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DAILY COVID-19 BRIEFING DDLMC – 20.04.2020

STOP PRESS!

Minor Surgery DES Payments. DDCCG have agreed the monthly payments for the first quarter (April to June 2020) will be based on 1/12th of the 2019/20 total annual expenditure. No need to submit monthly claims. The position will be reviewed for Q2 onwards. Email should have been received via NHSE.

COVID-19 and Death Certificates. We have sought clarity from the registrar as we were asked for clarification on using COVID-19 on death certificates. We can confirm that COVID-19 (proven) may be given as a cause of death alone. For possible or probable COVID-19 cases, these must be qualified in 1a or 1b e.g. 1a Pneumonia 1b Probable COVID-19 or 1a Probable COVID-19 1b Pneumonia.

NATIONAL UPDATES

Electronic Cremation Medical Certificates. Form 4 has been updated to provide for a medical practitioner completing the form on their computer or other device to embed an electronic signature. This will enable the form to be sent via another person’s email account, such as a medical administrator, without the form having to be first printed and signed.

Changes to Sick Pay Guidance. On 17 April, the new Coronavirus Scheme Statutory Sick Pay (SSP) guidance was issued. Krafts HR have produced useful advice for employers , (noting Furlough does not apply to GP practices).

LOCAL UPDATES

Chesterfield Royal Hospital Clinical Pathways. Updated referral guidance and templates for CRH attachments # 1 to 7. The LMC is seeking clarity on the 2ww referral and communication with the patient between GP .

Dementia Complex Palliative Care Resource. Launch of a new service for Care Homes and Supported Living Services to access help and advice across Derby and Derbyshire. This is specifically for people with advanced dementia and palliative care needs and can offer consultancy and advice via telephone and sometimes video and f2f if necessary. Support includes;

  • Identify and manage symptoms associated with advanced dementia and end of life, i.e. pain, terminal agitation, nausea and vomiting, secretions, breathlessness.
  • Palliative care needs holistic assessment
  • End of life care planning
  • Advance Care Planning
  • Support and management of co-morbid conditions
  • Delirium
  • COVID-19 pandemic guidelines support i.e. where managing the demands of guidelines is compromised by individual residents needs
  • Behaviour that challenges
  • Maintaining activities during COVID 19
  • Polypharmacy and medication rationalisation (where appropriate)
  • Offer education and signpost to further educational resources

See guidance attachment # 8.

End of Life Care guidance. V5 updated in line with updated death certification process that was circulated last week.

Update from DCHS. After a huge effort from the Redeployment team, DCHS have managed to redeploy 123 staff, with a further 60 completing training in the next few days. 19 nursing students have also started work in HCA type roles. This has made an enormous difference to the pressures in community nursing and to community hospital ward cover. Teams are now managing well, sometimes in very unfamiliar roles. As long as absence and demand don’t dramatically increase, the extreme pressures being reported over the last few weeks have eased and DCHS expects to have the capacity to manage through the pandemic. More stats available via our Twitter page, feel free to follow us!

Resuscitation. We have had a number of queries about community CPR and PPE. There remains something of an impasse; with the international evidence from ILCOR suggesting chest compressions are an aerosol-generated procedure (AGP) requiring PPE but national guidance yet to include this. The issue was discussed at the PCN CD teleconference today, supported by the LMC. It is the belief of this group that current evidence is that CPR is an AGP and hence Level 3 PPE (including gown and FFP3 or equivalent mask) should be used for community CPR. Hence as per RCUK statement : Early application of a defibrillator, while other healthcare professional colleagues don Level 3 PPE, maximises healthcare professional safety, while also providing the patient the best chance of effective resuscitation. In the meantime this issue has been raised to the local System Escalation Group to request provision of level 3 PPE for resus trolleys in primary care.

PPE and HCW. With the ongoing concerns regarding supply chains for PPE; we feel it is our duty to point you towards this guidance from the BMA about what to do if you find yourself in the challenging situation deciding whether to provide treatment in the absence of effective PPE. And the timely reminder that ‘the GMC does not expect you to provide care without regard to your safety and that of others’. Nursing colleagues can see the document (attachment #9) from the RCN.

OTHER UPDATES

General Practice DoS to report General Practice Capacity. (Attachment #10). The LMC and CCG have agreed that we will assume all Derbyshire practices remain at green capacity i.e. “Service has capacity available. The service can accept referrals and is likely to meet any disposition timeframe.” If practice capacity changes to amber (limited) or red (none) as per page 3, they must notify be telephone the COVID incident room and ask for Hannah Bliss. The CCG will make the necessary daily return to NHSE to save any practice workload. Please continue to complete the bi-weekly survey and we will also update our RAG ratings on the local snapshot survey to reflect the new guidance and can also follow up any issues from these returns.

NHSE absence rate tool. Practices DO NOT need to complete the new staff absence tracker service. We have agreed with the CCG that the bi-weekly local snapshot will suffice.

Clinical guidelines for children and young people with palliative care needs in all care settings during the COVID-19 pandemic. Guidance (attachment #11) produced by the Association of Paediatric Palliative Medicine (APPM). This is aimed at all professionals looking after children and young people with palliative care needs who are infected with COVID-19, potentially entering their end of life phase and the decision is not for medical escalation into paediatric intensive care.

Pharmacy and Optometry Services – COVID-19 opening times for Pharmacies are here and Optometry Services here.

KEY MESSAGES FOR THE PUBLIC

Ramadan. Local Muslim communities will shortly begin observing Ramadan. It is important to ensure, that all patients continue to follow government advice and stay at home. Practices may wish to share the WHO guidance (attachment #12) with their patients along with the EGP learning video; How to be Healthy in Ramadan in 2020 . The LMC has contacted both Derby Jamia Masjid and Muslim Welfare Chesterfield and North Derbyshire to share with their congregations.

AND FINALLY…

"If you cannot do great things, do small things in a great way." Napoleon Hill

You might be an innovator, a leader, a team player, a doer, a thinker, a reflector. We need all our different skills to rise to the constant daily challenge (COVID or not). We are all valuable. Never fail to underestimate your contributions, however small you may think they are.

We can’t all save lives; but we can help in our own big or small way. Let’s take a minute to be proud of ourselves and everything we are doing.

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