22 May 2020
Dear colleague
Please find below the latest GP update regarding Covid-19.
You will find this update with links to the files on the new North West London password-protected site page. You can also review the full list of Covid-19 related service changes, to ensure you have not missed any notices.
Website: https://www.nwlondonccg.nhs.uk/professionals/coronavirus-clinical
Password: NWLCovid-19
Today’s update includes:
- Update from Dr Mohini Parmar and Professor Julian Redhead on NW London elective care
- Supporting primary care safe practice during Covid-19
- Public Health England survey: Delivering Childhood Immunisations in General Practices in London during Covid-19 pandemic
Update from Dr Mohini Parmar and Professor Julian Redhead on NW London elective care
Dear colleagues
To keep you up to date with the recovery and work going on in our acute trusts, we will be sending a regular update on the work going on to start reopening acute services.
As you will know, reopening services will take time, as we ensure both staff and patient safety in doing so.
We will provide a regular update even if the position has not changed significantly.
Timeline for reopening elective
As you will be aware, at present non-urgent elective services are suspended in NW London, due to the Covid-19 pandemic and the associated issues of capacity, patient safety, and workforce resilience.
Currently the NW London specialty clinical reference groups are working on the priority patients requiring acute care. Each reference group has a mix of GPs and consultant specialists from across NW London.
The groups are reviewing patients awaiting procedures and placing them in four priority groups, with a focus on the most urgent cases going through for treatment at this time. These groups are as follows:
- Priority level 1a Emergency - operation needed within 24 hours
- Priority level 1b Urgent - operation needed with 72 hours
- Priority level 2 - Input that can be deferred for up to 4 weeks
- Priority level 3 - Input that can be delayed for up to 3 months
- Priority level 4 - Input that can be delayed for more than 3 months
We have started P1 and P2s now – some in the independent and some in the safe areas of our Trusts. We are managing this equitably across the sector.
We are working with NHS London to continue and extend the recommencing of elective work and we will update as soon as we have confirmation.
The aim of this work is to ensure elective pathways are kept from of Covid-19 and we shall not be re-starting work until we are assured on the following points:
- Physical separation of patient pathways
- Assurance on the adequacy of PPE and drugs supplies
- Pre-admission isolation and testing of patients
- Testing of staff.
Work has also been on-going with Trusts across the sector to understand our p2 and p3 requirements for the independent sector and how they can support these patients. Initial modelling outputs have been developed and further work is being undertaken. We are making our own sites as Covid-free as possible to undertake as much elective as we can (i.e. P3s). We requested additional capacity in the independent sector after June when the NHSE independent sector contract comes to an end.
As soon as we have more information and a definite timeline we will share this with you.
National guidance to support elective planning and reopening
National guidance for the reopening of elective care has been received this week. Teams are ensuring the national and London guidance are the same to ensure consistency in our planning approach.
The main points of reference, for when elective care can reopen include:
- All patients requiring elective surgery or day surgery will need to isolate with their household for 14 days prior to surgery.
- For diagnostics (for example, endoscopy), local guidance can be applied. For London this will require the patient to isolate for seven days isolation prior to procedure.
Additional points:
- Where patients can’t isolate, they will need a risk assessment on a case by case basis.
- Further clarity on patient pathways for plain x-rays and non-interventional radiology will follow.
- We are assuring that our Covid-free sites comply with guidelines, and that we have sufficient testing, PPE, drugs, diagnostics and staff. Once this work is completed, we will be in a position to say when we will start elective P3s.
Outpatients
We are still not in a position to reopen routine outpatient referrals but we are working with colleagues across the sector to look at this. For now please do continue to use the advice and guidance services that are in place. Please carry on referring Urgent, 2WW, and chest pain as you are currently doing.
Supporting primary care safe practice during Covid-19
ACTION: View all documents here – in particular, the four highlighted in bold
A range of materials and checklists have been developed to support the safe and effective delivery of primary care as we move forwards. They cover three areas. All documents are listed with key documents highlighted in bold and attached. The remaining documents can be found in the web-portal.
Note that the staff checklist and the estates check are there to help you consider what needs to be done to make the necessary changes in your practice.
Infection control
- Infection control prevention – NW London Primary care checklist (Please note a checklist return is required by 5pm Friday 2 June 2020)
- London Guidance on the Principles for Infection Prevention Control
- London Principles of Managing Infection Prevention and Control In General Practice whilst caring for all patients during the COVID-19 Pandemic
- A range of safe working practice documents including risk assessment of vulnerable staff
- Return to workplace principles
- Working Safely During COVID19 Offices
- Covid GP Risk Assessment
- Guidelines for individual staff risk assessment final
- Risk Assessment for High Risk and Vulnerable Staff Groups with potential work related exposure to COVID
- Primary Care Occupational Health Arrangements
- Ongoing Safe Delivery in Practices
- Practice check list - Safe and effective service delivery during the Covid-19 pandemic
- Clinical Areas (Reception, Waiting & Clinical Rooms) - Estates COVID-19 Recovery Risk Assessment
- Non Clinical Areas (Offices, Meeting Rooms) - Estates COVID-19 Recovery Risk Assessment Template
- Communal Areas (Entry exit, Corridors, WCs, Tea Points, Breakout) - Estates COVID-19 Recovery Risk Assessment Template
Public Health England survey: Delivering Childhood Immunisations in General Practices in London during Covid-19 pandemic
ACTION: Click here to complete the survey
This is a quick six-question survey to check that the Routine Childhood Immunisation Schedule continues to be delivered in London. The purpose is to provide an assurance report to the London Covid-19 Oversight Group and to help the integrated PHE and NHSEI (London) Immunisation Commissioning Team to identify where support is needed at this time. Thank you for taking the time to complete.
