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Somerset LMC Weekly Update Friday 10th April 2020

Date sent: Friday 10 April 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 3rd April - Friday 10th April.  
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 6th at 7pm.

Opening on Good Friday and Easter Monday There is still no clarity nationally on funding of staff payments and costs. It seems that any additional GP payments will be capped below the going rate and no additional payments will be made to reflect Bank Holiday rates. As a precaution and to assist with future negotiations, please keep account of all additional costs associated with these days. The CCG have assured us that they will come to a sensible local decision on this, and will make the the process for claiming as simple as possible.

Central Alerting System: Shielding - GP Practices The LMC is aware that practices will have received an email from the Central Alerting System today (Friday 10th April) regarding shielded patients. This instructs practices to urgently undertake work to review various lists of patients by no later than Tuesday 14th April at 1700 with a view to amending the patient code in EMIS in situations when a patient should not have been included on the shielded list.

Following national advice from the GPC the LMC believes that for the vast majority of practices this deadline is not achieivable. We also understand that the new codes required to flag patients are currently unavailable on EMIS but expect this to be updated imminently.

For now our advice is that practices can only do their best to check the lists for obvious errors as time permits and that we expect further details and clarity to be forthcoming next week.

Yeovil Hospital up date for primary care colleagues: To improve advice to GPs during the pandemic, YDH has now a dedicated consultant physician to advise on concerns about potential admissions including CV19. This service will run Monday – Friday 9-5 via the Consultant Connect service on the Acute Medicine option. Previously the Acute Physicians took these calls but now they are working in CV19 wards it is difficult to answer calls promptly. OOH calls will be routed to the expanded medical teams. We will continue to monitor how this service is used and make changes on call volumes and hours of demand.

COVID 19 & Care Homes: Colleagues will have seen news stories of the difficulties that some care homes are experiencing in the epidemic with some having large numbers of deaths of residents and staff shortages due to isolation. There are now instances of problems reported in Somerset particularly from some residential homes. The LMC encourages practices to at least keep in touch with care homes in their areas to see if their is anything practical that can be offered at this unprecedented time.  

DNARs & Care Plans: Colleagues will know that we have been directed to make sure that as many treatment escalation plans as possible are ready to make sure that frailer patients have their wishes respected and co-morbidities taken into account in the event of them becoming unwell during the present epidemic. We have however been reminded by the BMA, CQC, the joint Royal Colleges and NHSE&I (see Clinical Frailty link above)  that these must be prepared after individual discussion with patients, relatives and carers. We are sure that GPs who have sought to achieve this end partly through mail merged letters have acted only with the very best of intentions and professionalism. Unfortunately this has not always been the way that such letters have been interpreted in the age of Twitter. You may have seen the hostile coverage a Welsh practice received in the mainstream media? The LMC advice must be to avoid this method of communication. If any practice has already sent such letters out it would be best to withdraw them with clarification on adherence to the JRC and NHSEI guidelines.

Access to Yeovil Hospital Respiratory CNS for practice nurse queries: In order to help practices manage patients with respiratory symptoms in circumstances where diagnosis and management requires clarification, Yeovil Hospital is making a Respiratory CNS available for telephone advice.
CNS Jemma Evans will be contactable 9.30am - 4.30pm Monday to Friday, on 01935 384691.

COVID-19 testing for Primary Care staff Bridgwater: May we remind practices of the process for people who are presenting to the hospital to self present to the emergency/ambulance entrance at the side of the building , at a designated testing space. Unfortunately there have been several incidents when potential COVID cases have gone into the hospital main entrance and understandably this has raised staff anxieties. 

Cardiology A&G During COVID-19 from Dr Tom McConnell: Telephone discussions with cardiologists can be booked by the admin team on 01823 343824 Mon –Fri 0800-1600. The team will agree a mutually convenient time (most days 1500-1700 ) and ask for your direct dial number, patient name and identifiers. Ideally send more information using EMIS template document (including ECG pdf if available) to  cardiologysharedaccess@tst.nhs.uk. ​​​​​​We will arrange cardiology tests as appropriate and generate a letter outlining the mutually agreed plan. We are happy for all GPs in Somerset to use this service. Importing EMIS template.

Contraception update: As practices prioritise their workload we have been asked for guidance regarding smears:
Smears should be offered to all persons who have had previous high risk changes, are on more frequent recalls and have had treatment to the cervix.
For low risk persons if possible could be done but are not a priority as practices as asked to limit face to face contact to essential only.

EMIS information - GP Connect and COVID Clinical Assessement Service (CCAS) information: EMIS have produced a guide on how to configure your clinical system to support the CCAS.  
The National CCAS:

More information can be found here
The Somerset Digital team have recommended for now that you complete steps 1 & 2 in the guidance but please wait for final clarification from a national level before completing steps 3 & 4. 

Just In Case Prescribing: The LMC has been asked to reassure practices that the prescribing of subcutaneous JIC medication prescribing should continue as usual for the time being especially on the recommendation of community and palliative care teams. We understand concerns about shortages of supply but have been reassured that, although certain items may be hard to obtain, alternatives can still be found. In the longer term there are plans for topical, oral and rectal preparations to allow relatives and carers to minister to loved ones if community teams are overwhelmed. That has not happened yet and may never do. 

Death Certificate Books: The county Registrar is maintaining  a skeleton staff in the main offices in Yeovil, Bridgwater, Taunton and if you email  SomersetRegistrations@somerset.gov.uk  attaching a scanned signed copy of the standard request form, it will actioned. 

Accurx - Florey Survey: In response to the recent Coronavirus outbreak, Accurx have developed a Florey survey for practices to send to any patients who are visiting the surgery (e.g. regular appointments) to help them screen for any coronavirus warning signs. This should allow you to identify any at-risk patients and tell them not to come into the practice. Link on how to activate the template can be found here. ​​​​​​

HGV Medicals From GPC: We have just spoken to DVLA and they explained that they stopped requesting medicals as of 24 March. If colleagues have outstanding requests they can just refuse to do them and ask the patient to go back to the DVLA.
Further announcements will be coming out shortly once they have been approved by the Minister and will be widely communicated as was the MOT suspension.
Taxi medicals are the responsibility of the Local Authority but applying the DVLA or near DVLA standards  (You couldnt make it up) . We are trying to locate the relvant people at the LGA

Pathology Lab Communication: Despite the present situation SPS has pressed ahead with stopping using fax machines.
Consumable Requests must be sent to SPSstores@tst.nhs.uk using the SPS order form. Please do not add unrelated queries to stores emails
Additional Test (add on) Requests should be sent to: GPPathologyAddon@tst.nhs.uk.

 

and if you got this far as its a whopper this week, I do hope you have at least some down time this Easter Weekend

 

Stay Safe 

Kind Regards

 

Jill

Jill Hellens

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

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

www.somersetlmc.co.uk
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