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DDLMC WEEKLY UPDATE 13th August 2020

COVID-19 UPDATES

COVID-19 Support Fund for General Practice. You will all have seen the e-mail (Attachment A) from Hannah Belcher about the local claims process and we would urge all practices to submit their claims to the CCG before the 31st August deadline. This will ensure you are reimbursed for legitimate additional costs. Compared to many parts of the country our CCG has been proactive and supportive in this area and I’d like to publicly recognise that. If you have any specific queries, Hannah has asked that you contact her hannah.belcher@nhs.net .

NATIONAL UPDATES

Flu Campaign 2020. There is little new concrete direction to add to last week’s update. However, the CCG have now established a flu planning cell which should ensure practices are kept informed. Marie Scouse (marie.scouse@nhs.net) is leading on this and Marie is happy to take any queries.

From an LMC perspective our advice is perhaps best summarized by Paula Elliot who made the following observation at the PM webinar yesterday: “Surely we have to continue as though we are on a usual year - we only ordered for that and if we think in that way it lowers the stress!!!”

I think that is a really good start point and practices can adapt their plans as more information and/or vaccine become available. Having said that, at this stage there are a few things that we would advise you to consider.

  • Care homes. The general principle here is to maximise uptake but minimise footfall in the homes. To that end the CCG are encouraging practices, PCNs and Community Pharmacies (who are now permitted to go into care homes to administer vaccines) to work together to plan for only one visit to each home to vaccinate all the residents, regardless of where they are registered. This will require co-ordination, discussion and maybe some compromises, which are best agreed at a local level. Derbyshire LPC are part of the flu planning cell and we will continue to liaise with them to try and facilitate an efficient and fair delivery of the vaccines.
  • Prioritisation of eligible patients. The published list of eligible patients has no formal prioritisation within it and ultimately practices will need to decide their priorities based on their knowledge of their own patients’ needs. However, within your flu planning you may wish to consider focussing on the higher risk groups on the eligible lists before opening up clinics to the household contacts of shielded patients. We acknowledge this will be a delicate balancing act. Many of the 36,030 shielded patients in Derbyshire will be brought to the practice for their jab by a household contact who may wish to be vaccinated at the same time, and while there is an option to ask the household contact to wait until later in the campaign or go to the pharmacist this may result in both the contact and the higher risk patient going elsewhere. Hopefully the additional centralised supply of vaccines may negate this problem, but it is worth starting to plan for the early clinics.
  • Housebound patients. It is worth engaging early with your DCHS Community Services Manager to discuss how these patients will be vaccinated, particularly as this is likely to be a larger cohort than normal.
  • Indemnity. To remove any doubt, as it currently stands, the CNSGP indemnity scheme does not cover practices who immunise their own (non-healthcare professional) staff who are not registered patients. Practices who choose to vaccinate these staff must ensure they have suitable additional cover in place.
  • Practices should be signed up to the PPE portal, to ensure regular supplies of PPE in advance of the winter and flu campaign. More information is available on the guidance pages and the portal customer service team are on 0800 876 6802 for enquiries or registration support.
  • PSDs. When DCHS community nursing staff administer flu vaccinations for practices this will be against a Patient Specific Direction (PSD).  This is an instruction from a doctor, dentist, or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis.  There is no set protocol for PSDs written into the Legislation. As long as the prescriber (doctor or other registered health professional who is a qualified independent or supplementary prescriber) has considered the individual patient and has, as a consequence, given an instruction to supply or administer a drug to that patient the PSD is sound. There is no requirement for there to be a contractual relationship between the prescriber and the person carrying out the administration. Practices may choose to use the DCHS template PSD (Attachment B).  A PSD may be verbal or written but must be made after considering that individual patient and must constitute a clear instruction to the practice nurse or other competently trained health care professional to supply or administer the drug.  PSDs can be an electronic instruction, provided that it can be linked uniquely to the patient and the prescriber and is under his/her sole control. The PSD could also be a signed list of patients, such as in a flu or travel clinic. There is no requirement for the instruction to be defined as a PSD in the notes.

August bank holiday. NHSE have circulated the following: “Finally, August bank holiday is rapidly approaching - we do not anticipate primary care will need to offer additional services over this period unless under a specific local lock down or local arrangement which has been agreed with the local commissioner.” There are currently no local plans.

LOCAL UPDATES

Physical Healthcare for Mental Health Patients under the care of Derbyshire Healthcare NHS Foundation Trust. A number of practices have raised concerns regarding requests from mental health to perform, for example, pre-treatment ECGs and blood tests. The LMC raised these concerns with the mental health trust and we have received the following update

  • ECGs: “The Trust now has a Physical Healthcare team operating Trustwide who will complete ECGs specifically required in relation to the prescription of or ongoing prescribing of Anti Psychosis medication so this will no longer be requested via Primary care. Other requests for ECGs in relation to other treatments or physical health concerns will be referred to Primary care. In summary, the ask of Primary Care to do ECGs will now reduce considerably but will not be completely eliminated.
  • Phlebotomy: “The physical Healthcare team also perform this function for people prescribed anti-psychosis treatment either new prescriptions or ongoing treatment. Again they do not cover other phlebotomy requirements for other conditions or suspected physical health problems though so these would still attend primary care if no other solution is available”

Please let us know (via the office ddlmc.office@nhs.net) if you continue to receive such requests.

GP TASK FORCE DERBYSHIRE

REQUEST FOR SUPPORT: University of Derby research to compare stress, work autonomy and post traumatic growth during a pandemic. This survey is part of a research study being conducted by the University of Derby and will take approx. 5 minutes to complete. Responses to the first survey need to be completed by 23rd August and you will then be asked to repeat the survey 4 weeks later. You can withdraw your data using your unique identifier up to 2 weeks of completion by contacting the researcher, Duncan Gooch d.gooch1@unimail.derby.ac.uk d.gooch1@unimail.derby.ac.uk or his supervisor Edward Stupple E.J.N.Stupple@derby.ac.uk E.J.N.Stupple@derby.ac.uk

DEN Session: We are running a virtual Derbyshire Education Network (DEN) session (via Microsoft Teams) on Thursday 10th September covering the topic of Adult Safeguarding. This is a free event. There will be a short drug rep presentation prior to the meeting.

Adult Safeguarding: Thursday 10th September 2020 13:30 – 15:30 – Click here to book.

Once booked on the session, you will be sent details of how to join the Teams meeting on Tuesday 8th September 2020 via email.

Speaker: Bill Nicol (Assistant Director, Safeguarding Adults, Derby & Derbyshire CCG)

Learning Objectives: The following topics will be discussed - Abuse of Adults at Risk, Domestic Abuse, Prevent, Local Referral Arrangements, MARAC, MAPPA, Available Resources, Assurance Frameworks. This will be a merged event for Derbyshire and Chesterfield.

Sponsored by Daiichi Sankyo UK Ltd.

OTHER UPDATES

LPC Update. The latest Derbyshire LPC (Attachment C) may be of interest to practices.

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