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COVID 19 discharge and admission avoidance process. Dr Pauline Love has asked us to share the following: As part of this process we have agreed an interim process for accessing additional care and support for individuals in the community with increased care needs:

Admission Avoidance and Referrals for care and support from within the community
For any cases where there are increased care needs including End of Life requiring additional care to avoid hospital admission

  • For patients known to DNs AND where the increase care needs are identified by the DN (including end of Life needs) the DN will complete a short form assessment identifying nursing needs and care required or short version of FT document (attached) and forward to the MLCSU CHC team for brokerage of a care package
  • Where the GP identifies that the patient is approaching the End of Life and requires additional care and support –i.e. admission to Nursing Home or a care package at home the GP can complete the short version of the FT document (the GP is not required to complete the Care prescription within the referral form the CHC team will complete this) and forward to MLCSU CHC team for brokerage of a care package. The GP should provide contact details of a nominated person/representative for MLCSU to contact if further information regarding assessment of needs or care package is required. The CSU will contact the individual/family (which ever contact the GP provides) to undertake a telephone Nursing assessment to determine what support/type of care – Home or NH the individual requires and broker accordingly.
  • Where a GP identifies that a patient requires additional care and support (but not End of Life) the GP can contact MLCSU (contact details below ), with patient details and the CSU will MLCSU will complete a telephone assessment and care prescription and broker care as required.
  • Where a Care Home feels that a patient is rapidly deteriorating and approaching the end of life they should contact the GP to ensure appropriate RESPECT/DNAR is in place and any anticipatory medications arranged. The Care Home can also complete the short version FT form and contact MLCSU CHC team.
  • For all other cases i.e. where a social worker identifies that an individual has escalating needs that require additional care to avoid hospital admission – patient details should be passed to MLCSU – MLCSU will complete a telephone assessment and care prescription and broker care as required.

For all patients discharged end of life from Acute Hospitals the GP will be informed by the locality DN team AND the MLCSU will, if they broker any care – Dom care or NH will also let the GP know.

End of Life inbox for MLCSU CHC team: mlcsu.derbyshirechcfastrack@nhs.net Direct contact number for GPs/referrers to contact : 01332 888212 CHC SPA

The Palliative & End of Life Care Fast Track Pathway Tool is attached.


RCGP Guidance on workload prioritisation during COVID-19. This updated guidance has just arrived and is useful to focus on the entirety of general practice now we have settled into the new ways of working brought about by COVID-19.


Childrens Surgery. From today all urgent children’s (U16) surgery in South Yorkshire and Bassetlaw will happen at Sheffield Children’s Hospital (rather than at Barnsley, Doncaster, Bassetlaw, Chesterfield and Rotherham DGHs) (except time-critical surgery e.g. testicular torsion and blocked airway that will remain at the DGHs). Any practice requiring admission of a child probable (non-time critical) surgical condition (including appendicitis and bone fracture) should contact Sheffield Children’s switchboard on 0114 2717000 and ask for the relevant specialty registrar. This number should also be used to discuss/book travel arrangements (private car, taxi, PTS). I’ve included more detailed attachments about the pathway, a flowchart and patient facing comms that practices may need to refer to.

Community Support. As the lockdown looks likely to continue support to shielded, high risk and socially distancing patients with no social network will become increasingly important.

  • Community Response Hubs. These have been established by both County and City Councils and are available to any resident who needs support and does not have a trusted neighbour, friend or family member to help them. This includes those who are: Extremely vulnerable (Shielded), Vulnerable (those aged over 70, underlying health conditions, pregnant women) and Self-isolating due to the individual or someone in their household being ill with suspected COVID-19. For the shielded patients this is in addition to the nationally provided support including food parcels for which the patient needs to register separately. Full details are attached and contact details are:

The full details are attached.

  • NHS GoodSAM App. Practices are able to apply for access to individual volunteers through the good SAM App here .
  • Community health services. NHSE have now published the Novel coronavirus (COVID-19) standard operating procedure for Community Health Services which you may find useful.


Pharmacy Updates. Jackie Buxton from LPC asked us to share: “Following the release of the delivery service for shielded patients from both pharmacies and dispensing practices, I just wanted to let you know that if any of the dispensing practices don’t have means of delivery themselves (for the Advanced part of the service) then pharmacies are willing to support for shielded patients. Peter Cattee (PCT Healthcare so Peak and Manor Pharmacies) has a robust set up (his own vehicles and an arrangement using the Fire Service) and other pharmacies are also willing”.

Face Visors. The CCG have asked us to share details of a Nottingham company Kitronik Ltd which is able to make face visors for practices at 50p a time. As this is not something practices normally buy we thought the contact details michael.lockhart@kitronik.co.uk might be useful. Other face visor manufacturers are available.


Attached are two NHSE posters to reinforce the message to parents that childhood illnesses should still be dealt with in the normal way during the Coronavirus pandemic.


I am aware that we owe you an update on Death Verification (et al) and we did have a very constructive meeting with Dr Hunter yesterday. We were very close to publishing our guidance today but there have been a couple of national developments that we want to ensure are captured before we publish. I will provide a more detailed update tomorrow and apologies for the delay.

In line with the “Stay at home” guidance where travelling for work purposes is only permitted where you cannot work from home, we have been mostly working from home. However, for the last two days I have needed to come into the office and during my drive from the Dales to Derby, and my walk around the City Centre at lunchtime to get my daily exercise I had time to reflect on a few things:

  • There is much to be thankful for and there are beautiful things all around us, if we can take time out to be mindful of our circumstances.
  • “Team Derbyshire” is amazing and I am humbled to be part of our general practice rapid and innovative response to this pandemic.
  • This is likely to change all of our lives for years to come. Exciting, but change and the unknown is often slightly scary.
  • Some parts of normality remain. Temporary traffic lights proliferate (and is it just me that thinks the majority of these are unnecessary/mostly cordoning off roads where no work is then taking place? 4/6 on my drive in this morning).
  • A 99 year old veteran “Captain Tom” can walk 100 laps of his garden and raise over £12m for the NHS.
  • Despite predictions that unemployment could rise by over 2m, we are still having to fly people in from Eastern Europe to pick our crops.
  • Why do they need to advertise Psychic Fairs?

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