Post Covid Syndrome Referral Pathway - Information for GPs

How to refer

The referral form has been updated and embedded in both System One and EMIS. Please access it through these platforms.

Please note: GP/Clinicians are required to manually complete the fields highlighted in green on the form. All other fields will pull the information through from the patient’s records and auto-populate on the form,

The referral pathway

The following diagram illustrates the referral pathway [Download a version here]

Who is suitable for this referral pathway?

The service is for all patients over 18 within NWL ICS believed to have post-Covid syndrome who:

• require further clinical assessment and investigations related to suspected post-Covid syndrome

AND / OR

• who need a programme of physical and/or psychological therapy

Exclusion Criteria

The Triage Team will unfortunately have to reject referrals in the circumstances as listed below:

• Symptoms which are acute or life-threatening
• Symptoms where alternative causes have not been ruled out
• Where a standard face-to-face assessment – set out in this form as per London guidance - has not been completed by the Primary Care referrer
• Patients under 18
• Patients not registered to a GP practice within NWL
• Patients with symptoms less than 12 weeks after Covid infection
• Patients whose primary need is treatment of chronic conditions that existed prior to Covid infection (e.g. patients with a diagnosis of chronic fatigue syndrome/ME or fibromyalgia predating Covid infection) - in this case, please refer to the appropriate specialty
• Patients with a single need requiring investigation or treatment - in this case, please refer to the appropriate specialty
• Patients with symptoms resulting from Covid-19 vaccination

Information to be added shortly

North West London Post-COVID-19 Syndrome Single Point of Access

This is the NWL post-Covid triage service, which will review the referral form, and if accepted will refer the patient on to either:

• their local Post-COVID-19 syndrome assessment clinic (PCAC) if further medical investigations are required, who will assess the patient and refer the patient onwards for treatment
• their local Post-COVID-19 syndrome Multidisciplinary therapy team who will assess the patient and deliver/coordinate a programme of physical and/or psychological therapy

Post-COVID-19 Syndrome Assessment Clinics

These clinics provide specialist assessment for patients with confirmed or suspected Post-COVID-19 syndrome. The clinic model is described below.

Post-COVID-19 Syndrome Community Multi Disciplinary Services

Improved access to Psychological Therapies Services

Should you wish to refer your patient directly to Improving Access to Psychological Therapy (IAPT) services there are several referral routes that can be followed:

• Where there is diagnostic uncertainty as to whether ongoing physical symptoms are related to Covid 19, a pre-existing or new condition we would advise clarifying this prior to referral for psychological treatment
  • Refer to Acute Assessment clinic for diagnostic workup (this will be an assessment by a psychologist)
  • Acute Assessment clinic will agree care plan and refer for psychological treatment if indicated
• Multiple needs are identified and community rehabilitation programmes may be indicated e.g. pulmonary, cardiac or neuro rehab and/or several services likely to be involved in treatment alongside IAPT
  • Refer to post Covid community MDT in order to assess rehab needs and coordinate treatment options. Psychologist embedded in MDT will assess and advise.
  • The community MDT can refer to IAPT directly if needed but will do so in the context of an agreed care plan and can monitor all services involved with patient’s care.
• Straightforward presentation of anxiety and/or depression associated with some post Covid symptoms (single dominant need).
  • Direct referral to IAPT service as usual (referral form embedded for use in Systm1)

When to refer:

Referral indications for IAPT (common mental health problems, ongoing Covid symptoms and impact of Covid):

• New or exacerbation of pre-existing anxiety / depression / relationship problems / adjustment difficulties
• Anxiety and/or depression associated with the impact of Covid (e.g. bereavement, furlough, redundancy, lockdown restrictions, becoming a carer)
• Anxiety and/or depression associated with ongoing Covid symptoms (e.g. fatigue, poor concentration, breathlessness)
  • No requirement for a positive Covid-19 test during acute phase of Covid
  • No requirement for a confirmed diagnosis of post-Covid syndrome or to wait 12 weeks after acute Covid infection
• PTSD or other anxiety presentations associated with ITU admission and/or other medical interventions during management of acute

Times when a direct referral to IAPT services is unlikely to be appropriate:

• Ongoing symptomatic Covid-19 symptoms requiring acute assessment or intervention (e.g. oxygen desaturation on exercise, severe lung disease, cardiac chest pain)
• Diagnostic uncertainty as to whether ongoing symptoms are related to Covid-19, a pre-existing or new condition (e.g. requiring referral to post-Covid syndrome Acute Assessment clinics)
• Where community rehabilitation programmes are indicated e.g. pulmonary, cardiac or neuro rehab or when referring to the post-Covid community MDT to co-ordinate rehab options
• Diagnosis of severe and enduring mental health conditions or high risk/ significant self-harm requiring psychiatric review or multidisciplinary mental health interventions
• Complex drug and/or alcohol use, or eating disorder, requiring specialist services
• Immediately following a bereavement or traumatic event

Appointments offered:

IAPT services offer telephone, video and face to face appointments. In addition, some treatments are available using computerised CBT. The medium of consultation will depend on clinical need and patient choice. For face to face appointments infection control guidance will be followed.

Referral process:

GPs and primary care staff can refer to IAPT services using embedded referral forms within eRS

IAPT services also accept self-referrals and patients with post-Covid syndrome can use this route. However, we would recommend health professionals make a referral for any complex presentations to ensure IAPT clinicians have access to all relevant information.

Contact details for IAPT services are shown below:

Enhanced Service Required Codes

The codes required are based on the requirements for identification and referral within the Enhanced Service 2021/22.

Diagnosis codes: Ongoing symptomatic COVID-19 (4-12 weeks after infection); Post-COVID-19 syndrome (12 weeks plus)

• 1325171000000109 Acute COVID-19 infection
• 840539006 COVID-19 diagnosis (where not previously recorded)
• 1325181000000106 Ongoing symptomatic COVID-19
• 1325161000000102 Post-COVID-19 syndrome

Signposting and referral codes: Signposting to Your COVID Recovery when signposting patients to the publicly available Your COVID Recovery website (phase 1); Referral to post-COVID assessment clinic

• 1325041000000104 Referral to Your COVID Recovery/ Living With Covid rehabilitation platforms
• 1325021000000106 Signposting to Your COVID Recovery
• 1325031000000108 Referral to post-COVID assessment clinic

Resolution code: Post-COVID-19 syndrome resolved: to be used at the patient and clinician discretion when all symptoms are fully resolved and there is no evidence of persisting organ impairment or if an alternative diagnosis has been made to account for all symptoms (code not available at time of publishing)

Coding of key clinical information in letters from post-COVID assessment clinics or other specialist services is also required

Assessment (optional)

• 1325061000000103 Assessment using Newcastle post-COVID syndrome Follow-up Screening Questionnaire
• 1325081000000107 Assessment using C19-YRS (COVID-19 Yorkshire Rehabilitation Screening) tool Primary Care Minimum Data Set (as at April 2021)

For ongoing symptomatic COVID-19 or post-COVID-19 syndrome in primary care