DAILY COVID-19 BRIEFING DDLMC - 09.04.2020

STOP PRESS

The CCG have asked us to share the following: Please see the attached guidance from NHS England which sets out the reimbursement for GP and non-GP workforce for Good Friday and Easter Monday.

In light of the guidance from NHS England and clarity around the amounts that will be allocated to the CCG to reimburse practices for GP staff, we have had to amend our original proposal relating to GP reimbursed rates only. The non-GP workforce guidance that was shared this week, based on the agenda for change principles, still applies. In addition, the CCG will still honour our commitment for a shorter working day, with DHU cover in place from 4pm on both Bank Holidays.

The CCG is pushing back on the NHS England guidance but at this late stage, practices will need to assume that the NHS England rates will apply for this weekend and the CCG will confirm any changes / updates to this position next week.

JOINT DDLMC/ GPA / GPTF / DCHS COVID RESPONSE TEAM

The locally produced one stop shop EOL guidance has been updated and this is a link to Version 3. The update includes appendices for carer support and useful web guidance and the contact details for Specialist care.

NATIONAL UPDATES

NOTIFIABLE DISEASE. A reminder that on 6th March 2020 COVID-19 (suspected and confirmed cases) became a notifiable disease which should be reported using this form to PHE East Midlands Health Protection Team, Public Health England, Seaton House City Link, Nottingham, NG2 4LA. This remains extant and they should also be informed of cases or situations relating to the following contextual settings:

2 or more cases from a long-term care facility
any case from a prison or prescribed place of detention
any outbreak in a hospital or healthcare setting
schools
other unusual scenarios

In addition, any case meeting the criteria for avian influenza or MERS-CoV testing should be reported to the same address.

The fact that, as of 19 March 2020, COVID-19 is no longer considered to be a high consequence infectious disease (HCID) in the UK, has not changed these reporting requirements.

LOCAL UPDATES

Verification of Death. You will be aware that we put out guidance on 1st April about Death Verification, Certification and Cremation Forms, following the amendments to some of the processes. The Senior Coroner in Derbyshire Dr Robert Hunter has raised some fundamental issues with the guidance, particularly concerning Verification and we seeking to meet with him as a matter of urgency next week to resolve these issues. We then aim to put out some updated joint guidance.

In the meantime, in order to prevent any further anguish for relatives, we would ask GPs to revert to the previous arrangements for verification. Clearly, any attendance of the deceased will need to be conducted while wearing the correct PPE which for the avoidance of doubt is the same as for seeing patients (apron, mask, gloves and eye protection). You also need to consider how to remove and dispose of the PPE safely after attendance.

I have also been made aware of some complaints about the tone taken by some GPs when dealing with the Coroner’s staff and we would of course urge you to display the normal high standard of professional courtesy when dealing with them.

Blood Tests at CRH. Urgent and essential bloods for children can be accessed by contacting the duty nurse in The Den (Children’s Outpatient’s departments) 01246 514414, who will try to arrange as soon as possible. They are unable to undertake any other blood tests at this time.

DCHS COVID-19 Delivery Plan. DCHS have kindly provided a copy of their Delivery Plan (attached) which outlines the way they will deliver services through the pandemic.

PPE. If practices are still awaiting orders from NSDR then if you let the primary care team ddccg.primarycarequalityteam@nhs.net .have the details including the reference number, they will chase these on your behalf.

Easter Bank Holidays Pathology. The vans will do 2 runs on Friday and Monday as usual. However, the labs will start processing earlier in order to try and get any critical results to practices before 4 pm.

Safeguarding. COVID-19: Multi-agency update – Responding to safeguarding concerns is attached to remind everyone about the importance safeguarding during the pandemic.

School Nursing Service. They have offered to help practices with childhood vaccinations and immunisations at practices as they are currently not busy in school. Any practices wishing to explore this option should contact Judy Derricott at the CCG primary care team ddccg.primarycarequalityteam@nhs.net.

OTHER UPDATES

Education Resources. For those staff with children who you might be struggling to keep occupied, the DofE has pulled together a centralised pool of resources for home education.

IT. NECS and the CCG IT teams have provided the following:

Away From my Desk. The issues holding up the roll out are now apparently resolved and practices should be able to register using the details forwarded by NECS.
Laptops. 600 laptops have now been delivered to NECs/CCG and are in build. These should start being sent out early next week.

Care Planning. NHSE have issued a communique in respect of The BMA, Care Provider Alliance, CQC and the RCGP joint statement about care planning. The key principle is that each person is an individual whose needs and preferences must be taken account of individually. By contrast blanket policies are inappropriate whether due to medical condition, disability, or age. This is particularly important in regard (DNACPR) orders, which should only ever be made on an individual basis and in consultation with the individual or their family.

Clinical Updates:

Attached is guidance for the management of abnormal uterine bleeding in the evolving Coronavirus (COVID-19) pandemic (Joint RCOG, BSGE and BGCS).
An excellent Red Whale 4-page summary on Triage, Remote Assessment, Management and Management of Respiratory Conditions is also attached.
CCG Meds Management have produced the attached Guide for alternative inhalers during stock shortages related to Coronavirus (COVID-19).
- managing suspected or confirmed pneumonia in adults in the community
- And managing symptoms (including at the end of life) in the community includes recommendations about managing medicines for these patients and protecting staff from infection.

HR Update on Staff Sick Pay. Further to the Webinar today Liz Willetts from Kraft provided an update on the various combinations of sick pay in relation to staff absence due to Coronavirus. Clearly (apart from the first group) the practice should try and explore all options for remote working before resorting to the measures described below. There are number of groups of staff:

Symptomatic Staff. Clearly these staff are ill and should therefore be paid in line with their contractual sick pay.
Self-isolating but non symptomatic due to symptomatic household member. (normally 14 days). These staff are entitled to SSP. Individual practice decision if they wish to pay any additional sick pay.
Shielded patients (normally 12 weeks). The regulations are unclear, and it is a practice decision whether to pay SSP, full contractual sick pay or the staff member may be able to claim universal credit. Liz’s considered opinion is that practices should pay SSP (but can only reclaim the first 2 weeks).
Other staff who may want/need to take time off to look after relatives/children. There is no obligation on the practice to pay the staff and they may be offered unpaid leave. Please flag any issues where staff are being refused a school place.

KEY MESSAGES FOR THE PUBLIC

Promoting Primary Care Services open over Bank Holiday

The CGG has issued the attached press release to make the public aware of primary care services open over the bank holiday weekend.

SUPPORT SERVICE TO CARE HOMES 24 HOUR/ 7 DAYS A WEEK WITH RESIDENTS WHO ARE END OF LIFE. You should be aware that the following comms have gone out to care homes across Derbyshire:

Any routine enquiries regarding residents who are at end of life i.e issuing prescriptions etc during normal working hours, please call your usual support - GP or ANP (please note, GP practices close at 4pm on Bank Holiday Friday and Monday)
For any End of Life specialist advice and/or guidance needs please call 111*6 You will then either be given direct advice or referred to the most appropriate team to help you
Please try to ensure you have the residents details to hand e.g. ReSPECT/DNACPR status, advance care plan, capacity status
The on-call person will do a telephone assessment
Consider having skype or facetime facilities so that the clinician can see the resident as part of the assessment process if this is possible

AND FINALLY…

Sorry it’s been a bit of a long one today but a lot of information to get out before the Non BH weekend (and please don’t shoot the messenger). Thank you again for the amazing work that GPs and practice staff across the county have been doing in response to this crisis. It has been nothing short of amazing. I really hope everyone can get time to enjoy the strangest Easter weekend ever and I thought I’d leave you with a thought from the spectacled child wizard and one of my favourite song lyrics – if only I could follow my own advice sometimes!!

"Don't worry about the future, Or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing Bubble gum.

The real troubles in your life are apt to the be things that never crossed your worried mind.

The kind that blindsides you at 4pm on some idle Tuesday - Do one thing every day that scares you"