlessness
  9. Communication Guide for Goals of Care, advance care planning and DNACPR
  10. Breathlessness management guidelines
  11. COVID-19 PRN MAAR chart
  12. Practical Care for the Dying Person
  13. COVID19 Act – Excess death provisions info and guidance – 31/03/20
  14. Courageous Conversations: COVID19 key learning points from scenario
  15. Courageous Conversations: Useful words and phrases
  16. Evidence based advice for difficult conversations
  17. Patients with Implantable Cardioverter

NHSE/I London

27th March 2020 

Message from NHSE/I London Region: Londonwide LMC advice on Closed Doors

Dear Colleague

You will have seen today’s communication from London wide LMCs advising a ‘closed door policy’ in general practice and linking to further advice on their website

We thought it would be helpful to clarify the current advice on this and have included the links to Nikki Kanani’s letter (https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/preparedness-letter-primary-care-19-march-2020.pdf ) and the SOP (https://www.england.nhs.uk/coronavirus/primary-care/) published on 19 March.  As you can see they advise screening all patients before offering appointments, and managing as much as possible remotely via on line, telephone or video consultation, and are clear this does not mean ‘unilateral closing of practices’ doors’

We appreciate that this is a worrying time for patients and doctors and that guidance and advice may change.  We will do everything we can to support you and your patients.

It is important at this time that patients continue to receive the message that primary care in London is open for business and continuing to provide services, including – in the appropriate circumstances – and when necessary and with appropriate protection – face to face services.

Many thanks
Liz Wise
Director – Primary Care and Public Health Commissioning

for the latest updates from the WHO please click here

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