DDLMC WEEKLY UPDATE 5th NOVEMBER 2020
NATIONAL UPDATES
Heartfelt Message from NHSEI. In these difficult times, when we are all working under considerable pressures, I find it is all too easy to be critical of others and to question their motives. I do have to pause sometimes and remind myself that fundamentally, everyone is genuinely trying to do their best, within their own operational and cultural framework, which we often don’t fully appreciate or understand. Therefore, I was genuinely touched by the sentiment in this heartfelt message from Dr Nikki Kanani and Ali Sparke (Medical Director and Deputy Director in Primary Care NHSEI), since it echoes all our thoughts about what a fantastic job everyone in general practice is doing.
We want to take this opportunity to thank our staff and colleagues across primary care for everything they have done throughout the pandemic. We want to thank those working late into night - chasing advice, checking on shielded patients, reassuring your patients. We want to say thank you for the amazing work you've done in delivering flu vaccinations in new ways, in car parks, at weekends and in the pouring rain.
We want to specifically thank our practice managers, our receptionists and our admin teams, our nursing colleagues, pharmacists, and allied health professionals, because without you, general practice doesn't work. Thank you also to our colleagues from different ethnic backgrounds who have delivered care whilst feeling worried about their own health, and for missing special festivals that are usually celebrated with so many others.
We know you are feeling tired, and we know you are doing the very best you can in an incredible difficult time - please do try to take some time to rest and recharge knowing that you are valued and appreciated.
NHS111 First and Direct Booking. We have been made aware of continued problems with the bedding in of NHS111 First and direct booking slots. There appears to have been a disconnect in the communication of the requirements to practices and DHU/NHS111. There is an NHS111 First working group meeting today which has LMC representation on it and we hope to be able to report an improvement following that meeting. In the meantime, please continue to feed in any concerns you have and a reminder of the exact words from the Director of Primary Care in NHSEI on 30th September announcing a continuation of the 1 slot per 500 patients direct booking:
- The slots, which will be booked following clinical triage, are not appointments in a traditional sense; instead practices should clinically assess the patients remotely and arrange their ongoing management. This ensures that only those who need further care (in-person or via telephone / video consultation) are presenting to services, and they are managed as appropriate for their clinical condition. GP practices are asked to make sufficient slots available for NHS 111 to refer into; they should assess the use of the slots each day and adjust the number to meet demand. This could be fewer than 1 in 500.
- Patients should not therefore be told by NHS111 to attend in person at the practice, nor should they be told a specific time for a call back since they will be placed on a triage list and it is down to the practice to manage them appropriately.
- Given that the system has now been up and running for a few weeks we would hope that practices now have evidence for the number of slots that are being utilized and can adjust how many slots they are making available.
Updated Guidance for the Clinically Extremely Vulnerable. The updated guidance has now been published. As usual, since the guidance must try to encompass every eventuality it is perhaps a bit vaguer than we would like but the good thing is that this empowers practices to read the guidance and apply it to their own situation. In essence, since we are in lockdown, the guidance for this cohort could perhaps be summarised as “Stay at home and don’t mix with other people” (i.e the same as the general population) but be even more meticulous in sticking to the guidance and don’t be tempted to think that you can use the exceptions to justify going out and/or mixing. This includes trying to avoid shops, pharmacies, travel and socialising with more than one person. The guidance is clearer on 2 specific topics which may be useful for practices:
- Patients in this cohort can still come to the practice: “You should still travel to hospital and GP appointments unless told otherwise by your doctor”
- Practice staff in this cohort should work from home. The exact words are You are strongly advised to work from home. If you cannot work from home, you should not attend work for this period of restrictions. If you cannot attend work for this reason, you may be eligible for Statutory Sick Pay (SSP), Employment Support Allowance (ESA) or Universal Credit. Other eligibility criteria will apply. The formal shielding notification you receive may act as evidence for your employer or the Department for Work and Pensions (DWP) that you are advised to follow shielding guidance and should not work outside of your home for the period stated in the letter.
To put this into context consider the words
- “must” means it is an absolute requirement,
- “should” means there may exist valid reasons in particular circumstances to ignore a particular item, but the full implications must be understood and carefully weighed before choosing a different course,
- “may” means that an item is optional.
So, if you have staff in the clinically extremely vulnerable group then ideally, they should work from home. If this is not possible you may offer sick pay in line with practice policy or SSP (noting that you will only be able to reclaim SSP and not anything more generous). Alternatively, you may discuss these staff coming into the practice to work, with suitable and agreed mitigations.
LOCAL UPDATES
Stockport Pathology. As a quick way of getting to the target audience Richard Smethurst IT Lead for Stockport Pathology (Mob 07718920799 richard.smethurst@stockport.nhs.uk) has asked us to share “On Tuesday 10th November 2020 10:30-13:00 we will be having planned downtime to the tQuest Pathology electronic ordering system. If it is not possible to avoid making a pathology request during this time a hand-written form will need to be used and we will be sending out additional paper request forms. Electronic copies of the request forms are attached (Attachment A, B and C) should you need to print any additional forms”.
The (My!) LMC Committee Awards. Thank you to everyone who nominated a member of the LMC Committee “who has done something to support or help you or your practice this year.” We had a number of nominations and it seemed petty to try and judge which were the most deserving so congratulations to Dr Susie Bayley, Dr Kath Markus, Dr Simeon Rackham and Dr Gail Walton, who were nominated for various things; mentorship, support programmes, measured yet determined advocacy and production of dairy-milk popping candy. I’ll leave you to try and work which nomination goes to which GP. I’ve sent their £10 Cromford Mill Cheese Shop vouchers out to them. On behalf of the practices, thank you to all of the GPs on the LMC who work behind the scenes to support and represent all of our practices.
A special mention must also go to Claire Leggett. Although Claire is technically not a full member of the committee it would have been churlish to deny her nominations since she had a number of nominations. So congratulations to Claire and I’ve sent you a £10 voucher (even though you don’t like cheese!) and a voucher to Vikki Webb for her nomination – “I would like to nominate Claire Leggett, not only has she supported practices Derbyshire wide through COVID-19, she continues to develop new Projects and Developments to support all team members and practices across the patch. Her tireless commitment and dedication to improving and supporting General Practice is commendable.” And Vikki’s summary which really resonated with me “Overall, restoring my faith in the humanity. For which I will be forever thankful.”
GP TASK FORCE DERBYSHIRE
Burnout Webinar for GPs and Practice staff. We ran this webinar on Monday evening and if you didn’t get a chance to attend please see the Meeting Recording:
Derbyshire Education Network Sessions. We are running a virtual GP and Optometrist Joint Education Event (via ZOOM) on Thursday 12th November 2020 and Monday 16th November 2020 covering the topic of Anterior eye therapeutics. This is a free event.
Anterior eye therapeutics: Thursday 12th November 2020 18:30 – 20:00 – Click here to book.
Anterior eye therapeutics: Monday 16th November 2020 18:30 – 20:00 – Click here to book.
Once booked on the session, you will be sent a ZOOM link and details how to join via email.
Learning Objectives:
- How to undertake the assessment of commonly presenting anterior ocular conditions (for remote and face-to-face consultations)
- To have an awareness of differential diagnoses
- To identify red flag conditions
- To adequately manage appropriate ocular conditions in community practice
- To have an awareness of referral pathways in Derbyshire, including appropriate deflection to community pharmacy and optometry (CUES – COVID Urgent Eyecare Service) as opposed to the HES
- To be aware of what and when to refer patients to secondary care (for both GPs and Optometrists)
This will be a merged event for Derbyshire and Chesterfield.
We are running a virtual Derbyshire Education Network (DEN) session (via Microsoft Teams) on Wednesday 18th November 2020 covering the topic of Mental Health, Impact of COVID and Management of Dementia in Primary Care. This is a free event. There will be a short drug rep presentation prior to the meeting.
Mental Health, Impact of COVID and Management of Dementia in Primary Care: Wednesday 18th November 2020 1:20 – 15:30– Click here to book.
Once booked on the session, you will be sent details of how to join the Teams meeting on Monday 16th November 2020 via email.
Speakers: Professor Subodh Dave, Hayley Turner, Joanne Wombwell, Dr Antony Prakash
1: Professor Subodh Dave, Consultant Psychiatrist and Deputy Director of Undergraduate Medical Education, Derbyshire Healthcare Foundation Trust: Impact of COVID on anxiety and psychosis
2: What makes a good referral to older adult mental health services? Hayley Turner, Acting Service Line Manager for Older adults community services
Learning objectives:
- Structure of older adult services including specialist teams
- The relevance of social history
- Interaction between physical health and acute exacerbation of mental health
3: Joanne Wombwell - Clinical Nurse Specialist for Dementia and Memory Services: Management of dementia in primary care
Learning objectives:
- Monitoring choline esterase inhibitors in primary care
- NICE update on Memantine initiation in primary care
- Role of social care and dementia support services
Dr Antony Prakash, Consultant in Old Age Psychiatry: Question and Answers
This will be a merged event for Derbyshire and Chesterfield.
Sponsored by Daiichi Sankyo UK Ltd.
OTHER UPDATES
Management of the Long-Term Effects of COVID-19. Pending the publication of a more in depth study and guidelines the RCGP have produced a useful guide of “Top Tips” for dealing with patients with longer term effects of COVID-19.