MESSAGE FROM DR NICOLA JONES: Latest coronavirus information

Update from Dr Nicola Jones,

Chair of the South West London Primary Care Cell

Dear colleagues,

In the last few days the response in general practice to the coronavirus pandemic has increased hugely in scale and pace. The thought and effort that is going into making the necessary changes to the way we all work is immense and I know that these changes are not easy to implement, particularly as the workforce begins to be impacted.

I want to stress that the aim is to avoid face to face consultations where possible by operating a system of total triage and adopting remote consulting. Inevitably some patients will need to be seen and assessed, and we need to have systems in place to do this whilst protecting our workforce as much as we can. Hospitals will be under great strain in the coming days and weeks and we need to ensure that they can focus on the people who are the most critically ill. People who would previously have been in hospital will need to be cared for in the community and general practice will feel quite different as we try do our best for these patients.

As this week goes on there will be more information available to support the design of clinical pathways for safe assessment of patients in healthcare facilities and where assessment at home is needed. We are working on a framework for this in the absence of national guidance – although this will materialise soon we hope. Meanwhile your clinical and management leads are rapidly evolving plans that reflect what is needed locally and they are part of the SW London work to ensure that we all have a rapid cycle of learning and improving.

Thank you for all the work that is happening.

Best wishes,

Dr Nicola Jones

Clinical Lead, SWL Primary Care

 How we are working on pandemic response planning in SW London

An incident control room for the NHS in South West London has been set-up to provide command, coordination and decision-making for COVID-19.

We are also guided by experts in four ‘cells’ made up of our lead clinicians and managers across South West London.  These cells are working to advise on day to day clinical challenges as well as looking ahead to the issues we will face in the coming weeks to see how we can work together to best protect our population.

These cells are:

  • The Clinical Cell – Chaired by Dr Andrew Murray, GP Chair
  • The Acute Cell Chaired by Jacqueline Totterdell, Chief Executive of St George’s University Hospitals NHS Foundation Trust
  • The Primary Care Cell – Chaired by Dr Nicola Jones, Clinical Lead, SWL Primary Care
  • The Community Cell – Chaired by Patricia Wright, Chief Executive, Hounslow and Richmond Community Healthcare NHS Trust

Who is in the Primary Care Cell?

Our Primary Care Cell is made up of management leads from each of the boroughs and SWL and clinical leads.

What is the purpose of the Primary Care Cell?

The Primary Care Cell acts as a focal point for primary care leads in raising any issues from across South West London, to then decide on action plans and issues for escalation.

Stratification of work in primary care

We appreciate that primary care will face challenges in risk-assessing and prioritising its workload during the coming weeks. Current contractual arrangements will not be reflective of the priorities of either Primary Care or NHSE in their wishes to safely manage risk across the whole population.

We have prepared the attached document to help practices frame their thinking around stratification of their patient-facing, and other, workload. These categories are indicative, not exhaustive, but we hope they will help PCNs and practices prepare for the weeks to come​.

Advice to GP practices on limiting referrals to secondary care

During this period we need to avoid hospital outpatient appointments wherever possible, in order to protect our patients and colleagues from the risk of transmission of coronavirus. The attached SWL guidance maps out how practices can do this.

Create and update Coordinate My Care Plans for vulnerable people

We urge clinicians to share pertinent information regarding vulnerable patients on CMC. This shared information helps manage the demand on emergency services, aids decision making in ambulance conveyance, supports treatment and escalation and reduces re-admissions. The attached guidance includes information on identification of vulnerable groups, creating and updating CMC records, CMC log in credentials and CMC training / help.

Advice from St George’s University Hospital NHS FT on GP X-ray requests

Main points from the attached guidance:

  • For the foreseeable future, all GP X-ray requests are to be redirected to Queen Mary’s Hospital, Roehampton – please do not send patients to St.George’s for X-Rays.
  • There is no indication for chest X-rays in patients suspected of having COVID-19 beyond any direct clinical care. For any patients with respiratory symptoms, it is recommended that if they are well enough to be managed in the community, there should be empirical management with appropriate clinical follow-up and review if an X-ray is required at a delayed time interval.
  • For all other routine imaging requests you should consider whether the radiology investigation will have a direct impact on patient care in the coming weeks with appropriate clinical safety netting. It may be necessary in the near future to postpone all booked routine investigations.

National primary care bulletins

NHS primary care bulletins from Dr Nikki Kanani and Ed Waller are being produced on a daily basis and include lots of valuable information including details on weekly primary care webinars which are taking place every Thursday from 5-6pm. You can find the bulletins at the link below but please also ensure that you sign up to receive them in your inbox. We are passing on important national information to you through the SWL team as it arrives with us but this ensures you receive it directly.

https://www.england.nhs.uk/coronavirus/primary-care/other-resources/primary-care-bulletin/

Task and finish groups

We have established three overlapping task and finish groups:

Home visiting:  Focussing on the pathways for patients who have been triaged, are non-ambulatory and need care that cannot be managed remotely. Also on pathways for COVID positive patients both at home and by remote management.

Hot and Cold sites (including extended hours): Will aim to identify clinical pathways for ambulatory care patients and define what the hot and cold sites need to include

Intermediate Care: To agree a common model for this cohort of patients. Also inclusive of community nursing teams.

These areas will obviously need local implementation and consideration and I know that many of you have been working on local pathways and arrangements.

We are aware that much work has been done already and this work is to provide consistency and coverage across SW London. We have a number of clinicians and managers working on these with a very quick turnaround. If you have information/pathways designed then please send them through your CCG lead.

IT Update

Please find attached the latest update from our IT team.

Attachments 

  1.  Stratified task management
  2.  Outpatient COVID Guidance for GPs
  3.  CMC to support vulnerable people
  4.  St George’s X-Ray
  5.  IT Update

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