MESSAGE FROM DR NICOLA JONES: Latest coronavirus information

Update from Dr Nicola Jones,
Chair of the South West London Primary Care Cell

1st May 2020

Dear Colleagues

You will have received a letter from the Chief Executive of the NHS heralding a move into phase 2 of the NHS pandemic response. This is an important time for us in general practice. We continue to deal with COVID-related issues, under working arrangements that have changed considerably from what we had only 6 weeks ago. We know there are patients who, for a variety of reasons, are not presenting to health care services and we are doing our best to ensure that they recognise when they need our help and that they can access us when they need to. We are anxious to be providing once more the services that are central to general practice. We must have effective ways of seeing patients safely in the context of ongoing infection risk. We need to be able to respond rapidly to another surge of cases. There is no going back to “normal”. There will be a new version of normal and our task is to understand what has happened, evaluate the innovations and decide what we should stop doing, what should be restarted, what is new that we should keep and what more needs to be changed. This is an opportunity to embed new ways of working and redesign our provision. I am looking forward to working with you as you make this happen in the coming weeks.

Best Wishes
Dr Nicola Jones
Clinical Lead, SWL Primary Care

8th May Bank Holiday

Practices please submit your working arrangements through this link by 4th May

Working arrangements for the day

Practices will have received information on Tuesday about arrangements for the 8th May Bank Holiday. On that day practices have the option of opening individually as normal, or services can be provided at a PCN level. For both options we expect that:

– All patients should be triaged remotely as per a normal working day

– Patients should be able to arrange a remote consultation by either calling the practice or going online. If providing services at a network level each practice will need to ensure that the practice’s phone is diverted to a PCN hub and/or a practice managing calls in the network.  If this cannot be done then they would need to ensure that they have enough staff at the practice to manually manage and divert calls during core hours.

– Patients requiring face-to-face consultations following remote triage should be seen and assessed

– Practices should use the referral pathways into their local respiratory pathway/COVID-19 pathway arrangements for known or suspected COVID-19 patients

All practices have been asked to notify the team of planned working arrangements for that day by clicking on this link and completing the simple form by 5pm on 4th May. Thank you to the large number of practices who have responded already.

Texting

We recommend that practices text their patients to let them know they can access services on Bank Holiday Friday and as a general reminder that they should get in touch if they need advice. We have ensured that practices have enough credits for a max 320 character (including spaces) text to adult patients. Below is an example text message which could be amended if you are using a PCN approach:

Your practice is here for you. If you have a concern about your health, don’t leave it too long before you ask for advice. Please use online booking, visit the practice website or call the practice if you need us. We are open as usual on Bank Holiday Friday. Please contact us before coming to the practice.

Managing childhood illness

We are aware that there have been communications circulating during the past week about a rise in children presenting with a multisystem inflammatory state, requiring intensive care. The clinical basis for this has yet to be verified and we will send you any further information on this if and when it is received.

In the meantime, numbers of children being seen in general practice and urgent care services is much lower than usual. Parents may be reluctant to seek help as they usually would and this could result in some serious conditions presenting late. Please be aware of this and continue to take the appropriate steps to assess children. As previously suggested, consider putting information on your practice website to ensure parents and carers are aware that they can continue to seek advice about their unwell child.

There is some suggested wording below which you can amend as appropriate, along with a link to an information poster for parents and carers which can go on your website.

Suggested website wording:

For Parents/Carers:

If your child is unwell and you need advice from the practice then please contact us as you usually would.  Please do not delay contacting your practice and seeking advice if you and your child need it. During the COVID19 pandemic, don’t come to the practice – contact us first.

https://www.rcpch.ac.uk/sites/default/files/2020-04/covid19_advice_for_parents_when_child_unwell_or_injured_poster.pdf

Maternity care

A reminder that our antenatal care pathways in South West London are being reviewed to reduce risks to pregnant women, families and our staff. Nationally, a number of maternity transformation targets have been put on hold to allow prioritisation of these new safety measures.

The attached sets out the current situation but this may change as things progress – there will be further guidance if this happens. We sent this last week but are re-attaching to ensure that practices are aware of it.

Advice on observing Ramadan for healthcare professionals and patients with diabetes

With the recent onset of Ramadan, we thought it would be useful to share the attached short reference guide of information sources for patients and healthcare professionals on actions to be taken or points to be considered when observing Ramadan during the COVID-19 pandemic.

SWL pathway for accessing End of Life care anticipatory medicines

Patients dying with COVID-19 could have symptoms with rapid decline. Anticipatory medicines will be required in this situation to provide relief of symptoms and reduce suffering.

To support consistent prescribing and timely availability of EOL care medicines across SWL, a pathway has been developed to support all prescribing of EOL medicines. This has been customised for each borough. Please contact your medicines optimisation teams for details or see the generic pathway and related documents here.

In addition you can access the SWL EOLC webinar which was held last week.

Testing

Following the recent expansion of eligibility for tests, we would like to clarify that the local route that we have described in previous updates for reporting symptoms and accessing tests continues to be in place. As normal, during the week practices can access the reporting link through the daily SitRep form and access the testing reporting form directly at weekends. Locums can also report directly using the form.

IT & digital support webinar

As per yesterday’s e-mail from the SWL inbox, SWL CCG will be hosting a weekly IT & digital support webinar for all clinical and non-clinical staff to access. The sessions will cover support topics such as:

  • Laptop setup
  • Soft token set up
  • VPN
  • Video consulting
  • Total triage
  • Online Consulting
  • Clarity TeamNet

The first session will take place this coming Tuesday 5th May, from 12-1. Sessions will run for the next 6 weeks and will take place every Tuesday between 12-1. You can join the sessions using the link or dial in details below:

Join Microsoft Teams Meeting

Dial in No. 0203 880 0300

Conference ID: 955 038 464#

We ask that practices submit queries that you would like to cover in the session by midday on the Monday prior to the meeting to Zahraa Goolja – Zahraa.gooljah@swlondon.nhs.uk –  to help us in focusing the webinar on what you want to see and hear.

We have set out some guidance below for all participants to follow to ensure that the sessions run smoothly and everyone gets a chance to have their queries answered. We would ask that all participants read and adhere to the guidance.

  • Submit any questions or queries beforehand by Midday on the Monday prior to the session you are joining
  • Keep your microphone on mute during the session
  • If you have questions that arise during the session then please raise them using the chat function
  • If you would like to speak or comment during the session please raise your hand using the raise hand button and the host will take these in turn

Please also see attached guide which summarises the different remote working options available in SWL.  The supporting documents referenced in the guide are all available in the ‘how to… remote working’ section on the SWL COVID-19 GP Team Net page.

Further useful resources

FSRH CEU clinical advice to support provision of effective contraception during the COVID-19 outbreak

Calculating CrCl when monitoring patients on DOACS – South West London approved guidanceThis guidance has been developed by clinicians in SWL for use when monitoring patients on DOACS, changing patients from Warfarin to DOACs or when initiating DOACs. It has been approved by all NHS trusts and SWL CCG.

W​ebinar by RCP and AHSN Network:  Patient assessment and the role of physiology & pulse oximetry  

HIN resource for those caring for those with dementia during Covid-19 

Attachments

  1. SWL GPs COVID Antenatal Care – v6
  2. Advice on Observing Ramadan for in the context of COVID19 – v7
  3. SWL Remote Working Guide – 01/05/2020

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