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GPs go forth

GPs lacking ‘hot hub’ access advised to set up Covid-19 zones in their practices

GP practices that do not have a ‘hot hub’ within their PCN should set up ‘hot’ and ‘cold’ zones within the practice, NHS England has said.

In its latest standard operating procedure for general practice, NHS England said that practices should designate areas and staff to the management of coronavirus (Covid-19) patients or designate certain practices within their PCN as ‘hot hubs’.

The document reiterated that all patients should be triaged remotely and practices should use remote consultations ‘where possible’, however some face-to-face contact with symptomatic patients may be necessary.

Practices must maintain access to both urgent and 'essential' routine care 'for all patients', such as childhood immunisations, however routine care 'should be delayed where possible' for patients with coronavirus symptoms, it added.

NHS England said: ‘Most patients presenting with symptoms of Covid-19 can be assessed and managed remotely.

‘When face-to-face assessment is required, this will need to be managed either through use of designated sites (whether within practices or as separate locations, for example, hubs) or through home visiting services.’

One option is to designate a specific zone ‘within each practice’ to treat patients triaged as urgent, separated into those with and those without Covid-19 symptoms, and routine, for those without symptoms, NHS England said.

Some practices may have already implemented the 'zoning' model ‘to manage the risk of the contamination’ and must ensure ‘strict decontamination protocols’ are put in place, the document added.

It said: ‘Not all premises are likely to have separate entry/exits point to help maintain this kind of separation.’

Otherwise, NHS England said practices should be designated ‘across a PCN footprint’ to either treat symptomatic patients ‘needing further face-to-face contact’ or deliver essential care to those without Covid-19 symptoms.

Practices could separate clinics into patients with and without symptoms at different times of day ‘if local systems make provision of separate spaces or sites impossible’, it added.

Practices will need to consider which model ‘best suits their local context and arrangements’ with their CCG, it said.

The document also advised practices to separate their staff ‘where possible’ into those caring for symptomatic patients and those who do not, if necessary on a ‘day-to-day’ basis.

It said: ‘We recognise that this may be challenging and will depend on staffing levels in a local area footprint. If it is not possible to fully separate staff groups on a longer-term basis, consider separation on a day-to-day basis.’

Meanwhile, NHS England added that practices should review which staff are vulnerable and ensure they can work from home.

It said: ‘Staff who fall into these categories should not see patients face-to-face, regardless of whether a patient has symptoms of Covid-19 or not. Remote working should be prioritised for these staff.’

However, NHS England reiterated that there is no need for staff who have come into contact with Covid-19 to isolate unless they develop symptoms – ‘even if not using adequate personal protective equipment (PPE)’.

The guidance added that practices or PCNs must set up a dedicated home-visiting team for ‘shielded’ patients, unless a designated site has been set up for this.

Last week, CCGs had begun setting up GP-led ‘hot hubs’ to diagnose and advise coronavirus patients who are not in hospital.

Readers' comments (10)

  • In order to do this it is paramount that effective PPE is provided first for those in the firing line.

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  • "Face-to-face contact with symptomatic patients may be necessary". Yes, in a dedicated hot site called a hospital. Nebulisers do generate aerosol when patients cough, we have no free-flow oxygen on walls (and you're not replenishing our small tanks for free, nor our nebuliser masks and defib pads or cleaning solutions or drugs) and we have no full suit to be 'hot' in. If you're short of breath or getting worse, it's not rocket science - you need a hospital. Great vision.

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  • The ‘hot’ and ‘cold’ terminology really needs to be ditched . The most infectious patients are those likely not to have symptoms (ie the early stages of infection) -latest research from Wuhan: now estimated that 79.7% cases caught virus from someone not showing symptoms! The ‘cold’ clinics will be hotter than the ‘hot’ clinics

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  • The most important thing seems to be able to measure sats. This can be done anywhere. Buildings tend to become contaminated very easily whilst access to sufficient PPE is likely to be impossible for GPs judging by the national shortages and lacklustre efforts to date.

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  • The key indicators for patient admission are NEWS scores and history of deterioration by patient. These could be done remotely by providing patients with thermometers and o2 sat monitors(lots of most vulnerable patients have these anyway). We have taken this approach in our practice and it prevents unnecessary face to face contact. Pity health boards would not fund these rather than forcing GPs into Covid centres which the GPs actually have to pay for the running of. They also wanted our indemnity providers in Northern Ireland to provide indemnity paid for by us !!

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  • Can I ask what more a "hot hub" can do besides wasting staff lives, incresing infection and wasting PPEs?
    No vaccine, no anti-virals, no x rays, a lack of oxygen.

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  • I think once again Stable Door.

    Now all patients are deemed likely infected and we are using PPE there is no such thing as cold!

    Maybe when we can test and there is a point to bringing them up.

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  • RG is right. Gives one a false sense of security with "cold". Nobody can see the virus. PPEs.

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  • You can put lipstick on a pig: it’s still a pig.
    You can polish a turd: it remains a turd.
    NHSE/PHE can pump out algorithms and guidelines all week long: still no real testing, PPE, cure, inadequate clinician numbers .......

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  • Hot hubs are a sure fire way to ensure spread of infection and make no sense even in assessment terms. Certainly no medical intervention we can provide. We have purchased a bank of 40 pulse oximeters for home assessment of our patients given the multiple accounts of normal sats one minute and alarming desaturation the next. If patients have concerning symptoms, they will be loaned an oximeter and monitored remotely completely removing the risk of spreading infection. They are easy to decontaminate after use and we have a willing band of volunteers waiting to deliver them in a safe distanced manner. NHSE advice remains slow, incomplete, contradictory and frankly useless. Make your own plans!

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