6 April 2020

All attachments can be found here

Dear colleague

Please find below the latest GP update regarding Covid-19. It includes:

• Guidance and standard operating procedures: General practice in the context of Covid-19 (attachment)
• Update and clarification on the government’s shielding policy (attachment)
• North West London PPE guidance on home visiting (attachment)
• End of Life Care: Covid-19 primary care guidance and toolkit (attachments x2)
• Message from DHSC on clinical negligence indemnity and Covid-19 (attachment)
• Asthma guidance
• Independent sector key worker letter (attachment)
• NHSE/I patient safety note re oxygen therapy devices (attachment)
• REMINDER: patient registration

 
Guidance and Standard Operation Procedures (SOP): General practice in the context of Covid-19

ACTION: Practices must read and act upon the attached SOP

Practice staff are to be made aware of this standard operating procedure (SOP), the Covid-19 case definition, and the guidance on patients at increased risk of severe illness from Covid-19, including those advised to shield themselves and the wider group of patients at risk.
See attached SOP for full update to date guidance.

 
Update and clarification on the government’s shielding policy

ACTION: Read the attached letter

Professor Chris Whitty and Professor Steve Powis wrote to you on 21 March with information about the government’s shielding policy. The attached letter provides a set of FAQs to clarify and support this process for general practice, and a set of FAQs for patients, should these be useful. After reading the FAQs, if you have any further questions relating to the shielding process, please contact england.covid-highestrisk@nhs.net.

The full letter is attached.
 

PPE for COVID-19 and home visits

ACTION: Read and implement the attached guidance

The Public Health England updated guidance includes advice for community, primary, mental health and social care home visits. To understand if a patient is symptomatic or in the extremely vulnerable group and shielding, contact should be made prior to visit to ensure correct PPE is worn, if any. If contact is unable to be made or the patient is unable to identify if they are symptomatic or vulnerable then PPE should be worn as a precaution.

If a resident and/or any household members are not symptomatic (asymptomatic) nor self-isolating (within seven days of a positive result) for Covid-19, no additional PPE is required other than good hygiene practices such as hand washing, and the wearing of gloves and disposable aprons if you are providing clinical care within two meters of the patient. There is also new advice about caring for a patient who is socially shielding.

See attached document for full guidance.
 

End of Life Care: Covid-19 primary care guidance and toolkit (attachments x2)

ACTION: Read the attached covering letter and toolkit in full

The attached toolkit has brought together existing resources and guidance in an accessible way to help inform primary care clinicians during Covid-19. This approach was approved by the Pan-London Covid-19 Clinical Advisory Group on 31 March 2020. The toolkit includes information on:
-       Compassionate conversations
-       Communication skills
-       Identification (people likely to be in their last year of life)
-       Coordinate My Care
-       Community palliative Care
-       Decision making about hospital admission
-       Care home considerations
-       PPE
-       Care after death
-       Self-care (staff)

Read the attached covering letter and toolkit in full.
 

Message from DHSC on clinical negligence indemnity and Covid-19

ACTION: Read the attached letter

Comprehensive arrangements are already in place to indemnify healthcare professionals and others for the NHS work which they already do. The Clinical Negligence Scheme for General Practice (CNSGP) provides indemnity for GPs and others working in NHS general practice. NHS Resolution administers the scheme. Find out more here: resolution.nhs.uk. We expect that in the majority of cases during this emergency period, any person working for trusts or GP practices will be covered for NHS work by these existing indemnity arrangements.
The government has introduced the additional indemnity cover under the new Act. This additional indemnity cover will provide an additional safeguard and is complementary to any existing indemnity provision already in place.

The full letter is attached.
 

Letter to confirm key worker status for independent sector staff

ACTION: Issue attached letter to staff

If you have staff from the independent sector supporting your practice, there may be situations in which they require a letter to demonstrate that they are a key worker. Please find attached a letter which you can issue them for this purpose.
 

Guide to asthma management and prevention

ACTION: Use as needed for reference

The Global Initiative for Asthma (GINA) has produced a guide to asthma management and prevention. View it here. For further information, view the GINA website: www.ginasthma.org.
 

NHSE/I patient safety note re oxygen therapy devices

NHSE/I has issued an urgent patient safety note of the use of high flow oxygen therapy devices (including wall CPAP and high flow face mask or nasal oxygen) during the Covid-19 epidemic. The note mainly applies to acute trusts but please find it attached for reference.
 

REMINDER on patient registration

On 27 March, a GP Preparedness letter was sent out from NHSE/I. Following this letter, we would like to clarify the application requirements regarding new patient registrations. The regulations require that “an application for inclusion in a contractor's list of patients must be made by delivering to the contractor's practice premises a medical card or an application signed (in either case) by the applicant or a person authorised by the applicant to sign on the applicant's behalf”. We would like to confirm that in the current situation, delivery may be by any means, including by post and digital options. A signed, scanned application or picture of a signed application emailed to the practice is acceptable. Equally, where a practice has online registration options, a supporting signed letter from the patient, posted or emailed to the practice, is acceptable to complete the registration. Practices must, however, ensure that where online registration solutions are used, all GMS1 fields are collected and relevant information entered into the clinical system during registration. This will ensure Primary Care Support England can process the registration.