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Somerset LMC Weekly Update Friday 27th March 2020

Date sent: Friday 27 March 2020

Sent to all Somerset GPs and Practice Managers          This and previous updates are available here

General Practices' Alert State: Somerset LMC’s assessment of General Practices’ Alert State for the period 20th March - Friday 27th March.
You can follow this link for a more detailed assessment and an explanation of the General Practice Alert State system.
This information is for awareness and consideration when making decisions which may have an impact upon General Practice across Somerset.
The survey for this week is now open until Monday 30th at 7pm.

LMC Resilience Team: While the team will not be able to visit practices currently they are still supporting remotely if needed, please do let the office know if you need any support.

Coronavirus Act: HMG’s emergency Coronavirus Act 2020 has now become law. As mentioned previously, the Act includes a wide array of emergency measures that can be implemented in order to respond to, and manage the effects of, the COVID-19 pandemic across the UK. An overview of the Act’s powers are outlined in this Gov page. ​​​​
The Act will be reviewed in Parliament in six months’ time.

From NHSE Guidance 20.03.20: “The supply distribution helpline can answer PPE calls and emails 24/7 via the supply disruption helpline on 0800 915 9964 or email to help with queries. Emails will be answered within one hour.” Please notify the LMC of any difficulties. PHE maintains that surgical mask, disposable gloves and apron is the right PPE for non aerosol generating procedures we assume as coughing produces droplets.

Rescue Packs a useful message: “Inaccurate information is circulating (especially on social media) regarding ‘‘rescue packs’ of antibiotics and steroids for patients with lung conditions such as asthma or chronic obstructive pulmonary disease (or even for those who don’t have them) We would like to reassure you that patients with severe respiratory conditions already have them. Oral steroids are powerful medicines and any decision to use them would need careful evaluation by a prescriber. Please do not contact your GP practice for a rescue pack unless this is something that has been previously agreed and prescribed. You should continue to manage your condition in the usual way and if you feel you have symptoms of COVID-19, go to nhs website or if you cannot go online call 111 before doing anything else.”

Managing Acutely Unwell Children During COVID-19 (CV): The CCG issued sensible advice written by a GP this week which we summarise. Most children with CV will not be very unwell but, during the present crisis, we must remember the risk of missing a serious alternative diagnosis like sepsis or new diabetes.
It is appropriate for nearly all children’s health concerns to be managed via telephone or video consultations but clinicians must feel confident about decision making, risk management and safety netting. If there is doubt children need to be seen somewhere in primary care but, as all children are considered potentially infected, front line staff must be protected. 
There is advice on effective telephone triage in the document including how parents/carers can help with taking observations.
If you think there is an acute medical problem needing urgent hospital assessment - and trust your instinct - speak to the paediatrician at your local hospital.Via switchboard, bleep 2439 at Musgrove or 6715 at YDH when a senior clinician will give advice, refer to the acute respiratory ward (at MPH), acute paed assessment in the emergency department (ED) at YDH or the PAU as appropriate.
Please do not tell patients to present to the ED: the emergency teams are focusing on unwell adults. 
If you want advice short of admission call Consultant Connect for MPH or 07772832851 at YDH. The phone is carried between 10am to 4.30pm (4pm at YDH) by a  senior paediatric clinician. If you do not get answer first time please call  back later. We may well be doing other clinical duties which means we can not answer the phone immediately.
Advice & guidance will continue for now.
PLEASE NOTE: This plan is subject to change as the current healthcare situation evolves.

Sending Patients to A&E: The emergency department has asked us to remind colleagues that staff in the ED have no better PPE than we do in primary care. Therefore there is no benefit in sending relatively well patients with suspected CV19 to the ED to be assessed when it is focusing on seeing people who are unwell.

From The Chief Registrar of Somerset - MCCD Books: The Registration Service understands that practices may wish to order extra books of MCCD (death certificates) in the present situation. Unfortunately extra orders made to the General Register Office have not yet arrived. We estimate things may improve in a few weeks but a present practice orders must be limited to one each. 

Pharmacy Hours: Our colleagues in pharmacies are also experiencing high demand at present. This has been recognised by NHSE which has issued a contract variation allowing community pharmacies to shut for up to 2.5 hours a day for restocking without incurring a warning notice. Please be aware of this and speak to your local pharmacies to make sure practices can warn patients if necessary.

Routine Dermatology Outpatients: GPwSIs have been told to cancel all dermatology routine appointments. Patients will not need to be re-referred - the department will contact them in time. Teledermatology will continue for now and the ability to make 2WW referrals remains unchanged. 

From BMA Update on Home Working: Commercial products such as Skype, WhatsApp or Facetime can be considered where you urgently need to have a video consultation with a patient and if alternative channels are not available. Consider the clinical risk of not conducting consultation against any potential risk of using these types of consumer-focused services. BMA guidance on COVID-19 remote consultations and homeworking can be found here. ​​​​​

InHealth Intelligence CHIS: is currently continuing to function as usual, however they are expecting the offices to close as from Friday and start home working.
This will mean they are unable to receive our daily post, it will be delivered and left in a secure place and hoping to collect this post on a weekly basis.
In order to avoid delays, please do not send anything by post or courier but scan and email all documents to the generic email address. ​​​​

Subject Access Requests: We mentioned this a little while ago. If solicitors are insensitive enough to continue to request these then you can reply using the form of words that follows. Despite the ICO expressing leniency you should NOT refuse a SAR - she cannot change the law.
“Dear Data Subject, Thank you for your Subject Access Request (SAR) received by us on [date]. We acknowledge this as a valid SAR. We are responding within the 30 days required under GDPR. Due to the current emergency we are concentrating resources to providing frontline care. We will therefore require more than the usual time needed to prepare the data you request. Article 12(3) allows us to require an additional two months to fully comply with your request and therefore we will provide the data you request by no later than [insert date].”

And Finally...

Revalidation & Appraisal Suspended: Any doctor due Revalidation between now and the end of September will have it deferred by the GMC for 12 months. Any appraisal cancelled during this period will be classed as an Approved Missed Appraisal and the doctor given a new date for 2021. There is no expectation that doctors will gather appraisal evidence during the Covid 19 crisis (although we are all learning lots! - Ed). Appraisees should notify their appraisal toolkit provider so that any evidence gathered so far can be moved to 2021/22 and the 20/21 appraisal year closed off. (LMC note - we hope the providers will do this automatically so don’t rush yet). Regarding the supportive aspects of appraisal please be assured that the LMC pastoral services remain fully active.

The Somerset Pathology Services suspended andrology sample testing on Monday to reduce footfall through the laboratory.


Kind Regards



Jill Hellens

Executive Director
Somerset LMC
Crown Medical Centre, Venture Way, Taunton, TA2 8QY

Tel: (01823) 331 428            
Fax: (01823) 338 561
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