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DAILY COVID-19 BRIEFING DDLMC 23.3.2020

KEY MESSAGES FOR TODAY

We hope you’ve been able to have some down-time this weekend and managed through the difficulty of a contactless mothers’ day. It is important we all keep well and rested to tackle the huge challenge ahead.

Work has been continuing behind the scenes, as we’re sure it has in every GP surgery.

JOINT DDLMC/GPA/GPTF/DCHS COVID RESPONSE TEAM

The COVID TASK FORCE has been working hard on a number of resources to support Derbyshire general practice, all of which are attached:-

The COVID-19 Practice Plan – Is the probably the most important aspect of this bulletin and is the blueprint for a comprehensive approach to managing patients through the crisis. This has been agreed with all Clinical Directors and follows the guidance from NHS. It is intended to be an iterative document and updates will be communicated to you.

Wellbeing guide – a collation of advice and the offer for general practice teams to stay well during the crisis.

End of Life – We have attached the EOL drug guidance for COVID-19 and a guide for ReSPECT forms written by Dr Pauline Love.

Template letter for patients – We would like to thank Dr Ben Milton for creating the attached letter explaining to patients some of the challenges and behaviours needed to navigate this crisis.

Update on Death Certification – Following a discussion with the Derbyshire Coroner Dr Kath Markus has produced an update which is attached. If someone dies at home following a presumptive diagnosis of COVID-19 i.e. fits the case definition but no confirmatory swab, they may or may not have been seen by a HCW. All cases will be referred to the coroner who arranges transport to the mortuary. Each patient is swabbed. If COVID-19 positive, the coroner will issue a death certificate. If COVID-19 negative, there will likely be a post-mortem.

NATIONAL UPDATES

National Daily PM briefings. Saturday and Sunday focused on shielding for the 1.5 million patients being classed as extremely vulnerable (full details here), social distancing and self-isolation for at risk groups and the general population.

Extremely Vulnerable. These are solid organ transplant recipients, people with specific cancers, people with severe respiratory conditions, people with rare diseases and inborn errors of metabolism, people on immunosuppression therapies and women who are pregnant with significant heart disease. This group are strongly advised to rigorously follow these measures:

Strictly avoid contact with someone who is displaying symptoms of COVID-19.

Do not leave your house.

Do not attend any gatherings.

Do not go out for shopping, leisure or travel.

Keep in touch using remote technology such as phone, internet, and social media.

At Risk groups. Social distancing and self-isolation guidance remain extant but those at increased risk of severe illness from COVID-19 are advised to be particularly stringent in following the guidance. These are people who are; aged 70 or older; under 70 with an underlying health condition that means they would be instructed to get a flu jab on medical grounds) or; woman who are pregnant. Social distancing is:

Avoid contact with anyone displaying symptoms of COVID-19.

Avoid non-essential use of public transport when possible.

Work from home, where possible.

Avoid large and small gatherings in public spaces.

Avoid gatherings with friends and family.

Clinical Guidelines: The new NICE COVID-19 rapid guideline:critical care. has been produced which is a vital read in understanding some of the phenomenally difficult decisions that are being made on ICU-suitability, dependent on performance status. As yet, no age cut-offs for admission have been articulated. This emphasizes the need for EOL discussions throughout society.

PPE - The BMA has called upon the Prime Minister to guarantee proper protection provision for NHS workers and make testing immediately available for healthcare workers. You can read the press release here.

OTHER UPDATES

Contraception: The FSRH have updated their advice on contraception in light of the COVID-19 pandemic including evidence for extended use of LARCs. You can find the link here .

Management of Staff with underlying health conditions: The guidance on the extremely vulnerable and at-risk groups applies to practice staff. Our view is that extremely vulnerable staff should not be in the practice at all and at-risk staff should only be in the practice if they can work away from patients and maintaining 2m away from other staff in a segregated area. Both groups can work from home.

Pharmacy Preparedness. Community Pharmacies have seen a similar huge increase in workload pressures as a result of COVID-19 and the public reaction. The Chief Pharmaceutical Officer has issued an update which can be found here .

Cancer Referrals. We have received this message from the Medical Director of CRH and would ask for GPs to note “Could GPs be as proactive as possible regarding advance decision making regarding care and nursing home admissions and when it would be appropriate and when not? Admission at present is likely to carry significant risks and may not be appropriate for COVID 19 symptoms if escalation/ventilation isn’t appropriate. However uncontrolled symptoms (of whatever type) may justify admission”. JUCD has issued further guidance on UGI 2WW referrals and Mastalgia pathways and these are attached.

LOCAL ACTIONS/GUIDANCE FOR THE NEXT 24 HOURS

Work with the CCG to ensure no practices have short term cash flow problems.

Continue to try and get agreement to remove the 14-day qualifying period for reimbursement of locum costs for GPs who are sick or self-isolating and include other clinical staff in the scheme.

KEY MESSAGES FOR THE PUBLIC

Like many of you we remain concerned that social distancing and self-isolation are not being strongly adhered to by all. We are also concerned by the very sharp increase in cases and state of emergency in London. It is time to ramp up the public messaging to increase preparedness for what is coming. We will be on Radio Derby at breakfast time again this week and will be approaching the BBC with the following messages which we would be grateful if you would reinforce:

SOCAL DISTANCING will only work if we all do it and it is the only way to reduce impact on our NHS

Please ensure your children are not hanging around with one another when not at school.

Please do not congregate in houses as pubs/clubs are closed.

If outside, please maintain 2m separation and avoid busy areas such as popular parks.

The NHS is getting increasingly stretched. YOU CAN HELP

Only use General Practice/A+E if you need to. If you need to we are here and are managing the vast majority of problems by phone. Do not ring your practice if you think you are in the extremely vulnerable group unless you haven’t received a letter by Sunday 29th March.

Where possible try self-care first.

Please be aware that routine referrals to hospital have been suspended. The only exception is CANCER SERVICES where Two Week Wait Cancer referrals can still be made

DO NOT over-order medications, or order medications that you wouldn’t normally have. We have seen Social Media posts about ‘Rescue Medication’ for chronic lung complaints; these are used in specific circumstances and are not for all. We have sufficient medications at this time but inappropriate use will affect the supply chain.

General practice continues to adapt to the crisis. We will see practices working in networks to pool resources such as staff and PPE and manage at risk patients and probable COVID-19 patients in different ways:

You may start to hear the terms ‘RED’ clinics for respiratory problems or those self-isolating and ‘Green’ clinics for other medical problems where there are no symptoms of COVID-19.

You MAY be seen at a practice that is not your usual practice but is nearby. Please listen carefully and follow instructions given.

We need to start talking about death and dying. This excellent article from the BBC explains why and advises the sorts of questions we should be having with our loved ones.

A huge thanks to the vast majority of patients who are adhering to government advice, understanding of these changes and self-caring.

AND FINALLY

We are looking to host another Webinar on Tuesday and this will have a clinical section and an operational section. Practices might want to think about who dials into this and our suggestion would be GPs for the clinical section and practice managers for the operational section. Details to follow.

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