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DAILY COVID-19 BRIEFING DDLMC 17.3.2020

KEY MESSAGES FOR TODAY

Yesterday Boris Johnson announced key changes in how we as a nation will reduce the impact and burden of COVID-19. In brief:

  • EVERYONE -
    • should avoid gatherings and crowded places, such as pubs, clubs and theatres
    • should work from home if they can
    • should avoid all "unnecessary" visits to friends and relatives in care homes
  • By next weekend, those with the most serious health conditions must be "largely shielded from social contact for around 12 weeks" by practicing social distancing. Those high risk conditions are:
    • People aged > 70
    • People <70 with underlying health condition (i.e. anyone instructed to get a flu jab as an adult each year on medical grounds including pregnant women)
    • You can find guidance on social distancing here
  • If a person in a household has a persistent cough or fever, everyone living there must stay at home for 14 days. NHSE Coronavirus page has reflected these changes. If you live alone the self-isolation period remains at 7 days.

Impact on Practices:

The above will have a significant impact on general practice staffing both by protecting those who are >70 or who have medical conditions and because of the impact of self-isolating family members. Solutions will vary practice to practice but we would encourage PCNs to look at pooling staff resources or buddying up with practices to lessen the impact of staff losses.

As a result, with immediate effect Derby and Derbyshire LMC will be adopting a policy of Zero Tolerance of bureaucracy that distracts or undermines our front-line colleagues struggling to cope with Covid-19. We expect practices to be free to provide safe care to our patients, and actively supported by our commissioners to do so. The CCG agrees with this and is working with the LMC on how to reduce workload to allow practices to focus – see yesterday’s CCG briefing with more to follow.

Clinical Care for COVID-19 suspected self-isolating patients:
The key message we will be sending out to Derbyshire patients is that if they are well enough to manage at home, they should NOT contact NHS services including GPs and 111. Please see attached press release.

There is a significant gap between what 111 is contracted to do and what the general practice SOP for COVID-19 currently states. At the moment, with all services at breaking point, patients are being directed to practices for triage. We are urgently pressing the CCG/NHSE to provide a funded solution for home visiting which is likely to be cross system. This is PRIORITY. We are having daily briefings with the CCG and press briefings encouraging patients not to contact their GPs unless absolutely necessary.

Remove Routine Burdens
We have this afternoon received a letter from Sir Simon Stevens which has explained NHSE efforts to reduce administrative burdens on primary and secondary care. We are consolidating the information, but the full content of the letter is here .

ACTIONS FOR THE NEXT 24 hours

  • We recommend that all surgeries to risk assess members of the practice team and protect those in high risk groups.
    • Those with significant and unmanageable staffing losses to contact the CCG’s primary care quality team on ddccg.primarycarequalityteam@nhs.net (this box is checked regularly between 8am and 5pm) or 01246 514 088..
    • GPs who have additional clinical capacity and would be interested in supporting surgeries to please contact DDLMC.
  • DDLMC, GP Alliance and GPTF are coordinating a GP led emergency response team.
  • We anticipate an announcement coming soon that due to pressure on 111/OOH presumed COVID cases and their self-isolating contacts will be managed by primary care. This increases the need to plan for ‘dirty’ and ‘clean’ areas of the surgery / PCN and in addition the need for clarity over PPE supply lines. We will be clarifying this with the CCG for housebound and mobile patients.
  • We are planning to run weekly recorded Webinars run by the DDLMC team where PMs / Clinical Leads can gain updates, share challenges and ask questions. Details to follow.
  • DDLMC will continue to work with the CCG in coming-up with solutions to the increasingly pressing need to enable GPs to work remotely.
  • DDLMC pressure via national team to get urgent testing for all health care workers to lessen the impact on practices.

FAQs

  • Should the practice be issuing Med 3 Forms for 14 Day or 12 week (high risk patient) Self-Isolation? The Department for Work and Pensions promised an alternative online solution on 10th March but this has still not happened. DDLMC view is that practices should not be doing this as it takes staff away from frontline duties and we will support any practice refusing to do these until the national guidance catches up with reality. We have attached a letter above which practices might wish to use to notify patients that they will not be issuing Med 3s for employees or school children.
  • Should the practice be writing medical reports for people who have chosen to cancel holidays? No. This is non contractual and a travel company asking for a report places no obligation on the practices to do so.
  • Should we be switching to longer repeat prescriptions? No. If large numbers of patients switch from 28 day to 84 day repeats there is a real risk that the supply chain will collapse. Encourage patients to use online ordering and EPS.
  • Can EPS be rolled out to hubs? We are pressing the CCG and NECs for a solution as hub working may become more prevalent as more practice staff are affected by the new 14-day family self-isolation guidance.
  • Can the current reported 4 day turnaround to get remote working tokens from NECs be speeded up? We have raised this as a matter of urgency with the CCG and NECs and hope this can be wrapped up with the other IT issues that the CCG reported on yesterday.
  • Is there a template risk assessment form for practices to use for staff? We have uploaded a World Health Organisation template to our resources area.
  • Can the posters on the LMC Resources hub be translated into other languages? Polish, Punjabi and Romanian version of the posters we shared yesterday are coming very soon. If there are any other languages that would be useful please let us know. Please be aware these may go out of date quickly with updated government advice.
  • Can we suspend NHS 111 direct online bookings? Yes. In the same way you have suspended online bookings we advise practices to not make any appointments available for NHS111 direct bookings.
  • Should pregnant staff be at work? As being pregnant has now been added to the high- risk group we would advise practices to encourage pregnant staff to self-isolate and work from home if possible.
  • What should practices do with booked routine appointments? Practices may wish to call all their pre-booked routine appointments and triage to see if they need to be seen. If the clinical judgement is that patients do need to be seen the practice should then screen patients and any that are symptomatic should be seen in a separate part of the practice with PPE.

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