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Independents' Day

Dr Nikki Kanani's 12 March email to practices on coronavirus

NHS England's advice to practices, 12 March 2020

Advice for today

[12 March]

As you can imagine the new case definition has meant a huge amount of guidance needs updating. This will follow over the course of today and the weekend.

The following from the information commissioner is helpful.

For today, and the weekend please use the following as a crib:

⁃ anyone with a continuous cough OR fever (>37.8) must self isolate for 7 days (this includes children)

⁃ travel history is now irrelevant

⁃ anyone with these symptoms who is WELL can just stay at home and does not need to ring 111 or be tested

⁃ anyone with these symptoms who is UNWELL should go to 111 online for advice, they must NOT go to the GP, 111 will assess and advise

⁃ information on new testing policy to follow

⁃ this applies to staff as well as patients

If a possible case appears at the surgery :

WELL

⁃ go home immediately and self isolate

UNWELL

⁃ use PPE as per PHE guidance for possible cases i.e. gloves, apron, mask

⁃ isolate the patient

⁃ if acutely unwell treat

⁃ if not then ask them to ring 111 from the room and leave

⁃ decontaminate as per the SOP

In the meantime, practices should start:

⁃ Moving to TOTAL triage system (whether by phone or online)

⁃ Undertaking all care that can be done REMOTELY through remote means, being guided clinically and we will support those decisions

⁃ Agreeing locally which sites and staff could manage face to face assessments of any possible COVID-19 cases

⁃ Agreeing locally a plan to support patients who are particularly at risk of COVID-19 complications, including considering co-ordination of their care if in future advised to stay at home

⁃ Confirming business continuity plans, with a view to cross practice resilience

Again, thank you for your incredible commitment and patience in this rapidly evolving situation. Nikki

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Readers' comments (6)

  • Nikki - we are getting many patients contact 111 with fever, cough -including children.

    111 is passing some of these back to us for GP assessment which we can't do safely with inadequate PPE (1-2 days supply) and current decontamination rules, and no ability to test.

    We need to be able to get patients we are concerned about tested, possibly for diagnostic exclusion. What are the plans to allow us to divert into the testing pods?

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  • Sadly despite WHO reiterating that testing must be extensive and widely available in addition to other measures the UK has gone the other way
    We are going into great unknown with flawed uk policy

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  • Yes there definitely needs to be a pathway for sending patients to the covid pods for testing. I cannot understand why PHE are not going to test potential cases in the community; how will we ever know what the denominator is? It makes no sense whatsoever. Also frontline staff need access to testing and I have heard that PHE have said they won’t get it unless they have signs of pneumonia or acute respiratory distress. How can this be ethical ? We need to protect all frontline staff and offer rapid testing if any suspicion of covid 19. Anything less is beyond contempt and completely unacceptable.

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  • We are being told to pay attention to minor symptoms e.g. Matt Hancock on Andrew Marr show this am. Minor symptoms are very common, and most do not reach GPs. You could end up with half the country being off before they get COVID-19 and assuming they have had it. Coughs typically continue for 3-4 weeks. As individuals, health professionals and patients, would it not be helpful to know if we have had it? After a week if you are still coughing should you return to work? Presumably someone who is known to have had it can much more safely care for symptmatic or asymptomatic high risk people.

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  • Is there any facility for recovering clinicians to be tested before they are allowed back to work?

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  • Hopefully she's sending out a paper version, were running short of toilet roll.

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