Patients are being encouraged to call their GP if their oxygen saturation drops to 93% or 94% as part of NHS England’s Covid ‘Oximetry @home’ scheme.
It was revealed last month that NHS England is to make 200,000 pulse oximeters available to enable primary care practitioners to monitor high-risk Covid-19 patients remotely at home.
The standard operating procedures for the scheme, published last week, recommended that all CCGs put the model in place ‘as rapidly as possible during November’.
According to the document, the ‘default assumption is that the model is primarily implemented in general practice, e.g. including in hot hubs, working with community teams’.
This could be through individual primary care networks (PCNs) or a ‘a single community health service’, it added.
The pathway is open to patients who are diagnosed with coronavirus clinically or by positive test result and are symptomatic and over 65 or under 65 and clinically extremely vulnerable to Covid, NHS England said.
Patients will be referred to the scheme by the 111 Covid clinical assessment service (CCAS), the Government’s Test and Trace scheme and hospital emergency departments, it added.
Those referred to the service should have a ‘standard’ assessment ‘as soon as possible and ideally the same day as the referral’, including the ‘potential for face-to-face clinical assessment if deemed necessary’, it said.
Once onboarded, patients should be encouraged to record their oxygen levels ‘usually three times a day’ and followed up with text or email ‘prompts’ or ‘check-in calls’ at days two, five, seven, 10 and 12, the document said.
It added: ‘Patients should be instructed to attend their nearest emergency department within an hour, or call 999 if their saturation reading is 92% or less, or to contact 111/GP if 93% or 94%.’
A spokesperson for NHS England told Pulse that such patients should be considered for further clinical assessment.
And patients onboarded to the scheme with oxygen levels of 93-94% should be managed with ‘more intense clinical assessment and oversight in the community’, the document added.
Kent LMC medical secretary Dr John Allingham told Pulse he has concerns about the workload this could create for practices.
He said: ‘In practice, I think what will happen is if you give the general public pulse oximeters, they’ll be doing their oxygen saturation every five minutes and ringing general practice every five minutes as well.
‘That’s the danger – that it won’t be done at prescribed intervals in a way that can be managed, it will just be done randomly.’
He added: ‘To be honest, if you’ve tested positive for Covid and your oxygen saturation has dropped, there’s not a lot a GP can do.
‘Clinically if there’s a definite drop in your oxygen saturation and you’re Covid positive, I’m probably going to send you to hospital anyway.’
Meanwhile, those who show no signs of deterioration within 14 days of starting symptoms should be ‘actively discharged’ and provided ‘leaving information’ and safety netting, NHS England added.
They should also be given ‘safe’ advice on how to return their oximeter, such as directly to a ‘hot’ site, via a friend or family member or through the NHS Volunteer Responders, it said.
The document added that NHS England has written to CCGs about the £150m funding pledged to expand general practice capacity – and cover all additional GP Covid costs until March.
Updated guidance published in August had encouraged practices to work together to use pulse oximetry ‘where available locally’ to help manage patients at home.
Meanwhile, GPs in Wales are being advised to do face-to-face pulse oximetry.