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KEY MESSAGES: 18 March 2020

General Guidance

  • If practices follow the guidance and information contained within the joint Calderdale Covid19 General Practice Daily Bulletin “Key Messages”, they will be supported by the CCG, LMC and CDs. The CCG has agreed with the LMC and clinical directors that there needs to be a consistent approach across general practice for Calderdale, in the services we provide within general practice.  We are aware that over the next few days, weeks and months general practice will be operating outside of its usual remit and outside of its usual contractual obligations. In order to provide confidence to the public and also to NHSE we need to ensure decisions to suspend services are taken and understood at a Calderdale level. 
  • Due to the Covid19 outbreak we are asking all practices to provide a situation report (sit rep) daily.  This is in order for us to understand the current situation and pressure on all of us so we can work together to co-ordinate whatever support is needed wherever that may be. Although the document is still being finalised, we are aware decisions and guidance need to be taken today and ask you to self-assess for today against the opel levels explained in this document.
  • It is crucial that all practices read this and provide daily opel scores by 10am to Marcus Beacham of the LMC who is coordinating this process. This is to commence tomorrow (19th March 2020)
  • The CCG is aware that there will be financial implications to practices around providing the agreed Calderdale response to Covid19. The detail of this is still being worked through however our aim is to ensure that practices do not suffer financial loss as a result. Further details will follow and be communicated through the daily bulletin. As a first step in this, the CCG has agreed to cover the costs of bulk SMS messaging for the duration of the Covid19 Pandemic.
  • Following feedback the daily bulletin will be available on any device on a dedicated page on the NHS Calderdale CCG website from today (18/03/2020) to make it easily accessible to us all. Historical bulletins will be available but the intention is to standardise the presentation and highlight the changes to make it easier to see them.

Contractual Obligations

We are expecting national guidance on standing down any national contractual requirements in the coming days. We will communicate this as soon as possible

National Guidance

In brief, for clarity in response to questions we have had from you today:

  • Those who screen positive for covid19 (cv+ve) should self-isolate for 7 days from the start of symptoms.
  • Household members i.e. those who share the same dwelling/front door of those who are cv+ve should self-isolate for 14 days or 7 days from when they develop symptoms themselves.

More information can be found at:

https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance .

https://www.england.nhs.uk/coronavirus/primary-care/

IT

Accurx Video Consultations

  • Accurx is now working very well in lots of practices
  • Please continue to roll this out

THIS have provided a detailed guide which, which can be downloaded here.

For more information visit www.accurx.com/chainsms

Remote Working

The CCG is developing IT solutions for staff to be able to work remotely.

THIS IT Services

  • Covid-19 is affecting response times for THIS IT services.
  • They are prioritising requests for
  • IT issues relating to COVID-19  support
  • IT issues that are classed as Priority one (1) and especially in regards to Clinical services.
Urgency Description
Critical\High – priority 1 whole site affected, key business area affected, no ‘work around’ possible)
  • This does not mean that other requirements will not get attention, but it make take longer so please bear this in mind.
  • For information and support email theservicedesk@this.nhs.uk

Prescribing

ACEIs/ARBs

  • The guidance is to continue prescribing these as normal as any concerns are theoretical.  
  • There is a UK-wide position on this from two relevant professional organisations, issued on the 16th March

They refer to a statement from the European Society of Cardiology.

For more information visit:

Ibuprofen/NSAIDs

In brief, the interim NHSE guidance is that paracetamol is the preferred treatment for fever associated with suspected or actual Covid 19,  however a rapid review of the evidence is taking place around the possible concerns with NSAIDS/Covid 19 so this guidance may be updated in due course. Patients currently on NSAIDs for other reasons should not stop taking them.

For more information click here.

Prescription duration

  • Please ensure all clinicians issue normal prescription quantities, ideally 28 days. Issuing larger quantities will risk stock shortages.
  • Please put all suitable patients on eRD with 28 day supply as the standard.

Telephones

Appointment booking by telephone

Practices are already only allowing patients to book appointments by phone and this should continue.

111 Direct Booking via GP Connect

  • Please change your 111 Direct Booking Slots via GP Connect over to telephone appointments
  • A ‘how to guide’

Click here to download a ‘how-to’ guide – Telephone Slots for 111 Direct Booking.

Recorded Telephone Messages and Answer Phones

  • UPDATED: Please update answer phones and on hold messages:
  • The following message has been agreed across West Yorkshire as the preferred standard message for all practices to be using obviously with the final sentence adapted for your own practice.

The government has announced we are moving into the delay phase of COVID19. This means, If you have a continuous cough OR a high temperature, you should stay at home for at least 7 days from when your symptoms started. We expect the NHS to be exceptionally busy in the coming weeks. If you have serious symptoms that you cannot manage at home or persists longer than 7 days, please go to NHS 111 online, or call 111 if you cannot go online. Do NOT visit a GP surgery, pharmacy or hospital. For further information about our services (and access to online consultation – if applicable) please visit our practice website.

Practical GP Working

In this time of rapid escalation, changing guidance, and much reactive activity we thought that sharing some practicalities would be helpful to spread the message in Calderdale of what General Practice is doing to deal with the crisis but also keep as much routine care going as possible.

It is not thought to be helpful to ‘blanket’ cancel all routine work as this will have a knock on effect in terms of increased workload once the pandemic has lifted and, more importantly, create a group of people who become vulnerable because they don’t get a diagnosis; abnormal blood parameters are not identified or actioned; BP checks not done leading to the consequences of uncontrolled hypertension.

The current advice is to prioritise:

  • immunisations as per national programmes, managing patients with unstable long term conditions and assessing patients with acute presentations.
  • This will include phlebotomy for clinical safety, contraception procedures, zoladex, B12 injections , baby medicals and immunisations, dressings , suture removals etc (not an exhaustive list!)

This will be reviewed daily and any change in advice will be highlighted for you.

Open doors

  • The CCG is not in agreement with us locking surgery doors as yet although it is agreed that if you have branch surgeries it is reasonable to only have one site open to patients with adequate signage.
  • We are working hard on developing a PCN approach  for when we get to that stage. You are of course controlling the time when patients can come in the building by triaging but please do not bar patients from entering practice premises unless you have screened them and they are cv+ve. This can be at your front door or reception. The CCG rationale for this is that if there is a sign with opening times no matter what they are this will lead to patients queuing up outside which is exactly what we are trying to avoid. Some practices have already experienced this.
  • One option to provide time for full staff briefings is to carry these out in your reception area.

Rough guide to minimise patient need to visit

This is a rough guide of what most practices are probably already doing to minimise patient need to visit your premises.

  1. Full telephone triage
  2. All prescriptions are to be requested online or exceptionally on the phone and collected from a nominated pharmacy. If there are no nominations – ask patients and nominate a pharmacy for them so that even with EPS4 they will not need to collect a token
  3. Fit notes should be sent electronically. If you are unsure of how to do this guidance will be shared.
  4. All booked appointments especially nurse appointments are triaged with the covid questionnaire

Isolation room used for patients with respiratory symptoms who are covid19 negative (cv-ve) but require examination

Primary Care Situation Reporting

  • The detail behind the opel sitrep report can be found here.
  • It is crucial that all practices read this and provide daily opel scores by 10am to Marcus Beacham of the LMC who is coordinating this process.

Media Enquiries

If you are approached by the media we would ask that politely request that the journalist contact the Calderdale CCG Communications Team by calling 01422 307499 or by sending an email to calccg.comms@nhs.net with details of their enquiry and the deadline they are working to.

A member of the communications team will be in touch as soon as possible.

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