Somerset LMC Weekly Update Friday 17th April 2020
Date sent: Friday 17 April 2020
Sent to all Somerset GPs and Practice Managers This and previous updates are available here
- General Practices' Alert State
- Resuscitation Council UK CV19 Update for Community Settings
- Latest Update to PPE Guidance From PHE 12/04/20
- CQC Issues Clarification
- Death & Cremation Process in Time of COVID
- NHS 111 isolation notes
- Electronic Fit Notes
- Hand Sanitiser
- Support and Resilience tips for Practice Managers
- Total Triage/Video & Online Consultation
- Care Homes Batch Dispensing
- Routine Referrals
- Annual Leave
- Video Consultations With Patients & Community Nurses
- Calling the LMC
- And finally...
General Practices' Alert State: Somerset LMC’s assessment of General Practices’ Alert State for the period 10th April - Friday 17th 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 20th at 7pm.
Resuscitation Council UK CV19 Update for Community Settings: Because of the possibility of COVID-19, RCUK offers this advice:
- Recognise cardiac arrest by looking for the absence of signs of life and the absence of normal breathing. Do not listen or feel for breathing by placing your ear and cheek close to the patient’s mouth. If you are in any doubt about confirming cardiac arrest, start chest compressions until help arrives.
- If COVID 19 is suspected tell them when you call 999.
- If there is a perceived risk of infection, rescuers should place a cloth/towel over the victims mouth and nose and attempt compression only CPR and early defibrillation until the ambulance arrives.
- Early use of a defibrillator significantly increases the person’s chances of survival and does not increase risk of infection.
- If the rescuer has access to PPE this should be worn.
- After performing compression-only CPR, all rescuers should wash their hands thoroughly with soap and water; alcohol-based hand gel is a convenient alternative. They should also seek advice from the NHS 111 coronavirus advice service or medical adviser.
Latest Update to PPE Guidance From PHE 12/04/20: Primary care, ambulatory care and other non-emergency outpatient clinical settings.
“For primary care, ambulatory care and other non-emergency outpatient settings... plastic aprons, FRSMs [fluid resistant surgical masks], eye protection and gloves should be used for any direct care of possible and confirmed cases. Such PPE may be indicated for work in such settings regardless of case status, subject to local risk assessment. [In other words all patients might be shedding virus even without symptoms.
For health and social care workers working in reception and communal areas but not involved in direct patient care, every effort should be made to maintain social distancing of 2 metres. Where this is not practical use of FRSM is recommended.”
The strong evidence base for this guidance is set out here .
CQC Issues Clarification: Colleagues are encouraged to follow the link and rejoice!
Death & Cremation Process in Time of COVID: The LMC is grateful for to the cooperation it has had from the County Registrar, HM Coroner and crematorium referees on the sudden changes to these processes which have turned over decades of accustomed practice. The LMC has issued guidance and clarifications before but we are indebted to Wessex LMCs for the attached summary flow chart which both the County Reg and HMC have commended for your use.
Both suggested additions. The Registrar asks that we bear in mind that the "last seen alive" question on the MCCD should be answered with a name and GMC number if it was another doctor. Also that after scanning and emailing paper MCCDs can be retained by practices for collation by registrars in due course.
The Coroner wants us to stress the original guidance on which the chart is based and encourage reference to it when in doubt.
NHS 111 isolation notes: The NHS 111 Online Get an Isolation Note service issues isolation notes to individuals with symptoms of COVID-19 or those having to self-isolate due to residing with someone with COVId-19 symptoms. Employers have received clear guidance that for all COVID-19 related illness they should accept the Isolation Note as medical evidence to support absence from work and not require employees to get a fit note from a GP.
Electronic Fit Notes: Some practices are now using email or AccuRx to send patients a Fit Note with a QR code and signed electronically. Some have reported that although Job Centres and employers have accepted the eFNs they have asked for a paper copy in due course. BMA GPC advice from vice chair Dr Mark Sanford-Wood is that this is neither necessary, possible, nor safe practice. Colleagues can feel confident in rebutting these requests using these words and references.
Hand Sanitiser: A plea for practices to keep and reuse small hand sanitiser bottles as they are becoming increasingly difficult to procure and where available very expensive. Hand sanitiser is arriving in large quantities which needs to be decanted.
Support and Resilience tips for Practice Managers: we have set up a new page on the websites and with resources to help with resilience and professional wellbeing tips and videos, we will be adding further to this over the coming weeks, the page can be accessed from the hot topic section on the front page where there are also links to all other education and Covid information. For those practice managers who have not yet completed our survey we have extended the closing date to Tuesday 28th April. The survey can be found here. Please let us know what support would be useful and any ideas you may have.
Total Triage/Video & Online Consultation: A letter was sent to practices on 6 April by CCG IT lead Dr Justin Harrington about the move to total triage. The response showed that many practices have started using video and online consultations. In the background is the NHSE/I aspiration of 30 April 2020 to go online to help manage workflow with COVID-19 pressures. Many are managing well with telephone triage but now is the ideal time to implement online consultation (although the actual contractual date remains April 2021) because at least the first year will be funded from CV-19 monies. Going for it now may also help practices manage the increase demand that will result from the backlog of routine work that will hit us. For those without a solution please contact the firstname.lastname@example.org to find out how to get the best service for your practice or PCN.
Care Homes Batch Dispensing: Colleagues will recall last week we highlighted the plight of care homes something which has captured the news agenda since then. Research from the AHSN has shown that some care homes would be grateful to be relieved of the monthly responsibility of ordering some repeat medication. It could be helpful then to increase the amount of Electronic Repeat Dispensing (or EPS batches) for patients on stable drug regimens. The usual prescription duration would still apply of course. We know that practices have much to occupy them at the moment but clinical pharmacists and dispensary staff might find it profitable to contact local care homes to ask if this would be useful? Please see a helpful guide here for which we are indebted to the LPC and the Beacon Medical Group in Plymouth for sharing with us.
Routine Referrals: The LMC was appalled to hear that RUH Bath was refusing all routine GP referrals with the support of their local CCGs (not including Somerset). Therefore we were delighted to read in Thursday’s NHSE CV update that NHS guidance will be published shortly advising secondary care to accept and hold clinical responsibility for GP referrals. GPs should continue to refer patients to secondary care using the usual pathways and to base judgments around urgency of need on usual clinical thresholds (taking into consideration need for non F2F consultations, likely delays in recommencement of routine elective activity, and communicating likely delays to patients at point of referral). GPs should use specialist A&G to inform management of patients whose care remains within primary care including those who are awaiting review in secondary care when appropriate. Happily this guidance is far more in-line with the sensible approach taken by TST and YDH.
Annual Leave: The Government has announced that rules on carrying over annual leave to be relaxed to support key industries during COVID-19 ,The BMA legal department has confirmed that the annual leave entitlements through the Working Time (Coronavirus) (Amendment) Regulations 2020 (SI 2020/365) do apply to practices. Therefore annual leave should be allowed to carry over into future years. The law does not say that people cannot take booked holiday because of the impact of Coronavirus: employees can take annual leave in the normal way unless it is not reasonably practicable for them to do so. Remember, “it’s a marathon, not a sprint.”
Video Consultations With Patients & Community Nurses: Colleagues should be aware that all CNs have Smartphones and so (signal permitting) video consultations can and should be used to assist the management of patients, to help reduce the need for additional home visiting and so "footfall" in vulnerable people's houses.
Calling the LMC: The main phone lines have been redirected to my mobile, as we have 2 lines there are times that your call may not be answered immediately if I’m on another call , please do leave a message and a phone number and I’ll call you back as soon as possible. As a lot of practice numbers come up with no ID it’s impossible to tell who called.
A Friend of one of our Somerset GPs has set up a QUIZ website that is suitable for all ages, a little light relief in these challenging times.
Crown Medical Centre, Venture Way, Taunton, TA2 8QY
Tel: (01823) 331 428
Fax: (01823) 338 561
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