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Somerset LMC Weekly Update Friday 1st May 2020

Date sent: Friday 1 May 2020

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

SGPET Covid weekly update can be found here

General Practices' Alert State: Somerset LMC’s assessment of General Practices’ Alert State for the period 24th April - Friday 1st May.   
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 4th at 7pm.

Colorectal Referrals to TST: In accordance with national guidelines Musgrove Park Hospital is currently unable to offer any endoscopy services apart from emergencies. We are also unable to offer radiological colonic imaging e.g. CTC and although CT abdomen and pelvis are available these are also being limited to emergencies only. We are still accepting colorectal 2-week wait referrals and all of these patients are being triaged by the colorectal team. Any patient triaged as needing an immediate investigation will be offered this. All patients are being contacted with the reasons for the delay in their investigations. ALL patients will be kept on a pending list and will be investigated as soon as safety and resources permit.

Patients Stranded Abroad: Some colleagues have asked about patients contacting them from abroad.
NHSE says patients abroad must seek their own care and pay for it or be covered by insurance. The UK has reciprocal arrangements with some countries but only for emergency care (similar to what the NHS affords foreign residents here).
The Foreign & Commonwealth Office website advises those running out of prescription medication to contact their travel insurance company. If they cannot help they should seek local medical assistance. They may also contact the nearest embassy, high commission or consulate directly or through the FCO line 0207 008 1500.
CNSGP adds as a result of Covid-19 patients stranded abroad may ask for telephone consultations. Please note that the Clinical Negligence Scheme for General Practice ONLY covers patients in England. However we now hear that CNSGP will cover such exceptional circumstances as part of your qualifying GPC or PMS contract. As these assume that your patient is in the country there is a paradox. LMC advice remains that you direct patients abroad to local services. We suggest consulting your MDO if in doubt.

GP Connect to Provide Access to Patient data via the summary care record: To better enable the ability of the service to respond to COVID-19, additional patient data from primary care records will be made available to doctors, nurses and authorised professionals outside of primary care. The Joint GP IT Committee has indicated their support for this as an interim measure to help manage increased and complex demand during the current period. The letter of support is attached and also included in the guidance that has been issued here ​​​​​​.

Sessional and Locum GP's: These colleagues are now frequently experiencing cancellation of bookings causing some hardship. Practices have always needed sessional GPs to operate and will do again when all this is over. We understand practices are not made of money but now might be a good time for some to take a break and book a locum? 

All that cough is not Covid: The LMC was so impressed by this guide expertly prepared by our respected GP colleague Dr Steve Holmes that we thought it essential that we included it in our update too. The reference to our Upstart Crow is not only pertinent but Steve also reminds us that we are facing challenges in examination and diagnosis more like that of physicians in the past than of in living memory. Please read, mark, learn and inwardly digest.

Prioritisation of Routine Immunisations: Pertussis for Pregnant Women & Update on the school aged Immunisation Programme. Despite CV19 routine immunisation is obviously still important in preventing ill-health through other causes and so should be maintained as far as practicable. PHE knows that practices are minimising face to face interactions but pertussis continues to circulate at high levels and it remains important that pregnant women are offered the vaccine and that babies get protection against this and other infections from 8 weeks. To increase uptake PHE asks you reassure patients that social distancing and decontamination of premises and equipment is being followed. It may have occurred to you to adjust appointment times to avoid waiting with others. In some areas practices may be working with neighbours to deliver CV19 and non-CV19 activity on separate sites. Do consider the use of text messaging and telephone conversations to encourage take up. PHE is keen to tell you about a drive through immunisation service being piloted in Newham.
School Aged Immunisations Practices will probably guess that with to schools being closed the School Aged Immunisation Programme delivered in schools has paused. A national Task & Finish group currently working up ‘restart’ recommendations. There is no expectation that practices cover these immunisations and should continue to deliver your commissioned immunisation programmes.
If you have any queries please contact

Cervical Screening Survey: please find attached guidance.

For any queries or question regarding the guidance or questionnaires, please send to SIT team generic email:

Paramedic prescribing: In EMIS Web 9.7.11 can now configure a Paramedic job role with Independent/Supplementary Prescribing. The Paramedic is required to supply their registration number to be able configure them correctly. Details here.

CPR Controversy: Recently we published some guidance on CPR in the time of CV19 which attracted some comments and calls for clarification from readers centred on the lack of gown PPE in practices and conflicting PHE and RCUK guidance. This is a national issue and so we print an edited statement from Richard Vautrey of the GPC.
“We are aware of concerns that CPR is not classified as an Aerosol Generating Procedure (AGP) in PHE guidance. Members of the BMA remain concerned that they are being asked to resuscitate patients without adequate protection due to a lack of national consensus. The guidance from RCUK provides a clear process for both protecting patients and healthcare workers – treating CPR as an AGP. This involves one person shocking the patient up to three times with a defibrillator whilst wearing type 2 PPE (FRSM, disposable apron, gloves and eye protection), giving others time to put on type 3 PPE (FFP3 respirator, disposable gown, gloves and eye protection). 
“Our position is that CPR should be reinstated to the list of AGPs by PHE.”

And Finally...

PPE shortages are no laughing matter but this article from the Grauniad struck the LMC as important for two reasons. First because it just goes to show that even in Germany ​​​​​​​things don’t always go with typical health and efficiency and second we wonder if any Somerset GPs would follow suit in protesting? 


Kind Regards



Jill Hellens

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

Tel: (01823) 331 428            
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