Update from Dr Nicola Jones,
Chair of the South West London Primary Care Cell
21st April 2020
A mid-week update from me, packed with important information that will hopefully keep you up to speed in our constantly changing environment.
Please take some time in your day for reflection and consider the impact of all of this on your wellbeing, your ability to deliver care effectively and on the way your practice team is functioning together. At some point we will need to digest everything that has happened and learn from it so having a moment to assimilate it will help in that process.
Dr Nicola Jones
Clinical Lead, SWL Primary Care
Practices will have recently been contacted directly by the CQC about testing. This is an additional process to the SWL process that we have described in these updates.
Please do provide details of people who require testing but not through both testing routes – the CQC route is separate to the SWL route, which is accessible through the daily SitRep / the link below.
We have been contacted by a few practices about this, and have ensured that the forms reflect that the important GP locum workforce can access testing. So that we can ensure GP locums have access, practices and locums should do the following:
- Practices: If you are aware that GP locums working in your practice or members of their household have symptoms, please fill in the staff testing form linked through the daily SitRep as you would for an employee of the practice.
- Locums receiving this update: You can also fill in the staff testing form directly on your own behalf, here, if you or a member of your household have symptoms
Please ensure that locums and practices do not both fill in the form so that the team does not receive it twice.
Home testing pilot
A pilot for home delivery testing run by the national team began on Monday 13th April 2020 and identified a small number of eligible members of staff from across South West London to take part in the trial. Each member of staff has received a testing kit delivered by Amazon and then collected by Royal Mail and taken to a lab with results returned to participants within 48 hours of the test. Depending on the success of the pilot, Deloitte hope to roll out this home testing solution out nationally.
Primary Care and Community Respiratory Resource Pack
The NHS London Clinical Networks Primary Care and Community Respiratory Resource Pack has been reviewed and an updated version is now attached. This is the third version of the document that has been previously circulated to practices and it is currently being reviewed and re-released once a fortnight. Updates for this version include:
- Emergency oxygen therapy to treat hypoxic patients with suspected COVID-19 within primary care hot sites
- New guidance on safety netting for follow up of patients suspected COVID-19
- Updated guidance on identifying silent hypoxic patients
- New guidance on safety netting post discharge
- Alignment to NICE guidelines on ICS and removal of ICS
- Updates to target saturations admission thresholds, to take into account national and LAS guidance
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.
111 direct booking
We included the below in Friday’s Primary Care Cell Update. There has not yet been any further national guidance on this so the situation remains as below.
The latest national GP preparedness letter stated that “from the date of this letter until 30 June 2020, all practices in England must make available a minimum of 1 appointment per 500 patients for direct booking from 111”. We are aware that this has caused some concern. However, it is our understanding that these appointments do not need to be ring-fenced at this time and that practices can still use these appointments for bookings through all other routes. The aim seems to be to ensure that practices have capacity to see any patients that are directed to them from 111. Practices will want to carry out a second remote triage before deciding where and how the patient should be managed. We are expecting further clarification on this early next week and will pass on any information as we get it.
Routine GP referrals
The Clinical Cell Service Change Review Group (SCRG) have been looking at the management of routine GP referrals to secondary care during the coronavirus outbreak. Each of the four hospital trusts in South West London have developed tailored arrangements specific to each of their own hospital services and so we are now working together to review these so we can develop a harmonised single approach across South West London, in line with forthcoming NHSE national guidance. This is very likely to advise that GPs should continue to make routine referrals and that secondary care will accept and hold clinical responsibility for GP referrals. We are working on this basis as well as aiming to maximise the use of advice and guidance, remote triage and video/phone consultations.
Subsequent to the above discussions, the following information was included in the national primary care bulletin last Thursday, which aligns with the above position:
From National Primary Care Bulletin – referrals to secondary care
In the current context it is important that clear, consistent processes exist to ensure safe handling of emergent, urgent and routine referrals from primary care. At present this requires agreement between partners at a local level.
NHS guidance will be published shortly advising secondary care to accept and hold clinical responsibility for GP referrals. Therefore, GPs should continue to refer patients to secondary care using the usual pathways and to base judgments around urgency of need on usual clinical thresholds (taking into consideration need for non face to face consultations, likely delays in recommencement of routine elective activity, and communicating likely delays to patients at point of referral).
GPs should continue to use specialist advice and guidance where available to inform management of patients whose care remains within primary care including those who are awaiting review in secondary care when appropriate. Colleagues should work collaboratively across primary and secondary care to ensure this advice and guidance is provided in a timely fashion to ensure safe care is delivered, taking into account the exceptional pressures which exist across the whole system.
As the national ordering process is not yet up and running we are continuing to arrange at SWL level deliveries of PPE to practices on a weekly basis.
Egton Soft Tokens
In order to enable remote working in response to COVID-19 practice staff were issued soft tokens via an activation email from Egton at the end of March. These tokens are to allow access to the HSCN connection when working remotely. Users are given a window of 10 days to activate the token before they expire. These have recently been re-sent to users who have yet to activate their tokens to give another 10 day window to enable you to activate them.
Users are encouraged to look out for this email and if you were expecting a token we would urge you to please check your junk email folder. We have included a screen shot below to show what the email will look like. We have had additional requests from practices to allow more staff to be allocated a token and as such we will be looking to re-allocate any tokens that have not been activated by current users. Please do consider activating your token as soon as possible if it is still required.
If you were expecting to receive a token but you have not then please contact your local borough lead and let them know.
Often the quickest way to receive IT support is through Web Chats available on provider websites. Attached is a diagram with details of how to access these and where common issues are located.
SW London Gold Briefing
Please find attached Monday’s Gold Briefing, which captures progress and updates from the SW London COVID-19 cells.
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