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NHS advises ‘total triage’ as GP groups look to limit patient demand



Exclusive NHS England has issued advice for practices to move to a ‘total triage’ services, as LMCs and CCGs are implementing radical changes to GP access.

An email sent by NHS England director of primary care Dr Nikita Kanani said that practices should start ‘moving to TOTAL triage system (whether by phone or online)’, as well as undertaking all care that can be done remotely through remote means. 

At the same time, LMCs and CCGs have been advising GPs to take other actions, including cancelling routine appointments and cancelling online bookings.

The email sent by Dr Kanani advised that when patients present as potential coronavirus cases, and are unwell, GPs should: ‘Use PPE as per PHE guidance for possible cases i.e. gloves, apron, mask; isolate the patient; if acutely unwell treat; if not then ask them to ring 111 from the room and leave; decontaminate as per the SOP.’

She added: ‘In the meantime, practices should start:

⁃ Moving to TOTAL triage system (whether by phone or online)

⁃ Undertaking all care that can be done REMOTELY through remote means, being guided clinically and we will support those decisions

⁃ Agreeing locally which sites and staff could manage face to face assessments of any possible COVID-19 cases

⁃ Agreeing locally a plan to support patients who are particularly at risk of COVID-19 complications, including considering co-ordination of their care if in future advised to stay at home

⁃ Confirming business continuity plans, with a view to cross practice resilience.’

Pulse reported on Friday morning that GP practices in Derbyshire are poised to suspend all routine appointments in response to the coronavirus (Covid-19) outbreak, following advice from their LMC.

This afternoon, Cambridgeshire LMC issued the same guidance, Pulse has learnt.

Meanwhile, Doncaster CCG said that local practices are authorised to switch off online bookings ‘completely’ if this is their ‘preferred approach’.

An email sent by the CCG and seen by Pulse said measures can include:

– ‘Switching off online appointment booking completely if this is the practice’s preferred approach

– ‘Accepting prescription requests by telephone where the patient isn’t willing to register for/able to use online services

– ‘Moving an increasing amount of clinical care to telephone/video/online consultations where this is safe to do so and within the competence of clinicians

– ‘Changing your Proactive Care service to a predominantly telephone-based service alongside suspension of routine face to face external MDT meetings. As well as releasing capacity this should help reduce risk of rapid spread to a particularly vulnerable cohort of patients who don’t have a pressing clinical need

– ‘The previous point also relates to other proactive in-reach work such as routine ward rounds with care homes for the same reasons. Practices will need to agree with the care home managers how clinical input and support to these homes will continue during this period.’

Lancashire and Cumbria LMC chief executive Peter Higgins said the LMC has advised practices to start triaging all patients remotely and ‘undertaking all care that can be done remotely through remote means, being guided clinically’.

However, Mr Higgins told Pulse that he had decided not to advise practices to suspend all routine appointments.

He said: ‘I’m not doing it and it’s not because I don’t think they should do that, but what I’m pressing for is a local tactical operational group working across the whole health system that will advise when it’s appropriate to do what.’

The chief medical officers of all four UK countries said that expectations on routine GP services will be relaxed if the spread of coronavirus becomes a ’significant epidemic’ in the UK.

A Pulse survey revealed that two out of five GPs have still not received any personal protective equipment against coronavirus.

Meanwhile, GPs have been forced to draw up their own emergency plans amid a lack of guidance from NHS England on how to manage patients turning up with respiratory symptoms.

As of 13 March, 32,771 people have been tested in the UK, of which 31,973 were confirmed negative and 798 were confirmed as positive. 10 patients who tested positive for COVID-19 have died.

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