12 November 2020

Action: Read NHSE guidance on the immediate actions to take in response to patients who are quarantining following potential exposure to mink-variant SARS-CoV-2 virus in Denmark

SARS-CoV-2 is known to cause clinical disease in various domestic and wild animals, in particular, mink. Wide scale outbreaks have been reported in farms where they are raised for their fur in the Netherlands, Spain, the United States, Sweden, Italy and Denmark. A high prevalence in Denmark led to Denmark being removed from the UK travel corridors list at 4am on Friday 6 November.  Any travellers from Denmark returning to the UK will now be required to self-isolate for 14 days according to the national guidance and legislation.

You may have patients registered to your practice for whom this guidance applies. With this cohort, NHSE asks that you take measures to help them adhere to the self-isolation guidelines.

Actions for GPs include:

• Primary care organisations should assess that an individual has returned from Denmark and delay elective and non-urgent treatment until after the 14 days of isolation.
• Note that individuals should not be seeking routine outpatient, ambulatory or primary care, elective treatment while in their 14 days of isolation after return from Denmark.

Action: Note the funding available for additional venues and flu clinics in NW London. Read the latest guidance and submit attached claims form for additional flu venue costs (attached to this email as an excel spread sheet)

Please see this link for national guidance for CCGs and Practices/PCNs on how to claim for additional costs for delivering flu vaccinations through alternative models eg. drive in clinics, as well as delivery from alternative locations to their surgery sites. You may have already seen this in previous communications but we wanted to send a reminder should it not have been clear.

https://www.england.nhs.uk/publication/claiming-reimbursement-for-reasonable-additional-costs-for-flu-delivery/

What can CCGs and GP practices claim for?

Funding is restricted to contributions towards the costs of:

• additional venue hire and associated costs (signage, external temporary shelters)
• additional fridges/mobile cold storage.
• Claims cannot be authorised for costs that are already funded via other routes, such as other national funding streams, the vaccination Item of Service fee, existing GP contract or CCG funding or locally agreed contracts. The funding will therefore not cover:
• additional staff costs
• routine vaccination consumables ie syringes, disposal of sharps
• PPE
• communications and advertising.

Relevant additional costs incurred from 1 October 2020 can be claimed from your CCG but you should seek pre-authorisation from your CCG for the planned activity and costs you plan to claim reimbursement for.  Please notify your CCG generic mailbox or CCG primary care team to get pre authorisation using the attached form for ease.

Once the pre-authorised costs are agreed and incurred then you can claim for reimbursement within 6 weeks of the pre authorisation. Your claim should be accompanied by back up evidence of the costs ie. receipt, invoices. They will be then be paid to the claiming practice or PCN on the next available payment run.

Also note, you will see in the guidance that each CCG has been allocated an indicative budget for these costs and have been asked to manage claims within that fixed envelope.

We hope this is clearer but please contact your CCG or NWL Primary Care Team if you have any queries.

Action: Read the guidance from NHSE about an online platform created to support patients who are experiencing post-COVID syndrome. Also visit the associated yourcovidrecovery.nhs.uk website for further information

Your Covid Recovery is an online platform, with two offers:

• An publicly available website containing general information on all aspects of recovering from COVID-19 including physical, emotional and psychological wellbeing. This site launched on 31 July 2020.
• An online, interactive rehabilitation platform specifically for patients with post-COVID syndrome, that is tailored for individuals and requires referral and face to face assessment from a healthcare professional. This will be live on 31 October 2020, to be rolled out using a phased approach, and is to be offered as an adjunct rather than a replacement for usual primary care support and rehabilitation services that are available.

Action: Continue with the vaccination protocol for children in clinical risk groups, and those refusing LAIV due to porcine content. Share where appropriate the fatwa issued with the British Fatwa Council

Around mid-November, PHE supply of inactivated flu vaccine will switch to Fluarix® Tetra, manufactured by GlaxoSmithKline, for all eligible children aged less than 9 years who are contraindicated for, or too young to receive Fluenz^® Tetra AND are in a clinical risk group.

Vaccine arrangements for children in clinical risk groups aged 9 years and over, for whom Fluenz^® Tetra is unsuitable will remain as follows:

• Those vaccinated in general practice should be offered locally procured QIVc where available. Where QIVc is unavailable, GPs can offer QIVe, either from locally procured stock or centrally supplied stock available via ImmForm.
• School aged providers can continue to offer centrally supplied QIVe.

As set out in the flu letter published on 5 August, this year an offer of inactivated vaccine is also being made to children whose parents refuse LAIV due to the porcine gelatine content, subject to vaccine availability. Once available from around mid-November, Fluarix® Tetra, can also be ordered from ImmForm for this purpose. As always, the latest information on the availability of vaccines for the children’s flu programme is available on the ImmForm news page, so please check regularly for updates.

FYI the British Fatwa Council / Karimia Institute has issued a fatwa which concludes the nasal flu vaccine containing porcine gelatine is suitable for use by Muslims. Read more here: https://www.britishfatwacouncil.org/2020/10/fatwa-on-flu-vaccine-containing-porcine-gelatine/.

Action: Invite homeless residents for flu jabs with other at risk cohorts

PCNs and GP practices should note that all homeless residents of NW London are classed as vulnerable and thus eligible for a free flu jab.

GPs can offer a flu jab to any homeless resident if registered (or by registering them); they should be invited alongside other at risk cohorts to attend a flu clinic. Homeless people may also receive their jab via pharmacy or via hostel-located programmes.

Action: Vaccinate under-65s at risk, 2-3 year old children and pregnant women

Thank you for all the hard work you are doing to meet our ambitious 75% flu targets – we are well aware that targets are steeper this year and that we are dealing with a broader group of eligible cohorts; your efforts are appreciated.  Across North West London we are making excellent progress towards reaching our targets in the over 65s, with the following practices exceeding their 75% target for over 65s as of WSIC 11 November 2020:

Royal Hospital Chelsea; Headstone Road; Preston Medical Centre; Kenton Clinic; Cedars Medical; Burnley Practice; Elliott Hall; Mollison Way; Harness Wembley; Preston Road; Headstone Lane; The Ridgeway; The Town; The Surgery; The Medical Centre Brunel; Oldfield Family; Medical Centre Southall); Featherstone Road Health Centre.

Now we urgently need to step up our efforts with under-65s at risk, 2-3 year olds and pregnant women.

Congratulations to SMS Medical Practice in Brent and The Town Surgery in Ealing who have already achieved over 70% uptake in the aged 2-3 cohort, while Preston Medical Centre in Brent and again, The Town Surgery in Ealing, have achieved over 60% uptake with under 65s at risk.

We are here to work with you to meet our targets in the vital under 65s at-risk, aged 2-3 and pregnant women cohorts. Please contact your flu lead with any questions or requests for further support.

Action: Note, share and learn from best practice

Elliott Hall Medical Centre has achieved a 78% uptake so far in their over 65s group.

Practice Manager Marie Jolly submitted the following best practice story.

“We have worked hard as a team to achieve our target.  We had an organisational meeting with key members of staff to bounce ideas of how we saw this working, this involved partners, GP’s, Nurses, management and receptionist. It is really important to bring the team along on this journey as they are the ones that are going to help you achieve the target.

We ordered early so got an early delivery date and had all the order delivered in one slot for the >65yrs.

We arranged weekend and early morning sessions for patients. We made the appointments available to book online and sent text messages informing patients of this. Our nurses have done the housebound. We had help from the DN’s for 25 housebound patients who were already on their lists.  The sessions on the Saturdays were much longer than usual to take into account social distancing and the number of patients we needed to vaccinate. Everyone rolled their sleeves up and got involved Partners, GP’s, Nurses, HSW, and Admin support. We trained up additional staff by investing in the LMC course for administering influenza vaccine.

We had admin working to maintain social distancing both inside and outside the surgery, we operated a one-way system through the building and had up to 9 rooms giving patients the flu jab at any one time. We were lucky with the weather as well because it was dry on both days we did sessions at the weekend. We have also added sessions early morning and at lunchtime again adhering to the social distancing rules.

The IT team were heavily involved with searches etc. to target the correct patients. Non responders to the texts were contacted by the admin team.

It takes great team work - and we are lucky to have a hard working and dedicated team at Elliott Hall Medical Centre.”

Action: Read the latest guidance below about direct bookings using codes DX05 and DX06

The overall number of direct bookings for the DX05 and DX06 codes currently going to Urgent Treatment Centres (UTCs) and extended GP hubs is relatively low and we would not expect more than a few referrals a week and perhaps less than one a day.

When a practice receives a referral it is given a two or six hour timeframe to look at the referral. The timeframe is decided according to the pathway assessment.

This does not mean the GP needs to see the patient within two or six hours, but that they must look at the Post Event Message (PEMs) and see what the patient has contacted NHS 111, the questions asked and answers given and the outcome of the assessment.

Based on this and knowledge of the patient, the GP can then decide if a face to face or telephone appointment is needed or if they should be referred to another clinician within the practice or elsewhere.

The patient should be informed of the outcome of the decision made by the GP/clinician within the DX code time frame. This can be done by an administration member of staff.

As a reminder, Covid legislation is still in effect and this means GP practices should be reserving one appointment per 5000 patients every day for 111 to refer into. I.e., if your practice list is 7,000 you should be reserving two appointments.

To note that once the new 111 contract is awarded, the DX05 and DX06 codes will be triaged by a clinician in 111 which means that referrals to GPs will be more robust and time frames are more appropriate.

Action: Note the additional QOF points flu jabs for <65 LTHC

We remind practices that QOF points allocated to flu vaccination have been doubled in 2020/21 to 36 points for targets for four long term conditions (COPD, diabetes, stroke or TIA and coronary heart disease). In addition, the value of each QOF point has increased to £194.83.

Action: Share with patients the latest service update from The Royal Free Hospital

The Royal Free would like to share with practices and the public that they have restarted all of their services and are open for business.  They are aware that due to the on-going nature of the pandemic, some of our patients are waiting longer than we would like. 

Royal Free staff are working their way through waiting lists as quickly and safely as possible, prioritising patients according to their clinical need. Additional resources put in place include extended out-patient clinic sessions, the hospital is also carrying out procedures and operations on the weekend, and setting up more seven day services.

For further information visit the Royal Free Website at https://www.royalfree.nhs.uk/

Action: Feedback to Healthy London Partnership about what you think future cancer training should look like here

The Pan London Cancer Training Needs Assessment (TNA) for Primary, Community and Social Care Staff was launched this week. The survey aims to gauge the following:

• Your knowledge of prevention, screening and risks of developing cancer
• Your knowledge of potential cancer signs and symptoms
• Give you confidence in talking about prevention of cancer, early diagnosis and living with and beyond cancer
• Give you confidence about your role in diagnosing cancer earlier and in providing holistic personalised care
• Your knowledge about practice, process and systems that have been put in place locally to support cancer diagnosis and holistic personalised care.

Please find attached  a flyer for the TNA with information about the aims and objective of the assessment and a link to the survey itself.

The TNA will open from this week until the 15 December 2020. Healthy London Partnership who are organising the survey, would like to encourage as many frontline primary, community and social care staff to complete this assessment.

Action: Read the key messages from the NHS and primary care in NW London here.

Find below key highlights of upcoming training session for primary care staff: