DDLMC WEEKLY UPDATE 12th NOVEMBER 2020
COVID-19 Vaccine Programme. It won’t surprise you to know that this has been the number 1 issue this week. We absolutely understand practices and PCNs frustrations with many aspects of this programme and we hope everyone has seen the principles that the LMC will be working to as we try to represent and support you through this. Unprecedented has been a much-used word this year and in the case of a new vaccination programme for the entire population, it is entirely appropriate. All levels of the system are having to work with fast changing and often limited information. Given the enormity of the task, a successful outcome is far more likely by working collaboratively and allowing each part of the system to do its bit. We know that general practice has a huge amount of experience in delivering large scale vaccination programmes but must not and will not be expected to deliver the entire programme. As but one example, general practice won’t be expected to source freezers that can store the vaccine at -70C.
We will endeavor to keep you updated with pertinent information in a timely manner to help inform your decision-making process. The GPC have produced a summary of the current position, which you may find useful. A reminder that NHSE are running a webinar on 12th November at 7pm (that’s tonight!)
Clinically Extremely Vulnerable Patients. Further to the update last week the letter being sent to this cohort of patients has been published. In addition NHSD have published more detail on the process and codes that practices should use. The guidance includes a template letter for practices to use if you do need to add new patients - Updated High risk patient additions letter template.
Message from the Dermatology Clinical Innovation and Strategy Group. During the pandemic we know that patients have delayed seeking advice and referral for potentially serious problems. Now that referral rates are getting back up to normal, our dermatology colleagues are struggling with the volume of two week wait referrals, all of which are taking longer to see and assess due to social distancing, PPE etc.
We know that it can be difficult to assess a skin lesion by viewing a photograph, but it can also be a problem even when face to face. Occasionally, with a good history to support a lesion being malignant and a photograph that looks very suspicious, a 2ww referral would be appropriate, but this is actually quite an uncommon position to find ourselves in. As 2ww cases take priority inevitably there is a delay in seeing urgent and routine cases.
Our consultant colleagues have suggested that in many cases where you are unsure it may be more appropriate to request advice via Consultant Connect either using the App or web-based option. Some of these patients will have non-specific crusted lesions, which, with appropriate topical therapy, will resolve and save patients a trip to the hospital. Thank you.
DCHS Update. We all know how much pressure general practice is under at the moment and these pressures are being felt in different ways across the system. In order to help general practice understand some of the pressures that the community teams are under Dr Ian Lawrence from DCHS has asked us to share the following: DCHS have launched a new web page and newsletter specifically for general practice updates on DCHS Services. The GP web page is here. And the new newsletter is here.
He has also asked us to share that demand on community services is exceptionally high and it’s fair to say they are struggling. The ask is:
- For information; that we’re likely to be less responsive that we would like.
- Anything that can be done to help most appreciated, this might include:
- Warning patients with non-urgent nursing need that there may be a wait
- Advising self-care wherever possible
- Seeing otherwise mobile but isolating patients in red facilities
- Just being nice to the nurses and therapists if you see them!
The background is:
- Jan19-Dec 19 – we received on average 2070 referrals per week
- Jan 20- June 20 – we received on average 2400 referrals per week (this includes Covid)
- Since June 20 – Oct 20 – we are receiving on average 2570 referrals per week.
So the last 4 months, its approx. 25% higher than the total 2019 position and 7% higher than the entire 2020 position.
At this point in the first wave:-
- ICS had a c2 month period with a huge drop in referral demand c500 referrals per week on first phase. Rapid response referrals never dipped and grew slightly
- ICS had 150 redeployed DCHS staff in place, about half of whom were in community teams including sexual health and children’s’ nurses, speech and language……
Now we have
- Staff at work but not able to do their full roles and less staff to redeploy unless we stop more
- More patients isolating who many assume means they now need housebound care from DCHS
- Care and nursing homes in crisis and needing more support
JAPC Change on nomenclature. Sadaf Qureshi email@example.com from the CCG Meds Mgt Team has asked us to share: “With the recent world-wide black lives matter movement, JAPC has taken the decision to rename the BLACK and BROWN drug traffic light classifications to avoid any negative connotations which may be associated with these references. Under the new proposal all BLACK drugs will change to “Do Not Prescribe (DNP)” and all BROWN drugs will change to “GREY”. The Red, Green and Amber classification will remain the same.
This renaming of the BLACK/BROWN drugs will be a substantial piece of work which will include changeover of the traffic lights database, updating the local formulary, clinical guidelines and non-clinical guidelines, and any other relevant documents which make reference to the black or brown traffic light classification. Furthermore the practice based formularies and trust formularies will need to be updated to align to the amended JAPC traffic lights classifications.
Users will see an immediate changeover to the new nomenclature of Grey and DNP in the traffic light section of the Derbyshire Medicines Management website (phase 1). BNF chapters, clinical and non-clinical guidelines will gradually be transitioned over (phase 2). Due to size of this task it is not practical to amend previously published communication; these include previous JAPC minutes, JAPC bulletins, JAPC Annual Reports and Medicines Management Newsletters. However an explanation of the current and previous traffic light classification will be added to the Derbyshire Medicines Management website for ease of use.
The Clinical Policies and Decisions team are planning to complete phase 1 by the end of November 2020 and phase 2 by 31st March 2021. We apologise to our users for any confusion caused in the interim period whilst this work is ongoing.”
GP TASK FORCE DERBYSHIRE
LMC/GPTF Webinar. Our next scheduled regular webinar is Wednesday 25th November at 11:00. I will deliver the main part of the session on “The Positive Power of No” and we will introduce you to the newest member of the LMC team Mike Smith. The number of attendees will determine the format of the webinar so if you are planning to attend please can you book a place: https://www.derbyshirelmc.org.uk/events/11562. See you there.
Clinical Waste Collections. We have been made aware today that there is a national issue with clinical waste collection and the CCG are working on contingencies to support practices. We will monitor the situation and if any practices are reaching a critical point please contact the CCG on the LCSF email firstname.lastname@example.org and copy us in.