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WEEKEND SPECIAL COVID-19 BRIEFING DDLMC 05.04.2020

There have been a number of developments since the update on Friday afternoon, so we wanted to provide an update ready for the start of another week tomorrow.

KEY MESSAGES FOR TODAY

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

We have all acknowledged the need to look after ourselves and our staff (and the irony is not lost on me as I write this on a Sunday – I’m taking the dogs out later and taking a day off tomorrow). Several people have asked about the local wellbeing support offers:

Thrive App. Please encourage staff to download the App which helps you prevent and manage stress, anxiety and related conditions. Register with own e-mail/password and use code NHSDERBYS20 to access.

Employee Assistance Programme called “Well Online” . Again available for all staff using: Username DTlogin and Password: wellbeing

GPTF Buddy Scheme. Please see attached update for first 5 and Mid-Career GPs

NATIONAL UPDATES

NHS 111/CCAS/GP CONNECT. There has been some confusion over what has been commissioned through NHS111 and what the requirements are from practices. The national GP Connect update, attached, provides most of the answers going forward.

  • Pre-COVID-19, practices were contractually required to make available daily 1 appointment per 3000 patients. Many practices chose (on our advice) to suspend this as part of their early response to COVID-19.
  • In the early days of COVID-19, NHS111 were commissioned to provide a coordination service (including testing) which had responsibility for those who met the case definition but did not require hospital admission.
  • When case definition excluded testing (in 3rd week of March) this service effectively became redundant.
  • CCAS (COVID Clinical Assessment Service) has now been commissioned to clinically assess symptomatic patients in 4 cohorts. Cohort 1 (straight to hospital via ambulance if required) and Cohort 3 (self-care at home) require no further NHS111 input after “disposal”.
  • Cohort 2 (a/b) are those in the middle. 2a will be likely to need a Primary Care Intervention and will be triaged by CCAS and then booked into GP Practice. (Using direct booking slots – see below). 2b may not need immediate intervention but may need monitoring by GP. Processing of 2b patients is not yet clear, but in the meantime, it is likely the initial call handler will stream to either Cohort 2a (CCAS) or Cohort 3 (self-care). More to follow.
  • GP Connect update provided some more detail and CCAS will be run by NHS111 (but separately from “normal” NHS111) with direct booking through GP Connect.
  • All Practices in Derbyshire are already signed up to GP Connect and the recommendation is for 1 appointment per 1000 patients to be allocated, both AM and PM (quoted as 1 per 500 patients pe day in some documents) for direct booking for CCAS. We believe the current contractual position is that you must open up the slots, but the number is a recommendation.
  • We strongly recommend that these are made telephone only slots in the first instance.
  • We also believe this is instead of the “normal” NHS111 direct booking slots and would ask practices to implement on this basis unless/until otherwise notified. The letters from the NHSEI team are here.
  • The consensus in Derbyshire is that practices are recommended to re-triage these patients before deciding whether to see face to face.

Extremely Vulnerable Patients. The updated national guidance has now been published with 2 publications (attached) – one for clinicians and one for patients. These guides provide more detail on some of the nuances of the scheme and the FAQs are worth a read for specific cases. But in summary:

  • Phase One. The centrally generated letters which have already gone out and been notified to practices via S1 or EMIS.
  • Phase Two. The previously named Group 4 patients which were originally the practice responsibility but amended on 26th March to be done centrally. These are still being done and practices will be notified via S1 or EMIS.
  • Phase Three. Practices can now add patients (not in Phase 1 and 2), who you consider to be at highest clinical risk ( defined criteria), using template letters template letters. S1 and EMIS will notify you of the codes to use, plus the codes to remove any patient who was originally added but you don’t consider to be extremely vulnerable - these will be recoded as Low/medium risk.
  • Self-referrers. You will be sent a list of those patients who self-registered on NHS111 as extremely vulnerable and asked to review, treat and code accordingly i.e. Yes Highest risk or No low/medium risk.

GMC Registration. The GMC has used their emergency powers to reactivate doctors GMC registration so that this is not a barrier to recruiting retired doctors in a timely manner and this week 16,500 doctors were returned to the register. Many of these may choose not to work but to process all individually would have taken months. Any GP not on the Performers List will need to reapply to join as this remains a prerequisite to practice. The process is included in the letter sent to all GPs but can be referenced here.

BMA Update. The attached update provides some useful checklists for practices. Most practices will already be doing much of what is included but there may be a few useful additions that you hadn’t considered.

Community Pharmacy opening on Good Friday and Easter Monday. PSNC have now announced that Community Pharmacy will be required to open on Good Friday and Easter Monday but the details have yet to be finalised.

LOCAL UPDATES

Clinical Updates.

  • Dr Susie Bayley sent emails out about the 2 major new guidelines yesterday and is very apologetic for making the classic error of sending these “to” rather than “bcc”. Please let us know if this has caused any specific data protection issues.
  • NICE have also published some further Rapid Guidelines including advice on Covid-19 and Rheumatology, severe asthma, dialysis and a number of other conditions.
  • PCRS have also published some pragmatic guidance (attached) for “Diagnosing and managing asthma attacks and people with COPD presenting in crisis during the UK Covid 19 epidemic” which GPs may find useful when reviewing Phase 3 and self-referring patients in the extremely vulnerable cohort.
  • CPR and DNACPR. We have uploaded the attached patient leaflet guidance onto the JUCD patient facing website and practices may also wish to use. There is also guidance for patients on the Compassion in Dying website which practices may wish to signpost patients to.

Testing. The details about HCW testing were sent out by CCG Comms earlier this afternoon and practices are urged to read this and action please.

AND FINALLY

 You may have noticed some random yellow highlighting on these updates and I apologise as this is a technique I learnt in 2003 when (in a previous life) I was TTSH at the AWC and we used to run 2x CQWI and 1x TLT a year. Unfortunately, I nearly always ended up with the laborious job of writing the ATO for the following days CAMAO. This was done by copy and pasting the previous days ATO, highlighting in yellow and then un-highlighting as we completed that section for the following day to ensure we had done it all. Occasionally the highlight got missed.

And you thought the NHS was good at indecipherable acronyms…….

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