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DAILY COVID-19 BRIEFING DDLMC - 07.04.2020

NATIONAL UPDATES

SOPs. NHSE have published an update to SOPs Version 2.1 with amendments highlighted in yellow. (Shielded patients, Death Certification and NICE guidelines for pneumonia). The shielded patient’s guidance “We also wanted to clarify the situation for face to face assessment for shielded patients. If possible, a dedicated home visiting team for shielded patients should be set up, with staff who are not seeing patients with symptoms of COVID-19. Where this is not possible, shielded patients should be seen either in designated sites or by routine home visits, depending on the local model. Infection prevention and control guidance, including appropriate use of PPE should be followed at all times” is being assessed by PCN CDs to see how this might work in practice. (We should also clarify that housebound “Green” non-symptomatic patients should still be triaged and if appropriate a home visit conducted by the GP/ANP and the advice about home visiting yesterday concerned mobile Green non-symptomatic patients).

LOCAL UPDATES

EMAS Update. EMAS are working to a pandemic triage protocol called ‘Card 36’, which effectively categorises symptoms differently with different outcomes. As the public seem to be using 999 more appropriately, EMAS are generally achieving the 18-minute CAT2 target response time. They have a senior clinician in the control room to assist with prioritisation and will prioritise health care calls from red hubs. They also agree that if someone is not collapsed and is in a car then they should be taken to A&E in the car if at all possible.

Easter Bank Holidays. Thank you to the CCG who have arranged for DHU cover so practices are therefore providing essential services between 0800-1600 on Good Friday and Easter Monday. As mentioned previously this requires phones to be answered and the ability for patients to be seen when required in either individual practices or through hubs, depending on local patient needs. The Medicines Order Line will be open 0900-1300 and Community Pharmacies 1400-1700 on both days. We have not seen anything concrete yet, but practices may want to start thinking about the 2 May BHs (of course remembering that the 1sy May BH is Friday 8th NOT Monday 4th May).

Easter Bank Holidays HR and Finance. NHSE and the CCG have accepted that because these are additional days, practices will need to be reimbursed but the fine detail has not been published yet. As is usual in general practice, practices/PCNs will manage their own staff in accordance with their individual employment contracts in terms of annual leave and pay. The CCG have indicated that using AfC contract provisions for practice staff in Bands 1-7 is not unreasonable. For BH that is double time for any work over 37.5 per week and a supplement of between 97% (Band 1) and 60% for (Band 4-9). The full HR advice we commissioned from Krafts HR on behalf of practices is attached for information.

Finance. Practices are reminded to maintain records of additional expenditure due to COVID-19 and wherever possible process invoices through Tradeshift to speed up processing. (The second option is through the ddccg.finance@nhs.net e-mail address but this is likely to be slower) Hannah Belcher has requested that these are submitted monthly (with initial invoicing to 31st March 2020) and re-iterates that if practices are having cash flow issues they should contact her directly to discuss.

Testing. COVID-19 Antigen testing is now available for key NHS workers in general practice at the testing centre in Beeston. Appointments are only bookable through the CCG (see below). STAFF MUST NOT TURN UP WITHOUT AN APPOINTMENT OR CONTACT THE CENTRE DIRECTLY.

  • Criteria for testing: Any member of staff who is critical to the running of the practice who meets the following criteria
    • Member of staff who is self-isolating because they are displaying symptoms
    • Where an asymptomatic member of staff is self-isolating because they share a household with a symptomatic adult, then the symptomatic adult (NOT the member of staff) is eligible to be tested
    • Only apply if within 4 days of first symptoms. (Antigen testing only valid in first 5 days and appointments booked for next day. Antibody testing may follow)
    • Only 18 and over.
  • If staff member (or other household adult where applicable) meets all criteria please complete attached spreadsheet application and sent to ddccg.primarycarequalityteam@nhs.net. A member of the team will contact the staff member and confirm appointment details. Staff must not travel until they have received confirmation from the CCG.
  • Results will be sent directly to the member of staff, not the organisation.

OTHER UPDATES

The Good SAM NHS Volunteering Scheme. If practices/PCNs require volunteers they can now bid through the Good SAM website. The scheme has temporarily closed for new volunteers as they are processing the 750,000 applications.

EOL. The team have updated the Interim Guidance for End of Life Care for Patients with confirmed or presumed COVID-19 . The changes are highlighted in yellow so they are easy to see when re-reading the guidance.

DNACPR Forms. While we are sure this wasn’t happening in Derbyshire, the attached letter provides clarification about DNACPR and the Clinical Frailty Scheme:

  • The terms “learning disability” and “Down’s syndrome” should never be a reason for issuing a DNACPR order or be used to describe the underlying, or only, cause of death … Learning disabilities are not fatal conditions.
  • The CFS should not be used in younger people, people with stable long-term disabilities (for example, cerebral palsy), learning disability or autism. An individualised assessment is recommended in all cases where the CFS is not appropriate.”

Red Home Visiting Service. This is now up and running and DHU completed 16 visits (using 2 cars) yesterday with 3 cars out today. This is expected to increase as they have been managing some staffing issues and integrating the new service into existing rosters. They also asked us to share “For information - today we have seen a couple of patients who were suffering from anxiety rather than being poorly, although we are fully aware that anxiety can create symptoms reflecting other conditions.” They have apologised for the technical issues with the phone lines yesterday and these have now been resolved. The number to call is 0300 1000 432.

IT.

  • CCAS. This service is now up and running but the IT has not quite caught up yet to allow practices to make slots available for direct booking. Please do not try to upload these slots as they will not work. We will share further guidance in the next couple of days once this has been enabled.
  • Away from my Desk. The email address that was forwarded yesterday doesn’t work and NECs have promised an update direct to practices tomorrow on how to download this software and access the system.

AND FINALLY…

I’m not sure if it is just me but you’ve got to see the funny side so thank you to:

  • The Away From My Desk team who sent out an inactive e-mail address for practices to contact them on.
  • The government owned landlord who wanted to go into a practice to conduct an asbestos survey “so the building remained compliant”.

We’ve all been encouraging one another to look after ourselves and a big thank you to the LMC/GPTF team who told me to take a day off yesterday. I hadn’t realized just how tired I was, so this was a very timely intervention by the team. I even fell asleep for an hour in the afternoon when I sat down to watch Doctors on BBC1.

I’m also amazed nobody spotted my deliberate mistake on Sunday – of course it is COMAO not CAMAO……...

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