COVID-19: Round up of national comms

SENT TO LEAD GPs AND PRACTICE MANAGERS – PLEASE DISTRIBUTE TO ALL GPs AND STAFF IN YOUR PRACTICE

Dear colleague

As we understand that there continue to be a very large number of communications circulating on COVID-19 please find below, for your convenience, a round up of the national communications which have been circulated from Friday to today.

Letters on highest risk patients

 You can find two letters to GPs regarding the patients at highest risk of severe morbidity and mortality from coronavirus here https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk-patients/ – the first is from Professors Stephen Powis and Chris Whitty and the second is from Dr Nikita Kanani and Ed Waller, providing specific information and asking for specific action from GPs in relation these patients. Please ensure you read the second letter in particular. Main points are as follows:

  • The patients of your practice that have been contacted can be identified through an “at high risk” indicator code that has been applied to each patient record by your clinical system supplier. Your supplier will inform you of the code they have used, which should be treated as temporary until a definitive list of COVID-19 ‘at risk’ SNOMED codes is released.
  • Your GP System supplier will also provide a report listing those patients that have been centrally identified as being at high risk.  You should have this by 23 March (today). The letters asks that you review this report for accuracy and, where any of these patients have dementia, a learning disability or autism, that you provide appropriate additional support to them to ensure they continue receiving access to care.
  • You may know of other patients (Group 4) who you would consider to be at very high risk from infection. The RCGP will shortly publish guidance to support GPs identifying additional high risk patients. The guidance will also support GPs to have shared decision-making conversations with all high risk patients as needed, and help GPs to understand what health needs these groups may have.

The letter asks that, if you choose to identify additional individuals you consider to be at highest risk of severe outcomes, that you proactively contact this group of patients to discuss your recommendation with them.

In addition, the letter asks that you take the action listed below with respect to patients in your practice who are identified for the vulnerable group:

  • Immediately review any ongoing care arrangements that you have with these highest risk patients.
  • Support with medicine supplies – eg ensuring suitable patients put on electronic repeat dispensing, supporting patients to arrange delivery / collection of prescriptions through a nominated person where support needed
  • Support with daily living – if patients contact you asking for help, it is suggested that your social prescribing link worker, where available, helps them to arrange additional support.

PPE letter from Professor Keith Willett  

This letter “sets out in a single document, everything that you need to know on the supply and use of Personal Protective Equipment”. It includes information on:

  • Supplies you will be receiving
  • Reporting supply disruption
  • Securing additional supplies from manufacturers
  • Shelf life of PPE items
  • Correct use of PPE
  • Putting on PPE and fit test training
  • Disposing of PPE correctly

Also attached is an FAQ on using FFP3 RPE.

New National Standard Operating Procedure for General Practice

As per Nicola Jones’ e-mail on Friday this is available here – https://www.england.nhs.uk/coronavirus/publication/managing-coronavirus-covid-19-in-general-practice-sop_19-march/. Please take the time to read this very important document which covers what practices should do when patients present through different routes. Main points are:

  • All patients should be remotely triaged to assess whether a face-to-face appointment is clinically necessary or whether follow up care and advice can be given using remote consultation. All currently pre-booked face-to-face appointments without prior triage need to be remotely triaged following this process.

The guidance covers what practices should do for patients assessed as non COVID-19 or possible COVID-19, then splitting possible cases into three categories – severely unwell, needing further clinical assessment and patients with mild symptoms. It also covers what practices should do if patients present in the practice without prior triage.

  • Remote consultations should be used when possible to minimise risk of transmission. In SWL we have issued guidance to help practices with this as part of these regular updates.
  •  Infection prevention and control measures should be applied when seeing patients for face-to-face consultations. The guidance includes detailed advice on these measures, and on what to do if COVID-19 is suspected when an appointment is in progress.
  • Practices should carefully assess where they can safely segregate, as much as possible, non COVID-19 from possible COVID-19 patients. Guidance is included on how this can happen – for example, where possible, separate waiting areas or isolation rooms should be used for patients with possible COVID-19, with signage used to warn patients of the segregated area and practices should consider separating clinics into possible COVID-19 and non COVID-19 at different times of the day.

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