Update from Dr Nicola Jones,
Chair of the South West London Primary Care Cell
28th April 2020
I know many GPs are concerned about the reduction in the number of patients presenting to general practice with conditions that are not related to coronavirus. We are seeing fewer patients with symptoms of a cancer, and fewer people who may have heart failure. There are lower attendances to emergency care generally, and fewer cardiac events and strokes. We are concerned about children who are very unwell but are not brought, and about people with serious mental illness who are deteriorating unseen. We feel there may be safeguarding issues that are not as visible as usual, and domestic violence that we are unable to detect.
We are expecting a national campaign to be launched which encourages people to seek help and contact a healthcare professional if they need to, and it will be supported by a SW London campaign. We are looking at ways to collect data so that we understand what is happening, and looking at ways to ensure that we can open up access to healthcare appropriately, as circumstances permit, to ensure that we have the opportunity to provide care for those that need it. Thank you for doing what you can every day to look after your patients.
Dr Nicola Jones
Clinical Lead, SWL Primary Care
The extract below is from a recent national primary care bulletin regarding contacting patients on the shielded list. Practices are likely to have already contacted a large number of patients on their shielded list, either due to them being included on that list or because of their care needs. It is unlikely that these patients would need to be contacted again unless there is a specific need to do so – practices are advised to exercise their own judgement on this. Practices are also reminded that these patients do not necessarily have to be contacted by GPs – the wider practice team, such as social prescribing link workers, can be used for this.
Support is also available from local authorities, NHS Volunteer Responders and charities for people who need it, whether they are on the Shielded Patient List or not.
Extract from national bulletin
As records and coding have been updated, a further 79k individuals have been flagged to be at highest clinical risk nationally. Letters and text messages are now being sent to this group – starting on 24 April. You can find further information about the national algorithm on NHS Digital’s website.
Where you have not already done so, we are requesting that all practices make sure that they have contacted all the people on their patient list who are shielding as a follow-up to the letter. These conversations should: (a) discuss what shielding means, (b) describe any changes to their ongoing care and treatment, Including home visiting wherever this is clinically needed* (c) confirm they have an arrangement in place for receiving their medications and (d) check that they are aware of the government support offer.
We asked you to review a specific list of people who self-declared as clinically extremely vulnerable before 28 March which should have been provided as a task within your IT system (to be complete by COP 28 April). Going forward, please review any new patients that contact you self-declaring to be clinically extremely vulnerable, adding any that – in your clinical opinion – meet the criteria to the list.
We have been asked to clarify the position on patients who have had a splenectomy and whether they should be included in the shielded patients list. Government advice is that in general people with asplenia need not be advised to shield. They have a particular immune defect which is not an impairment of ability to mount an immune response to a viral infection. For the minority of people who have had splenectomy as part of their management of haematological malignancy, there may be a benefit from shielding. However clinical discretion may be needed.
Isolation period for hospitalised patients
There have been queries about the differences in the period of isolation required for hospitalised patients and those managed in the community. The guidance for stepdown of infection control precautions and discharging COVID-19 patients is very helpful in clarifying this:
In general, persons with COVID-19 who are admitted to hospital will have more severe disease than those COVID-19 patients who can remain in the community, especially if they require critical care. In addition, they are more likely to have pre-existing conditions such as severe immunosuppression. In healthcare settings, there also are considerable numbers of immunocompromised and vulnerable patients.
Therefore, a precautionary approach with more stringent rules for ending isolation and infection control precautions is recommended for hospitalised patients, notably 14 days for those in critical care and/or immunosuppressed, compared to the 7-day since symptom onset rule applied to those managed in the community.
SitRep / DoS
A reminder for practices to continue to fill in the daily SitRep form e-mailed through by the SWL team. This information will shortly be used to feed into the NHS Directory of Services (DoS) in the case of practice closures, which is a national requirement – so it is particularly important that all practices use the form.
London Immunisation Survey
Please see below from the NHSE/I (London) Immunisation Commissioning Team:
The NHS England and Improvement (London) Immunisation Commissioning Team would like to check if the Routine Childhood Immunisation Schedule continues to be delivered in London during the COVID19 Pandemic.
We would be delighted if you could fill out this short survey – https://surveys.phe.org.uk/TakeSurvey.aspx?SurveyID=llKLl64KL
The purpose is to provide an assurance report to the London COVID-19 Oversight Group and also to help us identify where support is needed at this time. This survey has 6 questions and will take 5 minutes of your time.
Please respond by Monday 11th May 2020.
Many thanks for your help. Should you have any queries, please contact us on firstname.lastname@example.org
Webinar on patient assessment – the role of physiology and oximetry
The assessment of patients who are unwell with COVID-19 or other causes presents a significant challenge for GPs and clinicians working in Primary Care. The Royal College of General Practitioners (RCGP) and the AHSN Network are holding a joint webinar looking at the role of oximetry and other physiology in that assessment.
The webinar will be led by:
- Dr Jonathan Leach, RCGP Honorary Secretary and COVID Lead
- Dr Alison Tavaré, Primary Care Clinical Lead at West of England AHSN
- Dr Simon Stockley, RCGP Lead for Acute Deterioration and Sepsis
Overview of content to be explored:
- Clinical features of COVID-19
- Importance of oximetry in COVID
- Clinical judgement and physiology in Patient assessment
- Role of NEWS2 in General Practice and Care Homes
- Remote oximetry in the assessment and management of COVID disease in the community
- This will be followed by a Q and A session.
The webinar will be held on Wednesday 29 April, 1.30-2.30pm and you can register here. The webinar will be recorded and shared afterwards.
The BMA has published guidance on death certification and cremation, specifically targeted at the COVID-19 emergency. We are awaiting new NHS England guidance on this.
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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