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Practices' preparation for coronavirus: NHS England's letter in full

NHS England’s advice to practices, 5 March 2020

NHS England and NHS Improvement

5 March 2020

This is the first of a series of regular updates to general practice regarding the emerging COVID-19 situation

 

Dear colleagues

I recognise that COVID-19 is placing a new and increasing challenge on already busy practices, and this will be an area of concern for you, your teams and your patients.

I would like to reassure you that we are continually refining our plans for this outbreak, working with our key partners, and drawing on lessons learned from previous incidents and listening to feedback received on emerging COVID-19 issues.

In this letter, I would like to update you on what is happening, and share some key resources and how we plan to communicate with you.

As part of our preparedness plans, we will have advice and plans in place to prioritise work to help manage increased pressure on the workforce, models to care for vulnerable and self-isolating members of the public and staff, and approaches to temporarily increase workforce capacity. Further details of these arrangements will be announced as required.

What is happening?

It is important that you are kept safe and informed during this period. You can find the latest guidance for keeping yourself safe and well here: www.gov.uk/government/collections/wuhan-novel-coronavirus

We have recently published standard operating procedures for primary care: https://www.england.nhs.uk/coronavirus/primary-care/. Please can you read through these and take the actions requested. Public Health England has also issued interim advice for primary care which you can also find on our website: https://www.england.nhs.uk/coronavirus/primary-care/

An initial stock of protective kit (PPE) for each practice, including 400 general use aprons, 300 pairs of examination gloves and 300 fluid repellent face masks will be issued early next week to all practices. Larger surgeries will receive repeat deliveries to ensure they have sufficient amounts.

Major regulators have issued guidance to support health professionals in these challenging circumstances, encouraging partnership working, flexibility and operating in line with the best available guidance. You can read the statement here: https://www.nmc.org.uk/news/news-and-updates/how-we-will-continue-to-regulate-in-light-of-novel-coronavirus/ The Care Quality Commission is also working closely with NHS England and NHS Improvement and writing to providers today outlining their plans.

We would like to encourage all practices to check their business continuity plans (BCPs) and identify specific roles and actions that could support practices with managing local demand. Ensuring your BCPs are common with your neighbours (primary care network, neighbourhood or CCG) will allow additional support if needed.

Changes to online booking: To mitigate any risk that potentially infected patients book appointments online and attend the practice when they should be receiving advice to self-isolate or go through testing, all practices are now being advised to change face-to-face appointments booked online to triage appointments via telephone or video. You can read more on our website: https://www.england.nhs.uk/coronavirus/primary-care/

Prescriptions: Practices should not change their repeat prescription durations or support patients trying to stockpile: these actions may put a strain on the supply chain and exacerbate any potential shortages. Practices should consider putting all suitable patients on electronic repeat dispensing as soon as possible. The whole repeatable prescription can be valid for a year but each repeat should be for no longer than the patient has now. For example, if the patient has prescriptions for a month’s supply now then the repeat dispensing should be set up as 13 x 28 days’ supply.

Useful resources

You can download the latest materials to display to the public on our website: https://www.england.nhs.uk/coronavirus/primary-care/. This will soon include posters for GP practices that need to close for cleaning. On the same link you can also find new wording for practice websites and other communications channels.

Our current standard patient guidance is as follows:

The latest information on symptoms of coronovirus infection and areas where recent travel may have resulted in a high risk of exposure can be found on https://www.nhs.uk/conditions/coronavirus-covid-19/.

NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do.

Use this service if:

• you think you might have coronavirus

• in the last 14 days you’ve been to a country or area with a high risk of coronavirus

• you’ve been in close contact with someone with coronavirus.

Do not go to a GP surgery, pharmacy or hospital. Call 111 if you need to speak to someone.

Everyone is being reminded to follow the public health advice on the NHS website to avoid catching or spreading coronavirus.

Please bookmark the dedicated NHS England and NHS Improvement COVID-19 web page https://www.england.nhs.uk/coronavirus/primary-care/ that includes important updates for the NHS including primary care providers (including general practice, community pharmacy, dental and optical providers).

If you need any COVID-19 specific public health advice which is not already covered in published guidance, please contact your Local Health Protection Unit or your local commissioner.

How we plan to communicate with you

1. Urgent messages: Central Alerting System:

• For urgent patient safety communications, we will contact you through the Central Alerting System (CAS).

• Please ensure you have registered to receive CAS alerts directly from the MHRA: https://www.cas.mhra.gov.uk/Register.aspx

Practice action: Please use a generic practice email account, not a personal one. For continuity of access, ideally use an nhs.net email account – it’s more secure. Please register a mobile phone number for emergency communications.

2. At less urgent times: Commissioner’s cascade:

• For less urgent COVID-19 communications we will email you through your local commissioner.

Practice action: Please share a dedicated nhs.net COVID-19 generic practice email with your commissioner to receive communications and also share this email with your local medical committee. In the event of user absence, practices should ensure auto forward for emails to an alternative nhs.net account and designated deputy.

Supportive additional information

We will host a targeted webinar to discuss the support in place for colleagues and patients in managing COVID-19, and details will be announced shortly via this update and through your regional teams.

We will use a variety of additional methods to keep you informed of the emerging situation, alongside Royal Colleges, regulators and professional bodies, and through formal and informal networks including social and wider media. You can follow these Twitter accounts to keep up to date:

• NHS England and NHS Improvement @NHSEngland

• Department of Health and Social Care @DHSC

• Public Health England @PHE_uk

Thank you for your understanding and continuing support, it is very much appreciated.

Yours sincerely

Nikki

Dr Nikita Kanani

Medical Director for Primary Care

NHS England and NHS Improvement

See the full letter here

 

Readers' comments (11)

  • Azeem Majeed

    Many thanks for the update Nikki.

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  • Reflects on the delusional world our glorious leaders live in that they think GPs have time to read the deluge of emails stacking up in their inboxes.

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  • I agree with the delusional Stelvio... I don't know one GP who supports her.... she could instruct the CQCs to stop temporarily ...but she doesn't.... she could point out that bringing back retired GPs and medical students is not actually a substitute for a properly funded service and use this as part of her argument to increase GP funding...but she doesn't... she could demand a NZ style compensation scheme to reduce the legal fears of our colleagues....but she doesn't. She comes across as only interested in her own career, and like Helen Stokes Lampard in the RCGP, will achieve nothing in her tenure to make General practice a more desirable job, but I doubt that is her aim, only to enforce government policy.

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  • Waste of virtual ink.
    Suspend QOF / CQC and appraisal
    It is a national emergency
    Suggest get back on the coalface

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  • Here's a plan NHSE:
    Perhaps this is what your workforce actually wants in this crisis.

    1. 2 week enforced GP waiting time for all routine appointments stated to the public. Stated explicitlya and without risk of trivial complaint. This will negate most infectious risks and self-limiting demands.
    2. 2 month disabling online access and it's insurmountable threat and bypassing of any safe triage system.
    3. 2 month hold off all cqc inspections until review.
    4. A new PHE advert of what NOT to seek or demand (antibiotics/sick notes/paracetamol) from GPs. Not filled with cartoons, but with authority.
    5. A suspension of routine 'mandatory' NHSE/ccg driven meetings in March and April in all localities.
    6. Immediate use of newspapers, television, radio, transport and Internet communications to get the self-isolation message out and to NOT engage with general practice for trivia.
    7. Utilisation of dentists - you gave them contracts and a gold crown service...find out how to use them, not medical students!
    8. Supply of alcohol gel and disinfectant sprays...you're expecting GPs to keep delivering this, for free to the public.
    9. Actually changing appraisal - actually. Just make it 30 hours and your workforce morale will multiply for no cost to you as this epidemic breaks.
    10. Put a STOP to hospital workflow into GPs such as consultant to consultant referrals and prescription requests.

    At some point whoever is the puppeteer will realise that the glue you all use to heal and coordinate the woes of society will soon disintegrate and close and will never return, like a retreating glacier set on by flames. And if a member of NHS staff suffers, a cascade will happen of anger and distrust towards your haloed 'access' policy. This virus will keep returning. BASIC steps are available to your privileged 'clean' hands to help your staff, before things get dirty.

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  • Dear Government,
    If you seriously want retired doctors (who by virtue of their age are at the highest risk) to fill any gaps in the virus-affected workforce, then you need to commit to awarding next of kin the full pension, not the current half pension, should any doctor die. Until this is forthcoming, then no doctor should consider coming back.

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  • Agree need more radical measures dr Kanani - hold QOF to stop us dragging in elderly patients, hold CQC and tell the inspectors/staff to return to the front line, suspend all non urgent CCG, BMA, RCGP, NHS England and PCN meetings and get the staff to get on the front line.

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  • Please engage with & support OOH GP services- they are going to collapse without urgent action. We need PPE & control over what 111 sends to us. Also imminent major staffing crisis- negligible permanent staff & not many GP’s are going to step up if it’s an unsafe work place.

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  • This runs directly OPPOSITE to the advice also issued by NHS England on the SAME DAY:

    https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/Commissioner-guidance-local-requests-to-suspend-online-booking_050320.pdf

    "A national suspension of online booking is not in place."
    and
    "Rather than seek to suspend online booking, where there are specific
    concerns about infection risks GP practices are advised to change face to face
    appointments offered for online booking to triage appointments. "


    I will ask Dr Kanani to clarify!

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  • start charging for ALL gp appts

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