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COVID-19 UPDATE BRIEFING DDLMC – 03.06.2020

JOINT DDLMC/GPA/GPTF/DCHS COVID-19 RESPONSE TEAM

Derbyshire Operating Framework for General Practice – Infection Risk from COVID-19. As the easing of lockdown continues the Derbyshire Team have pulled together a summary of considerations for infection risks associated with the return to work. (Attachment A).

NATIONAL UPDATES

Updated General Practice SOP. NHSE have published an update to GP SOPs . There had been some confusion about the pathway for patients presenting with COVID-19 symptoms at the practice and these SOPs now clarify this. The main pathway is for patients to access support through NHS111 (who may then be directed to the practice via CCAS), but if patients do present to the practice they should be triaged and dealt with rather than just referring them to NHS111. I hope that clears up any confusion. In addition, the BMA have produced a useful summary (Attachment B).

Update to guidance for people who are clinically extremely vulnerable (shielding). You will have seen updated guidance for this group which came into effect on Monday. In summary:

  • They should continue to shield until at least the 30 June can now spend a short period of time outdoors each day with members of their household, still maintaining 2m distance from others.
  • If they live alone, they can meet one other person from a different household (ideally the same person each time) while maintaining strict social distancing.
  • Other aspects remain the same. Apart from going outside once per day, they should continue to avoid all non-essential face to face contact, including shopping or going to pharmacies.
  • The support package remains unchanged.

The next review will be on 15th June. Further information on NHS Employers website.

Test and Trace. This was launched last week (Attachments C and D) and we have received clarification that if someone who works in – or has recently visited – a health or social care setting (including practices) tests positive for coronavirus, their case will be escalated to local public health experts, who will liaise with the relevant setting to agree on the most appropriate action. If they were wearing PPE at the time of the contact, this will not count as a contact.

LOCAL UPDATES

Restoration of Imaging at UHDB. Urgent and Cancer imaging has continued during the pandemic, and UHDB are now able to start imaging less urgent patients, in all modalities and all specialties. The details are in a letter (Attachment E).

DCHS updates:

  • Phlebotomy for housebound patients. Community nursing teams are gearing up to accept referrals for routine phlebotomy visits to housebound patients from 8th June Please prioritise carefully, capacity will not be at full strength due to COVID-19 related absence, there will also be a backlog to clear and phlebotomy capacity will need to be set aside for Antibody testing.
  • Health Visitors
    • Safeguarding, antenatal and New baby checks have continued throughout COVID
    • 98% of new baby checks have been face to face. The 2% that haven’t, have been for symptomatic families or where a visit has been declined.
    • 6-8 week reviews were paused according to NHSE/I guidelines. All being well they will recommence on 15th June.
    • Healthy Child Programme and Universal Plus contacts will be reinstated after 15th June but we don’t have confirmed dates yet. These are dependent on the availability of returning redeployed staff and PPE supplies.

Dermatology Update. Further to the update last week Dr Mark Wood has asked us to share the following: Further possible clinical associations with COVID-19. There is a growing clinical suspicion of specific Cutaneous and Ocular presentations during the current pandemic.
Increasing reports are being collated from both North and South Derbyshire.
Supported by speciality professional bodies, there appear to be more cases of vasculitic and urticarial type rashes emerging in patients without any pre-existing skin or viral disease. The British Association of Dermatology is keen to be informed of similar presentations via their Survey , with more information from Dermnet and a published BJD article also available.
The possible Ocular associations appear to be more subtle in nature, including visual field defects in otherwise young and healthy patients. Changes in the retinal circulation have been identified, with two local Case examples and a published Lancet article for reference.
The newly commissioned Tele-Dermatology and CUES Optometry services can offer help.
With greater GP awareness and more skin and eye cases being identified, this will hopefully feed into a growing evidence base, aiding understanding further. If appropriate, this may then support further guidance from Gov.UK and perhaps more COVID-19 testing indicators.

Antibody Testing. Many of you will have seen the national communications about the availability of antibody testing. The initial phase of antibody testing has started in acute hospital settings but not yet in general practice. The Derbyshire testing cell will communicate with general practice as soon as the details are finalised about testing capacity and processes for GP staff and patients. It is important to reiterate that the science is currently uncertain and a positive test result for antibodies only means than an individual has had Covid-19. There is currently no evidence to show it means someone cannot be re-infected with the virus, or pass it on to others, or have protective immunity. All infection prevention and control measures must continue to be in place irrespective of the presence of antibodies. Public Health England are conducting a study to establish whether antibodies detected by this test do indicate immunity to Covid-19.‚Äč

DOACs/NOACs Holding statement. Following publication of the national guidance the CCG have asked us to share the local position with practices. (Attachment F)

OTHER UPDATES

Video Consulting. NHSE have updated their guidance about Video Consulting (Attachment G).

Employee/Employer and Schools requests. With the relaxation of the lockdown rules and staged return to work and school there will be an inevitable increase in queries to practices. We have put together a short summary to support practices in dealing with such requests and included two template letters for use with employees and parents of schoolchildren.

The Centre For Perioperative Care. They have produced a set of FAQs for patients having an operation during the COVID-19 (coronavirus) pandemic which practices may find useful. (Attachment H).

LMC Webinar. Thank you to those who joined us for a virtual coffee this morning and the recording is here. John Krafts has shared the Generic Return to Work Risk Assessment (Attachment I) and we have asked him to produce a summary of the information about the various categories of workers and we will share this as soon as we have it.

AND FINALLY…

On behalf of general practice across Derbyshire, the LMC, GP Alliance and GPTF wrote and letter of support to the main Secondary Care Trusts in Derbyshire and our surrounding areas (Attachment J). We have received some very positive responses which reminds us that as a health and social care system we are all in this together:

Many thanks for your very kind letter, it is much appreciated. I will make sure that this is shared with consultant colleagues.
Dr Keith Girling, Medical Director Nottingham University Hospital

That’s a really nice letter – thank you! I’ll share it with our consultants.
Dr Hal Spencer, Medical Director Chesterfield Royal Hospital

Thank you for that very kind letter.
Dr Colin Wasson, Medical Director Stepping Hill Hospital, Stockport

A few years ago I had the huge honour of doing some work about being in captivity with Terry Waite and I was drawn to an article that he wrote recently in the Daily Express . There were two particular quotes that resonated we me as we start to come out of lockdown:

But remember, you are not stuck at home, you are safe at home. And by keeping yourself safe, you are helping to keep others safe too.

This crisis will bring out both the best and the worst in people. For the vast majority it will bring out the best. Be grateful that you have shelter, possessions, friends to talk to on the phone or online.

Let’s hang onto those thoughts, particularly the amazing “best” that we have seen from everyone involved in Derbyshire general practice.

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