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DAILY COVID BRIEFING DDLMC 19.3.2020

DAILY COVID BRIEFING DDLMC 19.3.2020

KEY MESSAGES FOR TODAY

JOINT DDLMC/GPA/GPTF/DCHS COVID-19 RESPONSE TEAM


A Task Force drawn from the DDLMC/GPTF/GPA/DCHS has been working together to coordinate general practice preparedness for the COVID-19 crisis. We have been working closely with the CCG and advising on key areas of need.

Key achievements can be found here .

NATIONAL UPDATES

You will all have heard Boris Johnson’s announcement regarding school closure.

Schools will shut from FRIDAY until further notice

The children of ‘key workers’, including health professionals and vulnerable children will still be able to attend.

We are awaiting details on what this means for children who have only 1 parent in the medical profession or where all children in a family don’t qualify (e.g. only 1 with EHCP)

We also received an update from Richard Vautrey, Chair of GPCUK:

  • We will undoubtedly be working in very different ways very quickly. Practice income will be protected.
  • PPE and testing of healthcare professions are right at the top of government and NHSEI priority lists.
  • There will be emergency legislation brought forward to enable retired doctors to return to work, primarily through digital and telephone consultations and via a new COVID response service, linked to NHS 111, to meet increased triaging needs.
  • The peak of activity could coincide with Easter, and so legislation will also enable an emergency contract variation relating to opening hours on Good Friday and bank holidays if this is required. Funding issues have been raised.
  • There are proposals to offer the opportunity for locum GPs to be employed by a lead provider and thereby have death in service benefit.
  • Dispensing practices and pharmacies will be expected to provide a home delivery service and this is being discussed with the DDA.

UPDATED LETTER FROM NHSE

The attached letter from NHSE answers many questions that we have been asking. Priorities are:-

  1. Move to a total triage system (whether by phone or online).
  2. Agree locally with your CCG which practice premises and teams should be used to manage essential face-to-face services.
  3. Undertake all care that can be done remotely via appropriate channels.
  4. Prepare for the significant increase in home visiting.
  5. Prioritise support for particular groups of patients at high risk.
  6. Help staff to stay safe and at work, building cross-practice resilience.

They have grouped impact into 3 groups:-

National

  1. QoF. Currently 19/20 collection going ahead but accepting that practices have ceased any activity. Payment will be adjusted to 18/19 levels if (when) these levels not met. We are urgently seeking clarification sue to the admin burden of completing the returns. QoF Income for 20/21 WILL be protected.
  2. Dispensary Services Quality Scheme (DSQS) suspended but income protected.
  3. PCN DES. Service requirements adjusted (Structured Medication Review and Medicines Optimisation postponed – Cancer and Care Homes work continues). ARRS Workforce returns delayed until August, unused ARRS Funding protected until September. Investment and Impact Fund (IIF) delayed to Oct.
  4. Appraisal. We are expecting this to be cancelled by RO at Regional Level but awaiting confirmation – effectively a 12 month extension. Revalidation If you're due to revalidate before the end of September 2020, this will be deferred by one year. https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation
  5. CQC. Routine inspections suspended.

Activities that Practices may wish to consider suspending/delaying/delivering differently

  1. New Patient reviews. Over-75 health checks. Annual patient reviews, including under QOF. Routine medication reviews. Clinical reviews of frailty.
  2. Friends and Family Test (FFT) and Patient Participation Groups (PPG) can be suspended.
  3. Dispensing list cleansing suspended.
  4. PCN clinical director functions can be delegated to non-clinician.

Services and activities NHSE are recommending local commissioners consider suspending

  1. LESs/LISs and local and national pilots. Funding will not influence clinical decision making by ensuring that all GP practices in 2020/21 continue to be paid at rates that assume they would have continued to perform at the same levels from the beginning of the outbreak as they had done previously, including for the purposes of QOF, DES and LES payments.
  2. Local audit/assurance activities and other local data collections. Default position should be to cease (or reduce frequency).

IMPACT ON PRACTICES

This remains a huge concern and we are hearing staggeringly high rates of clinical and non-clinical staff shortages. We are working with the CCG to get accurate timely data so we can support pooling the workforce and rapidly deploying additional support in areas of need. We are also urgently working up a wellbeing and support package for all practice staff.

MEDICAL CERTIFICATION

Whilst we await a national solution to medical certification for sickness/holidays/insurance etc and strongly support you to push back on requests. Our colleagues at Londonwide LMCs have created the attached which we wanted to share as felt some practices may prefer this approach.

KEY MESSAGES FOR THE PUBLIC

We are conscious of needing to step up the intensity of public-facing message to protect you, to protect the vulnerable, to protect the NHS.

We are continuing to co-ordinate the media and are looking at novel ways of getting the message out so that it lands on those who still do not appreciate the need for collective public responsibility in the face of this crisis. We will mainly be using Radio Derby and our social media outlets.

General practice staffing has been devastated by the impact of COVID-19; both self-isolation and the need to protect high risk members of staff. We will therefore only focus on urgent patient need.

It is imperative the general public work with us to protect the NHS, not just for unwell patients with COVID-19 but all other urgent conditions e.g. heart attacks, car accidents, cancer care.

  1. DO think before ringing any services; use online services first. General practice does not have the capacity to field minor queries for well patients.
  2. DO NOT use services unless absolutely necessary
  3. DO NOT request Med3s / reports / Holiday Cancellation Letters for COVID-19
  4. YOU MUST follow self-isolation/social distancing guidance
  5. DO use Electronic Prescribing Service to order NORMAL QUANTITIES of repeat medications
  6. DO be patient with all staff – everyone is doing their bit and working flat out

LOCAL ACTIONS/GUIDANCE FOR THE NEXT 24 HOURS

  1. System Plan for managing COVID-19 patients in the community including EOL care planning. This includes but not limited to – syringe driver provision, guidelines for management, support to aid Care Homes in EOL decisions
  2. Release of daily quick-complete status check for general practice to look at key areas of staffing / IT / equipment need
  3. Media – Social Media guide for practices

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