Update from Dr Nicola Jones,
Chair of the South West London Primary Care Cell
Over the weekend you will have been sent several letters, guidance and information from NHS England and Improvement.
Across South West London we need to focus our energies on 4 key areas:
1. Advance care planning for high risk patients to avoid hospital admission
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
Please use your existing mechanisms for identifying these patients.
The SWL Palliative Care Task and Finish Group are liaising with hospices, community nursing teams and Marie Curie to identify additional support for practices to undertake the Advance Care Plans. The SWL team will be circulating guidance to support you with this work tomorrow. This will be circulated through each CCG’s nominated GP and managerial leads.
2. Ethical framework
We will rapidly develop a process to support GPs and other community clinicians involved in EoL decisions including the ability to seek expert or peer review/advice where needed and will circulate recommendations for decision making guidance/tool/support in primary care as soon as they become available.
3. Hot and cold sites/respiratory pathways
We have written to you previously and there is national guidance available about the respiratory pathways and dual functioning. There is a three phased approach to managing the respiratory pathway. Not all boroughs/PCNs will use all 3 phases, but they should all be planning for phase 3 in case it is needed.
- Zoning in a practice – hot and cold areas within a practice to see suspected Covid-19 patients face to face (dual functioning) if they still need to be seen despite telephone or video consultation
- PCN solution – PCNs can help support their practices and might offer one site or buddying. It is likely to be a very mixed picture according to local capacity and estate. PCNs need to review resilience of the business continuity plans and collectively as a PCN to support practices. PCNs may want to designate their own respiratory clinics if they wish between their practices
- A pan borough site/s which may be repurposing a practice premises or other healthcare facility such as Hub or UTC
- Workforce identification for redeployment
With the levels of ICU beds needed locally and the Nightingale Hospital at the Excel centre going live, we anticipate that the need for clinical and non-clinical staff to be redeployed is imminent.
Please can practices identify staff that might be able to support our London health system in community beds, local hospitals or at the Nightingale. Appropriate training will be provided. If you have any staff with any experience of critical care then do flag this up. Please forward details of people who could be redeployed to your local primary care team contact. This would not constitute signing up – this is just an initial scoping exercise at this stage. This may affect the practice’s ability to deliver essential services or provide hot and cold duality, hence the ask for planning hot and cold sites at both PCN and Hub levels.
We are supporting boroughs in identifying their home visiting needs for COVID+ patients by working with their OOH providers who already have access to transport, systems etc to deliver a service. We will be supporting this work through local leads and providing SWL solutions if needed.
Essential primary care activity
There have been a number of guidance documents detailing what is considered essential and non- essential primary care activity in these unprecedented times. In SWL, through our clinical chairs and clinical cell, have agreed to work from the RCGP Guidance on workload prioritisation.
If you have any questions about any of the above issues please contact your local borough primary care lead.
Dr Nicola Jones
Clinical Lead, SWL Primary Care
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