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Coronavirus primary care 3pm briefing

Information correct as at 2.45pm on Tuesday 31 March 2020

Today is Tuesday but I’m not sure any of us can now tell what day of the week it is anymore. The reason I say this is that we’ll be holding our Wednesday live video stream (that’s tomorrow), you’ll see details further on in today’s briefing, but I realised I’m finding that days are going by in a blur.

I’m aware that there continues to be a steady and regular stream of updated guidance for everyone to familiarise themselves with. We were considering reducing the frequency of this briefing but based on your feedback this doesn’t appear to be an appropriate action to take just now. We will of course look for any opportunities to streamline our communications to you and welcome any feedback from you.

I say this everyday as it’s really important. Please take care of yourselves and your colleagues as well as your loved ones. And take time to reflect and say thank you to all those that are pulling together to help people in Leeds.

Dr Simon Stockill
Medical Director, NHS Leeds CCG
Live video conference – 1 April 2020, 1pm-2pm

The event will be hosted by Dr Sarah Forbes, GP and Associate Medical Director, NHS Leeds CCG.  The panel will include:

  • Dr Gill Pottinger, GP and Clinical Lead for End of Life Care, NHS Leeds CCG
  • Jim Barwick, Chief Executive, Leeds GP Confederation
  • Kirsty Turner, Associate Director of Primary Care, NHS Leeds CCG

You’ll need to access the video conference online  (link available from 12.45pm), using this password pcLConf25. If using a laptop please use Google Chrome or otherwise use your phone or tablet. Please email through your questions to: leedsccg.target@nhs.net. For those unable to join we’ll provide a link to the recording.

Pause on identifying vulnerable patients

Following the update in the NHS England bulletin on Saturday 28 March, practices were advised to pause their work on identification of vulnerable patients. An updated list of those identified nationally is expected to reach you this week.
 
We recommend that you use this valuable time to still undertake some of this work but prioritise and focus on identification of those of highest risk and making contact.  The update referenced streamlining the process so whilst the focus might change, time spent identifying the most vulnerable will still be time well spent.  We are also working with LTHT to see how we might best work together to avoid duplication of effort and will keep you updated.

Expediting hospital discharges

Robust daily planning between LTHT / associated health and care partners and third sector is enabling a significant proactive decrease in hospital bed occupancy in readiness for an anticipated surge in COVID-19 + patients. This is in line with HM Government Guidance published on 19 March 2020.
Managing Hospital Referrals for GP Follow-up Post Discharge

  • LTHT will assess all discharges and identify those patients requiring next day follow up by the discharging ward. 
  • Some follow-up calls will inevitably lead to the identification of issues that may still be managed in the community, thus avoiding hospital re-admission. In such cases, LTHT will contact GPs, the relevant community service /third sector organisation by telephone for a rapid response. 
  • If on assessment at discharge the discharging clinician feels the patient requires rapid follow up at home by their GP this will be indicated via the Electronic Discharge Advice Note (e-DAN) / clinical system (SystmOne /EMIS). 
  • All requests for discharge follow up should be triaged within the practice and face to face contact minimised with assessment via remote means e.g. telephone / video consultation in the first instance. 
  • More straightforward discharges may still require GP follow-up and will be communicated via a clear request on the e-DAN. Again, patients must be advised that follow up will be remote, either by telephone / video consultation. 
  • To achieve a significantly reduced bed occupancy rate in preparation for the surge it is highly likely that some LTHT patients will be discharged following investigations and pending results /plan. We are working with LTHT to ensure a safe and effective process to manage this; further communication is anticipated towards the end of the week. 
  • Discharged patients are likely to be anxious and create additional demand by ringing practices for advice. Where a follow up is required, but triage determines it is non-urgent, the practice may choose to utilise appointments via the Extended Access (EA) Service.  
  • The Extended Access (EA) Service is currently reviewing opportunities for reconfiguring its service offer at varying points in the surge period and dependent upon its own staffing availability. Plans will be shared in due course. 
  • Given that we do not yet fully understand the numbers of patients needing follow up this process will require regular review to ensure GPs can effectively and safely manage increased demand. 
  • To help manage patient expectation, LTHT will also advise patients that GP follow up will be delivered remotely via telephone / video consultation. 
End of Life / Fast Track Process
  • There have been some changes to the End of Life Fast Track referral form that will be used by LTHT to advise GP’s and the Neighbourhood Teams of a discharge. The referral form is generated by PPM+ and you will continue to receive these via the usual route, there have been no changes to the End of Life Fast Track process. 
  • The Association for Palliative Medicine have produced a COVID-19 update on their website at: www.amponline.org
Supply of discharge medicines during COVID-19 outbreak
LTHT will discharge patients with:
  • 28 day supply of medicines (TTOs)
  • 14 day supply for those with a compliance aid (an increase of 7 days)
Medicines queries related to the discharged patients
  • If it’s related to amber drugs monitoring in patients who have been on the medication less than 12 months, then contact the specialist overseeing the patients care.
  • If it’s related to amber drug monitoring in patients who have been on the medication for greater than 12 months see new amber drug guidance sent out yesterday.
  • Any general queries can be directed to either LTHT medicines information – medicines.information@nhs.net or via the Confed clinical pharmacy team email address leedsccg.medsoptcovidresponse@nhs.net or via the locality lead pharmacist connected to your PCN.
Primary care clinicians are still able to access the advice and  guidance function provided by LTHT to gain specialist advice for patients from secondary care re appropriateness of an urgent referral. Advice and Guidance requests will be passed on to clinical teams.
Medical certificate cause of death

As we outlined last week, the government has now introduced emergency measures which enable a registrar to register a death by telephone.

Medical Certificates of Cause of Death should no longer be issued to a family member but should now be scanned and emailed (without the stub section) to the registrar’s office at Register.headoffice@leeds.gov.uk

Please include the name and contact details for the person who will be registering the death. You also need to include your GMC number and print your name, as well as sign the certificate.

This will enable the registrar to make contact with the family and register the death by phone. Where we do not have a scanned copy of the MCCD or contact details, it can involve a significant delay in the registration process. We’ve updated our website so that all guidance is in one place. The update includes a flow chart developed by Dr Lucy Clement, GP, Oakwood Lane Medical Practice.

Local updates

Verification checks for returning GPs
Some practices have been approached to carry out verification checks for GPs who are returning to the NHS to support the COVID 19 response.  Details of the checks were included in the NHS England bulletin dated 30 March 2020.  The CCG recognises this places an additional burden on practices and therefore has arranged for some ID verification sessions to take place over the next few weeks.  Any individual who approaches you for ID verification and you are unable to complete this, can attend our ID verification sessions every Tuesday and Thursday at WIRA House between 10am and 2pm.  If you have any queries, please contact Kirsty.turner@nhs.net

Leeds Breathlessness Pathway
A revised version of the Leeds Breathlessness Pathway will be included in the Bulletin tomorrow. It will reflect emerging consensus including moving away from the use of prophylactic antibiotics.

National updates

Pausing the NHS complaints process
Due to the ongoing COVID19 pandemic NHS England and NHS Improvement are supporting a system wide “pause” of the NHS complaints process which would allow all health care providers in all sectors to concentrate their efforts on the front-line duties and responsiveness to COVID19. We’ve developed some text for your websites as below.

Text for GP practice websites
Due to the ongoing COVID19 pandemic, we are currently pausing our complaints process, in line with national guidance.

You can still raise concerns or make a complaint, but we may not be able to investigate it and respond as we normally would.

We will acknowledge your complaint, log it on our system, and check for any immediate patient safety, safeguarding or practitioner performance issues. If there are, we will take immediate action as necessary.
If your complaint is about anything else, it will remain open until further notice, unless you choose to withdraw it. When normal services are resumed, we will investigate and deal with it as soon as we can.

Please note that of 26 March, the Parliamentary and Health Service Ombudsman has stopped accepting new NHS complaints and has stopped work on open cases.

Thank you for your understanding.

Managing the COVID-19 pandemic in care homes
This guidance published by the British Geriatric Society provides further detail on managing residents who have recently had an in-patient stay in hospital. 

Free meals and rides for NHS staff from Uber
Uber is making 200,000 rides and 100,000 meals available to all NHS staff for free. To redeem, register using your NHS email at uber.com/NHS - you will then receive a code to use on free trips of up to £15 as well as a £10 voucher to buy a meal or groceries through Uber Eats.

Patient resources

Macmillan support
This is undoubtedly a worrying time for patients and we want to help to take some of the pressure away from you by answering some of their queries. Our website  is a source of reliable information and is the gateway to the Macmillan Online Community, where thousands of people connect and give each other support every day. We have created a dedicated webpage to advise people with cancer concerned about COVID-19.

We will be prioritising the continued running of the Macmillan Support Line (0808 808 00 00, now open Monday – Friday, 9am – 5pm) to provide practical, emotional and financial information and advice, so please do share this with your patients.

Link of the day
The Leeds Palliative Care Network team is now working remotely and significantly focused towards supporting the optimal delivery of palliative and end of life care across Leeds during the COVID-19 pandemic. We have added a quick link banner and created a specific COVID-19 page.
Social media message of the day

We'd welcome your support in sharing this changes at your GP practice tweet through any of your personal social media accounts as well as those from your practice

Communications support

If you receive any media queries or need help with developing any patient-facing resources please contact our communications team. You can contact the team on 0113 84 35529 or Leedsccg.comms@nhs.net

Frequently asked questions

We’d very much like to work with colleagues in primary care to answer any questions you may have. Please email your questions through to: leedsccg.primarycare@nhs.net

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