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GPs go forth

NHS England tells GPs to prepare for 'significant increase in home visiting'

NHS England has told GPs to prepare to do significantly more home visits to patients as a result of the Government's strategy to deal with coronavirus (Covid-19).

Earlier this week, NHS England told hospitals that discharge thresholds for patients should be lowered, while people across the UK were advised to avoid all non-essential contact with others and whole households were told to isolate for two weeks if anyone develops a cough or fever.

Anyone over 70 or with underlying health conditions should enter a 12-week isolation, and a group of particularly vulnerable patients should completely shield themselves from potential exposure.

In a letter, sent today, advising GPs on the consequences for general practice, NHS England said:  'Prepare for the significant increase in home visiting as a result of social distancing, home isolation and the need to discharge all patients who do not need to be in hospital.'

But, reiterating advice for GPs to carry out all initial patient consultations via telephone or online, NHS England stressed this must not mean patients do not get treatment for health matters unrelated to coronavirus.

The letter said: 'This does not mean not advising/treating patients for other health issues, where there is clinical need, or unilateral closing of practices doors, rather ensuring that patients are appropriately triaged to the right health professional setting.'

NHS England said GPs should 'prioritise support for particular groups of patients at high risk' - who will also be contacted directly via letter by the NHS during next week advising them on what steps they must take to shield themselves.

It also summarised the latest advice on how to deal with potential cases, and linked to new guidance published by PHE yesterday.

Referring to the cancellation of routine CQC inspections and GMC revalidation, NHS England added that it would 'seek to do all we can to support practices to manage inevitable increases in workload at this extremely difficult time'.

This will also include issuing advice to suspend appraisals, NHS England clarified.

Meanwhile, practices were urged to 'consider stopping any private work they are doing to help free up capacity'.

NHS England also told GPs in the letter that they will top up QOF payments; defer parts of the PCN DES; allow delays to medication reviews; and urge responsible officers to defer GP appraisals - all in the effort to free up practices to deal with the coronavirus crisis.

NHS England's six priorities for GP practices and commissioners

  1. Move to a total triage system (whether by phone or online). This does not mean not advising/treating patients for other health issues, where there is clinical need, or unilateral closing of practices doors, rather ensuring that patients are appropriately triaged to the right health professional setting. The upsurge in telephone calls to general practice means that providing a reliable and timely response for patients has already become a vital operational priority.
  2. Agree locally with your CCG which practice premises and teams should be used to manage essential face-to-face services.
  3. Undertake all care that can be done remotely via appropriate channels, guided by your clinical judgement. We ask you to read the guidance note at annex A.
  4. Prepare for the significant increase in home visiting as a result of social distancing, home isolation and the need to discharge all patients who do not need to be in hospital
  5. Prioritise support for particular groups of patients at high risk. Next week the NHS will be writing directly to all patients in this category, and you will receive further advice shortly
  6. Help staff to stay safe and at work, building cross-practice resilience across primary care networks, and confirming business continuity plans.  

Source: NHS England's letter to GP practices 19 March

Readers' comments (61)

  • I bet Portun Down has some equipment we and our colleagues can use. Health and safety. Totally reasonable.

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  • Rogue1

    This is cut+pasted direct from the GMC website:

    Doctors working outside their normal field of practice

    Doctors will play a vital role in helping to treat and contain coronavirus.

    If the situation worsens, it’s likely that doctors will work outside their normal field of practice. This may include providing care to patients with coronavirus, or patients with other conditions.

    Patients must not be exposed to unnecessary risk. Difficult decisions may need to be made quickly about what is the safest and best course of action at any given time.

    When deciding the safest and best course of action in the circumstances, doctors should consider factors including:
    •what is within their knowledge and skills
    •what support other members of the healthcare team could offer
    •what will be best for the individual patient given available options
    •the protection and needs of all patients they have a responsibility towards
    •minimising the risk of transmission and protecting their own health.

    Doctors’ own health

    We understand you may be concerned about the risks to your own health when treating patients with coronavirus. We don’t expect you to provide care without regard to the risk to yourself or others.

    If you know or suspect you are infected, you should follow the current public health advice, including self-isolating.

    I think the only solution is not to visit...

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  • See BMJ 14th March. Pg 390 on the Control of Substances Hazardous to Health Regulations and Public Health England's guidance: As a minimum, correctly fitted FFP3 respirator, long sleeved gown, gloves and eye protection.

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  • They want us visiting the sick Covid cases-
    I have experienced this today-( LONDON GP)
    A pregnant patient, high fever and short of breath- couldn’t get a response from 111 yesterday and finally they told her to call her GP. I visited her this morning- assessed her: temp 39.5. sats 94 p 106-
    I Even did bloods- got them back a few hours later.....
    CRP 110 with normal white cell count- was sure it was Covid
    Discussed with med registrar in local big LONDON hospital - “ send her to A&E they’ll triage and call me if we’re needed”- I was gob snacked- pretty sure you’ll be needed mate! I called A&E- to confirm this was the right route....- it was! they have a red and a green zone and she could “go wait in the red zone”. The 999 ambulance call to send her to A&E had us on hold for 1 hour and 45 minutes. I then had to leave to see the next patient- she sent me a message that’s she’s still in A& E waiting to be seen having taken a taxi as couldn’t get through to blue light 999 ambulance! This is the reality! The service is not functioning- god help anyone having a stroke- never mind Covid death rates - what are cardiovascular death rates??? No one left to do normal stuff- all overwhelmed already!

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  • The broader question, Doc, is what did your visit add? I'm not criticising you (who seems to have gone above and beyond) but rather the system.

    Pregnant / SOB / Temp approaching 40 is something that we would have referred without visiting. You can tell from the obs that this was not someone that could be managed in the community without hospital assessment.

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  • NHSe out of their depth as usual, and disconnected from reality opening their mouths to be seen to act when theres actually no resource to act with.... its a bit like the movie downfall where Hitler orders his non-existent forces to attack.... as usual all the 'management mask each others incompetence by not pointing out the bl33ding obvious... like.... theres no staff and no PPE to do this...... Im glad to see the other contributors have the same lack of faith our leadership and seem a lot more pragmatic...... dear Ed, can you please arrange an interview with NHSE to quiz them on who is going to do this? Where is the PPE? How family isolation impacts NHS staff frontlines and finally, will we see the leaders on the frontline as opposed to working remotely from home? I think anyone who is still a member of RCGP / BMA needs to rethink their position.... how have these organisations helped us in the current crisis ??????

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  • JAM GP. totally take your point and some of my colleagues had said the same- so an interesting debate and am open to others thoughts. . The difficulty was NHS11 would bot see the patient and told her to contact us and she was alone pregnant with 2 small children in tears on the phone.....prior to my assessment no one had or would see her? (NHS111 doesn't even acknowledge the vulnerability of pregnant women to Covid but this is a group I am seeing increasingly affected). I felt uncomfortable advising her over the phone and at least after examining her I knew she needed to be in....though getting her in was another matter- she took a cab in and has just messaged me to say she was there all night and on obs told she needed admission and waiting for a ward an then sudden turn around... as no beds-so sent home for GP review this morning....other thing visit added was reassurance for her- she was desperately scared and genuinely unwell- unlike 1/2 the cals I get which are " I have a bad cough I think I have corona can you test me"-no go away.....

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  • https://theunionjournal.com/nhs-doctor-52-is-on-life-support-amid-fears-many-more-medics-will-catch-coronavirus/

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  • Council of Despair

    unfortunately, I can't find any stats for mortality rates for doctors re: COVID let alone any data re: family physicians / GPs. It's probably data that no one wants to release but I think the government are prioritising secondary care as the optics will look bad if hospital doctors start dying in hospital due to lack of PPE. I think they view GPs as low risk and so we are back of the queue but it's the constant lying by the state about how much they are doing and the complicity of the media that bothers me. No interviewer has put Hunt under pressure as he was in charge whilst the NHS was being run down. No one has questionned the drop in GP numbers or ITU beds. The government gets a free pass and the NHS takes all the risk as usual.

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  • Cardinal Rule of Medicine -- First do not harm -- TO YOURSELF !!!

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