28 May 2020
All practice staff must be made aware of the NHS England standard operating procedure (SOP), and the latest case definitions and guidance on patients at most risk of severe illness as a result of COVID-19, including those advised to shield themselves and other at-risk groups.
Urgent updates to practices are being provided by the central alerting system (CAS), so they have been asked to ensure the MHRA has an up to date email address that is regularly checked by staff.
Second-phase NHS response
In a letter to NHS organisations, dated 29 April, NHS Chief Executive Sir Simon Stevens said that the NHS could now move into phase two of its response having passed the peak of the outbreak. His letter is at: https://cached.offlinehbpl.hbpl.co.uk/NewsAttachments/PGH/Stevens-letter-phase2.pdf
Key updating guidance GP practice staff need to know
These links are continually updating and, on most of these pages, the nature of the updates are listed if you click on “show all updates”.
NHS England, Guidance and Standard Operating Procedures (SOP)
General Practice in the Context of Coronavirus (COVID-19):https://www.england.nhs.uk/coronavirus/publication/managing-coronavirus-covid-19-in-general-practice-sop/
Public Health England case definitions and updated information on local testing, COVID-19: Investigation and Initial Clinical Management of Possible Cases: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection#interim-definition-possible-cases
Public Health England’s personal protective equipment (PPE) hub, Coronavirus (COVID-19): Personal Protective Equipment (PPE) Hub: https://www.gov.uk/government/collections/coronavirus-covid-19-personal-protective-equipment-ppe
Public Health England, Guidance on Infection Prevention and Control (IPC) for COVID-19: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
PHE’s Guidance: Considerations for Acute Personal Protective Equipment (PPE) Shortages: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/managing-shortages-in-personal-protective-equipment-ppe#medical-masks
Royal College of General Practitioners (RCGP), latest COVID-19 guidance: https://www.rcgp.org.uk/covid-19/latest-covid-19-guidance-in-your-area.aspx
NHS England, Coronavirus Act – Excess Death Provisions: Information and Guidance for Medical Practitioners: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/COVID-19-Act-excess-death-provisions-info-and-guidance-31-03-20.pdf
All relevant COVID-19 guidance is provided by NHS England including on prevention; infection con-trol; assessment; management of confirmed COVID-19; discharge; isolation; workforce; finance; men-tal health, learning disabilities and autism; cancer; and other resources: https://www.england.nhs.uk/coronavirus/primary-care/
NICE clinical rapid guidelines
A range of clinical “rapid guidelines” in response to the COVID-19 outbreak has been produced by the National Institute for Health and Care Excellence (NICE) for GPs and their teams, all of which are published on the continually updating NICE website page at: https://www.nice.org.uk/guidance/published?type=cov,coa
They include Managing Symptoms (including at the end of life) in the Community; Managing Suspect-ed or Confirmed Pneumonia in Adults in the Community; Severe Asthma; Rheumatological Autoim-mune, Inflammatory and Metabolic Bone Disorders; and Community-based Care of People with COPD.
GPs' workload prioritization
Guidance from NHS England on 19 March details routine work that practices can now suspend and income protection measures that will be implemented: https://www.england.nhs.uk/coronavirus/publication/preparedness-letters-for-general-practice/
The RCGP produced guidance on workload prioritisation on its COVID-19 resource hub: https://elearning.rcgp.org.uk/course/view.php?id=373
This is intended to be read in conjunction with guidance from the British Medical Association (BMA): https://www.bma.org.uk
Patients with symptoms of COVID-19
NHS England’s SOP highlights a British Medical Journal (BMJ) article for guidance on remote as-sessment and management of patients with symptoms of COVID-19, at: https://www.bmj.com/content/368/bmj.m1182
The SOP also includes guidance on seeing possible COVID-19 cases, saying most patients with symp-toms can be assessed and managed remotely.
When face-to-face assessment is required this should be done according to the local operating model, which may be via designated sites, either within the practice or as a separate location or “hot hub”, or home visiting. Details of the possible operating models are set out in the SOP.
The SOP recommends that local areas/practices should allocate staff to patients with symptoms of COVID-19 or other groups, where possible. This should also apply to home visiting teams.
It states that routine care for patients with symptoms should, where possible, be delayed.
For a possible case of COVID-19, staff should wear the currently advised PPE, and all PPE should be disposed of as clinical waste.
NICE's rapid guideline NG165 on managing suspected or confirmed pneumonia cases provides advice on when to consider hospital admission, and is available on NICE’s website at: https://www.nice.org.uk/guidance/published?type=cov,coa
Remote consultations and homeworking
The BMA has issued advice on remote consultations and homeworking, COVID-19: Video Consulta-tions and Homeworking at: https://www.bma.org.uk/advice-and-support/covid-19/practical-guidance/covid-19-video-consultations-and-homeworking
All patients should now be triaged either by phone or online before deciding whether they should have a face-to-face appointment. NHS England has published Advice on How to Establish a Remote 'Total Triage’ Model in General Practice Using Online Consultations at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0098-Total-triage-blueprint-April-2020-v2.pdf
Practices should designate and prepare a suitable isolation space, ensuring there is a phone in the room if possible. An RCGP guide to setting up an isolation room is available: https://www.rcgp.org.uk/about-us/rcgp-blog/covid-19-guide-to-setting-up-an-isolation-room.aspx
Patients attending the surgery
Latest guidance in the SOP addresses procedures to follow when patients attend the surgery.
After the patient has left the surgery
Cleaning and decontamination should be carried out in line with Public Health England's IPC guidance at: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
Guidance on home visits is in the latest SOP. Remote triage for symptoms of COVID-19 should take place before the visit. If COVID-19 is suspected during a home visit a similar process should be followed.
Guidance from Public Health England should be followed: https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing
NHS England has written to patients at most risk from severe complications from COVID-19, asking them to stay at home and avoid face-to-face contact. GP practices are being asked to ensure the list is correct.
NHS England's guidelines, Guidance and Updates for GPs: Highest Clinical Risk Patients, are to be followed: https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk-patients/
NHS Digital has also provided information on the shielded patient list at: https://digital.nhs.uk/coronavirus/shielded-patient-list/guidance-for-general-practice
NHS England latest guidance for patients is available at: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
Under the “Second Phase” NHS response, practices have been asked to increase support for at-risk patients and deliver weekly "virtual care home rounds”.
NHS England and NHS Improvement have given full details of what is expected from practices and PCNs in a letter at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/COVID-19-response-primary-care-and-community-health-support-care-home-residents.pdf
NHS England has produced information for clinicians on the use of volunteers: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0112-NHS-Volunteer-Responders-Information-for-Primary-Care-Professionals_31-March-2020.pdf
Pregnant healthcare staff
RCOG continually updating advice for GPs and healthcare staff who are pregnant, Coronavirus (COVID-19) Infection and Pregnancy is at: https://www.rcog.org.uk/coronavirus-pregnancy
Changes to death verification
DHSC guidance, Coronavirus (COVID-19): Verifying Death in Times of Emergency, is at: https://www.gov.uk/government/publications/coronavirus-covid-19-verification-of-death-in-times-of-emergency/coronavirus-covid-19-verifying-death-in-times-of-emergency
NHS England and NHS Improvement’s latest information on death certification is at: https://www.england.nhs.uk/coronavirus/publication/preparedness-letters-for-general-practice/covid-19-act-excess-death-provisions-info-and-guidance-31-03-20/
NHS X has produced guidance on information governance during the coronavirus outbreak at: https://www.nhsx.nhs.uk/key-information-and-tools/information-governance-guidance
Doctors forced to work outside their normal scope of practice during the coronavirus outbreak will have that context taken into account if they face complaints. A joint statement from the General Medi-cal Council (GMC), NHS England and the UK's chief medical officers, Supporting Doctors in the Event of a Covid-19 Epidemic in the UK, is published at: https://www.gmc-uk.org/news/news-archive/supporting-doctors-in-the-event-of-a-covid19-epidemic-in-the-uk
For specific guidance for Wales, Scotland and Northern Ireland, including information relating to in-fection control and much of the information aimed at the public relevant in all four UK countries:
Health Protection Scotland guidance for primary care: https://www.hps.scot.nhs.uk/web-resources-container/covid-19-guidance-for-primary-care/
Public Health Wales latest information: https://phw.nhs.wales/topics/latest-information-on-novel-coronavirus-covid-19/information-for-healthcare-workers-in-wales/
Public Health Agency Northern Ireland latest information: https://www.publichealth.hscni.net/news/covid-19-coronavirus