MESSAGE FROM DR NICOLA JONES: Latest coronavirus information

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

24th April 2020

Dear colleagues

There are some indications that we are now beyond the most intense period of the pandemic. Let’s hope so. We know that there can be no absolute certainty about the next phase and our priority must be to ensure we in general practice are able to deal with whatever happens next. This situation will continue to require practices to be flexible, resilient, and focussed. The SWL team and your borough teams are working hard to support you to deliver the best care possible to your patients, to protect your staff who are working so hard, and as we head into unknown territory, to design our future.

Best Wishes
Dr Nicola Jones
Clinical Lead, SWL Primary Care

London Primary Care and Community Respiratory Resource Pack (updated)

As highlighted in our previous update, this helpful guidance is being frequently updated as more is understood about how to manage COVID-19. Version 3 is attached and there are important changes to note on the following issues:

  • Emergency oxygen therapy in hot sites – p30
  • Safety netting after discharge from acute or ED – p18. This is important and practices will need to set up a system to ensure this happens. We are constructing some advice about ways to do this effectively, particularly over a weekend.
  • Safety netting for suspected Covid – p11
  • Silent hypoxia and how to manage it – p30
  • Updates to target admission thresholds including oxygen saturation levels have changed – p9

In addition, page 14 has a helpful section on cardiopulmonary resuscitation (CPR). There is variation between different sets of guidance and this helps to clarify and lay out the issues.

London Ambulance Service guidance

The London Ambulance Service has published the attached guidance outlining the national process to prioritise calls, as well as provide advice on the use of the Healthcare Professional line. Some key points from the guidance are:

  • Always consider whether the patient can make their own way or if other arrangements can be made to take them to hospital or other healthcare facility. If that is possible, ensure they have advice on calling 999 if they deteriorate en route
  • Ensure all GPs have the details of the HCP line number. Do not display the number where it is visible to patients.
  • When calling the HCP line if delegation is unavoidable, please ensure the individual making the call is able to answer triage questions about the patient’s condition.
  • If you are unsure of the response required for your patient this can be discussed with a clinician in the LAS Clinical Hub.

Medicines management

Interim Consensus Guidance on Monitoring of High Risk Drugs during the COVID-19 Pandemic

For practices that are already carrying out blood test monitoring of drugs the attached guidelines have been produced by the SWL CCG Pharmacy Teams.

The monitoring parameters referred to in this guidance have been obtained from a range of national COVID-19 specific guidance and local clinical expert opinion / consensus, and so must therefore be considered suggestions only.

Electronic Prescribing System Phase 4 (EPS4)

Please see the attached fact sheet and FAQs.

EPS Phase 4 is now available to GP Practices using EMIS and can be activated by completing and returning this form to EMIS. Work is ongoing for VISION.

Local borough IT facilitators plan to hold small group online sessions with GP practices to support with business process changes required to prepare for implementation. Practices must ensure relevant staff have read this document before EPS 4 is activated.

Changing patients from Warfarin to DOACS

Clinicians are reminded to ensure that both patients and their community pharmacists are made aware when changes from Warfarin to DOACS are made. A message should be put in the community pharmacy notes box on the EPS system asking the pharmacist to ensure the patient knows to stop their Warfarin and return the remaining supplies to the pharmacy.


Following yesterday’s announcement regarding the 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 – please for now continue to use this. 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.

In SWL home testing capacity has now been expanded and there is also an additional testing site at Twickenham Stadium – you will be directed appropriately using the answers given in the form.

GP indemnity

As we have been receiving queries about indemnity cover, this is a reminder that the Department for Health and Social Care, NHS Resolution, NHS England and NHS Improvement published this letter in early April.

The letter states that:

  • It is expected that in the majority of cases during this period, anyone working for trusts or GP practices will be covered for NHS work by existing indemnity arrangements.
  • The government has introduced additional indemnity cover under the Coronavirus Act 2020 for clinical negligence liabilities that arise when working as part of the coronavirus response or undertaking NHS work to backfill others, and existing arrangements do not cover a particular activity. This additional indemnity cover is complementary to any existing indemnity provision already in place.
  • Healthcare professionals and others carrying out NHS activities will continue to be covered for clinical negligence incidents if they must work in different ways or locations – for example, advising more patients over the telephone instead of in face-to-face appointments or working in different settings.

NHSX letter on changes to GP Connect and Summary Care Record

We have been asked to cascade this letter from NHSX on temporary changes being made to GP Connect and to the Summary Care Record, to enable increased access to patient information. We want to reassure you that we are working with a number of colleagues, including clinicians, within SWL to develop a guide for how your practice can manage the requirements. We anticipate this will be made available next week and GP IT Facilitators will be on hand to support practices.


  1. Primary and Community Care Respiratory Resource Pack during COVID-19 FINAL
  2. LAS Guidance for GPs
  3. SWL consensus guidance on Monitoring of High Risk Drugs during the COVID-19 Pandemic
  4. Factsheet Electronic Prescribing Phase 4 (23/04/20)
  5. Electronic Prescription Service Phase 4 FAQ (23/04/2020)

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