MESSAGE FROM DR NICOLA JONES: Latest coronavirus information

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

Dear colleagues

It has been a busy start to the week for many in primary care as people work through the new London clinical pathway guidance which was issued in my last bulletin. Your clinical and management leads are using the guidance to establish your local protocols for managing the various cohorts of patients. I hope this will enable clinicians to feel confident about their practice in these unfamiliar circumstances.

Looking after our most vulnerable patients is always a priority for general practice. Pro-active management is needed more than ever for people in care homes, those in end of life care, the severely frail and people with multiple complex co-morbidities. Please give them your attention, ensuring that their care is co-ordinated, planned and well documented. To assist, we have included some resources to support you in having an advance care planning conversation, and in using CmC.

Best wishes,
Dr Nicola Jones
Clinical Lead, SWL Primary Care

Advance care planning for high risk patients to avoid hospital admission

In Monday’s update we included the below advice on identifying and care planning for high risk patients. To further support practices with this, attached is a call script developed for London Clinical Networks which may help practices with conversations with patients relating to advance care planning, as well as guidance we have circulated previously on use of Co-ordinate My Care (CMC).

With bed capacity approaching a critical point in hospitals we must urgently prioritise proactive care planning for vulnerable people over the next few days. There has been some confusion around national lists, however we would suggest that the following groups should be prioritised:

  • People in care homes
  • EOLC register
  • Severely frail
  • Multiple co-morbidities

For these patients, the ask is to:

  • Review their record
  • Have a realistic conversation with patients and carers about their wishes regarding ceilings of care, hospital care and resuscitation
  • Agree the care plan with the patient
  • Update their care plan
  • Create or update the CmC record
  • Record DNAR where relevant, including on CmC

In addition the BMA, CPA, CQC and RCGP have published a joint statement on advance care planning.

National process for identifying high risk patients

We are aware that there is a lot of confusion about the national process for identifying and writing to the highest risk patients. We thought it would be helpful to highlight the below information from the recent NHS primary care bulletin from Dr Nikki Kanani and Ed Waller, which may help to answer some of these questions. This national process should not delay the work on advance care planning for high risk patients to avoid hospital admission referred to above and in Monday’s update.

Information from NHS primary care bulletin, 30 March

We have received a number of questions about this process and are producing an FAQ document which aims to answer as many of those queries as possible. In the meantime, the information below covers some of the key issues that most of you have raised with us:

  • All patient letters generated by the central process have now been distributed and should have been received via Royal Mail.
  • In line with the letters from CMO and NHSE/I, all patients included in the CMO defined cohort that could be identified through centrally available data should have been flagged in practice IT systems.
  • GPs should have received a report from their system supplier.  This report can be run locally on your practice IT systems – you will not receive separate notice about this.
  • If your practice have not yet got your patient flags, or report, please contact your IT system supplier and let NHSE know immediately, via: covid-highestrisk@nhs.net Please do not send any lists of patients or other patient identifiable data to this email address.
  • We knew the data in the initial extract would not be complete due to the limitations of centrally available data.  This week, NHS Digital will update the original cohort and identify some additional patients based on GP data.  Any additional patients identified will be flagged in GP systems in the same way as the original cohort and practices will have an updated report in their system. 
  • After this next update we would like practices to review the list for accuracy and identify any additional patients who meet the CMO’s original criteria but are not included amongst those identified.  We will provide further details of how this should be done via GP system suppliers.
  • As set out in the CMO letter, there may be other patients, not included in the original CMO cohort, that GPs consider to be in the highest risk category and who should be advised to shield. We expect this to be small numbers; shielding will only be effective if we focus these most stringent protective measures on those at the highest clinical risk.
  • We will be in touch later this week to confirm a streamlined process for reviewing and updating your lists. We advise you wait for this before running any further searches.

Situation Reports

The below went out to Lead GPs and Practice Managers earlier today:

The Primary Care Cell and localities have been working on a way in which we can understand the impact of COVID-19 across South West London and to identify practices who need support during this period.

The form should only take a few minutes to complete and will allow us to liaise with Practices, PCNs, Federations, Boroughs and across the CCG to ensure we are supporting our practices.

We are asking that submissions are made by 10:00am daily, starting tomorrow, 2 April 2020, using the link below, please. This will enable us to act quickly in getting support to areas that require it.

COVID-19 – General Practice Daily Situation Report

Patient Triage

Following publication of the most recent National Standard Operating Procedure for General Practice which said that all patients should be remotely triaged to assess whether a face-to-face appointment is clinically necessary, NHSE/I have now published advice on how to establish a remote ‘total triage’ model in general practice using online consultations.  The key messages are:

  • All practices should move to a total triage model as rapidly as possible to protect patients and staff from avoidable risks of infection
  • Practices should manage patients remotely (online, phone, video) and any pre-booked appointments should be converted to remote appointments unless face-to-face contact is absolutely clinically necessary
  • Turn off online pre-bookable appointments and, instead, triage all demand
  • Encourage use of other online patient-facing services, eg repeat prescription ordering and patient access to medical records
  • Appointments made available to NHS 111 for direct booking should be set up as remote appointments
  • NHSE/I are working with local commissioners on implementation resources and capacity to help practices deliver the changes required for a successful total triage model

Easter Bank Holidays

Please note the below from the most recent national primary care preparedness letter. The April Bank Holiday dates will be identified as normal working days for GP practices. There will be further details about this shortly for practices.

Extract from primary care preparedness letter

Practices and the wider NHS will continue to be under ever-increasing pressure over the coming weeks, including through Easter (10 and 13 April) and, looking forward, to May bank holidays (8 and 25 May). We need your help to be prepared and aligned with the rest of the NHS, which will be treating these as ordinary working days and cancelling staff annual leave to ensure services are able to be maintained. 

To enable this, changes to the GP contract coming imminently mean the April dates will now be identified as normal working days for GP practices, so that we can manage demand together. The position for the May bank holidays will be confirmed next month. 

PPE

Practices running low on stocks of PPE should contact their borough primary care lead to arrange an urgent supply. This is an interim solution until a new national process is rolled out from 6th April.

NHS mailbox size

Due to the very large amount of e-mail traffic at the current time, we have received confirmation that NHSE will move NHS mail users to the next storage banding free of charge as they reach the warning point. NHSE hoped this would happen automatically but for now a request will need to be made through the NHS Mail help desk as you reach a point you feel it needs to be addressed – the e-mail address is helpdesk@nhs.net, tel: 0333 200 1133

They hope to move to an automatic process soon and are working on this.

UK Biobank

We have been asked to circulate the attached letter from the Department of Health and Social Care. The Secretary of State for Health and Social Care has issued a notice to GP practices whose IT systems are supplied by TPP or EMIS to require them to enable UK Biobank access to data on patients who have consented to be part of the Biobank Programme. The data will be used for the purpose of responding to COVID-19 – the letter states that the data will enable them to obtain a more complete assessment of the determinants of COVID-19 outcomes. The notice only applies to GP practices with IT systems provided by TPP or EMIS as UK Biobank has established extraction processes with these companies.

Pharmacy update

Please find attached information on daily pharmacy closures and NHSBA support for electronic repeat dispensing.

Attachments

  1. ACP call script
  2. CMC guidance to support vulnerable people
  3. C0069 Final Biobank COP notice
  4. C0069 Covering note for UK Biobank notice
  5. Pharmacy update

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