This toolkit provides a step-by-step guide for managing coronavirus (Covid-19) in a primary care service such as general practice. It provides links to key information and template policies on Croner-i. The information is being continually reviewed and updated.

Coronavirus

The World Health Organisation (WHO) defines coronaviruses as a family of viruses that cause infectious illness ranging from very mild to very severe diseases, such as Severe Acute Respiratory Syndrome (SARS-CoV). Covid-19 is the infectious disease caused by the most recently discovered coronavirus strain, SARS-CoV-2. It originated in China at the end of 2019 and quickly spread as a pandemic worldwide.

Symptoms include a high fever, a new, continuous cough, and loss of, or change to, sense of smell or taste. Some may suffer from a mild illness and recover easily. However, in other cases people can become seriously ill and suffer a range of complications. The elderly, those with weakened immune systems, and those with underlying health conditions such as diabetes and chronic lung disease are the most susceptible to serious illness and death. Symptoms can appear in as few as two days after infection or as long as 14 days.

Throughout the pandemic a series of public health restrictions have been required to suppress transmission of the virus and reduce pressure on health and social care systems. Measures have included compulsory self-isolation if infected, periods of national “lockdown” and the mandatory wearing of face masks in some settings, such as in healthcare premises.

A vaccination programme was rolled out in all areas of the UK during 2021. This has proved effective in protecting people and has allowed the Government to gradually ease restrictions. On 24 February 2022, the Government in England relaxed the last of its formal restrictions, that of legally requiring people to self-isolate if they have Covid symptoms or following a positive test.

With formal restrictions now lifted, Government guidance for the general public over the prevention of infection and transmission has been changed to advisory recommendations. However, note that specialist professional guidelines, such as those relating to NHS health care provision, remain in place.

In February 2022 the Government published its strategy for living with Covid-19 in the future. COVID-19 Response: Living with COVID-19 is built on the fact that the Covid-19 virus, SARS-CoV-2, is still a risk and will continue to circulate and evolve for the foreseeable future, possibly producing more dangerous variants. The document includes a range or advisory guidance for the UK population.

Vaccines will continue to underpin the response to Covid-19. Their deployment will continue to be guided by the Joint Committee on Vaccination and Immunisation (JCVI).

Employer duties

Primary care service employers should remember that they have a duty of care towards their staff, patients and visitors, and should take reasonable steps to protect their health and safety, preventing them from exposure to unnecessary risk. This includes assessing the risk of contact with the Covid-19 coronavirus.

What should you do as a primary care service employer?

  1. Make sure that at least one person is responsible for keeping abreast of developments from the World Health Organization, the UK Government and official NHS public health coronavirus guidance for primary care services. Note that the National Institute for Health and Care Excellence (NICE) Covid-19 webpages are now the single point of advice on caring for people with coronavirus and the management of the virus in different healthcare settings.

  2. Review risk assessments and assess the risks of exposure to coronavirus in your practice’s operations. Draw up a policy on how your practice is taking steps to address risks identified. See a template policy for general practice.

  3. Communicate plans to staff. Keep patients informed about the outbreak and any changes to services as appropriate, including changes to the way they access practice services and arrange consultations.

  4. Keep infection prevention risk assessments and procedures under review and ensure they are informed by current guidance and best practice. Infection Prevention and Control for Seasonal Respiratory Infections in Health and Care Settings (including SARS-CoV-2) for Winter 2021 to 2022, published by the UK Health Security Agency, sets out the standard infection control precautions (SICPs) and transmission-based precautions (TBPs) that should be adopted in premises such as general practice. The document replaced the previous guidance, UK IPC COVID-19, and removed the specific high, medium and low care pathways. The guidance states that the use of, or requirement for, care pathways should be defined locally.

  5. The UKHSA guidance states that a recommendation for universal use of face masks for staff and face masks/coverings for all patients/visitors will remain as an Infection Prevention and Control (IPC) measure within health and care settings over the winter period at least. In all other settings, the Government has relaxed the mandatory requirement to wear face coverings, although it still recommends considering wearing a face covering in crowded and enclosed spaces when rates of transmission are high, especially when in contact with people not usually met.

  6. Make necessary adjustments to premises in line with risk assessments. For instance, arranging waiting rooms to enable people to keep a distance from each other, increasing ventilation and installing precautions such as screens, where needed. Display appropriate safety signage, eg hand hygiene, “catch-it-bin-it-kill-it” and face mask posters, etc. Infection Prevention and Control Procedures

  7. Obtain expert infection prevention advice and support as needed. Liaise closely with local planning teams and public health directors, and their teams.

  8. Increase levels of environmental cleaning in primary care premises in order to prevent the potential transmission of the virus by touching contaminated surfaces. Frequently touched objects and surfaces should be cleaned more often than usual. Cleaning in General Practice

  9. Ensure your practice has robust hand hygiene policies and procedures in place. Staff should use sanitisers or wash their hands frequently. Hand sanitisers should be distributed around the practice, including for patients use. Effective Hand Hygiene

  10. Ensure your staff follow the latest guidance on using personal protective equipment (PPE) and are competent at putting it on and removing it. Maintain a stock of appropriate items. The proper use of PPE is a vital element in ensuring the safety of staff and patients from Covid-19 infection. Coronavirus (Covid-19) PPE Guidance

  11. Any member of staff who develops symptoms of Covid-19 infection, or tests positive for the virus, should follow the latest Government recommendations on self-isolation set out in their guidance, COVID-19: People with COVID-19 and Their Contacts. Under no circumstances should they attend for work where they could spread the virus. Self-Isolation

  12. Revise working procedures to minimise risk of virus transmission. For example, avoiding face-to-face working where possible, cancelling non-essential face-to-face training and meetings, increasing use of online digital working methods, etc.

  13. Provide a range of “blended” patient consultation methods. Increase the use of remote consultations, such as email and phone, but still provide face-to-face access for those patients that need it. Every effort should be made to ensure that vulnerable patients, or patients with disabilities and additional communication needs, have appropriate ways to access services. Appointments

  14. Provide support for national public health mitigation measures, including the Covid-19 coronavirus vaccination programme. Following a successful “third” jab booster campaign in the autumn of 2021, the JCVI has recommended another booster campaign for vulnerable adults in the spring of 2022. Covid-19 Vaccines

  15. Practices should encourage and support their staff to access vaccinations themselves. Vaccines remain the best way for people to protect themselves and their families from infection. Following a public consultation, a move to make Covid-19 vaccination a condition of deployment for health and social care staff is currently being revoked by the Government. See Revoking Vaccination as a Condition of Deployment Across All Health and Social Care: Consultation Response.

  16. Identify members of staff who may be at increased risk from the virus, such as those with underlying health conditions. Consult with them and make reasonable adjustments to their working arrangements as necessary.

  17. Follow all appropriate NHS workforce, employment and human resources initiatives. Covid-19: HR Policy and Practice in the NHS

  18. Review your emergency planning and business contingency procedures. Ensure they are up to date and cover disruption caused by the Covid-19 pandemic, particularly in the case of staff emergencies and the delivery of services such as flu immunisation. All practices should have contingency plans in place for a possible outbreak or rise in local coronavirus transmission rates. Emergency Planning topic.

Useful Q&As

Q: Now that England is returning to Plan A, and Covid-19 restrictions are easing again, what Government advice has changed for primary care workforces?

Q: Can I get personal help with managing issues in our GP practice caused by the rapid change, additional demands and staff stress in the pandemic recovery phase?

Q: Is extended GP access going to be supported in 2021/22, during Covid-19 pandemic pressures?

Last reviewed 7 March 2022