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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.