Primary Care Coronavirus briefing – Coventry and Warwickshire – 14 April 2020 (Issue 19)
14 April 2020
Attachments
Sent on behalf of the COVID-19 Primary Care Incident Management Team for Coventry and Rugby, South Warwickshire and Warwickshire North CCGs
Primary Care Coronavirus briefing – Coventry and Warwickshire – 14 April 2020
**Please find below the latest daily primary care coronavirus briefing.**
Information provided by NHS Coventry and Rugby CCG, NHS South Warwickshire CCG and NHS Warwickshire North CCG in line with Public Health England guidance.
This information may change rapidly as the situation develops. For the latest information for primary care, visit: https://www.england.nhs.uk/coronavirus/primary-care
Today’s topics – use the links to jump to each section
**Latest local picture**
**Local updates**
**Latest updates for each PLACE (Coventry and Rugby, South Warwickshire, Warwickshire North)**
Latest national picture
Communications from NHS England
Actions for Primary Care
Today’s attachments
• Attachment 1- COVID ReSPECT FAQs .pdf, Attachment 2- sample forms April2020.pdf, Respect form v2.0.docx, Attachment 3 -Final Flow chart options for completion of ReSPECT forms during COVID v1.3.pdf (item 5)
• EMIS Tips 5 Creating Deferred Treatment.docx (item 4)
• EOLC drug list.png (item 7)
LATEST LOCAL PICTURE
Please remember: we are issuing daily (Monday to Friday) communications via: warnoccg.covid19primarycarecommunications@nhs.net. We would also ask that if you have questions or concerns relating to the current situation around coronavirus and COVID-19 you use the same address: warnoccg.covid19primarycarecommunications@nhs.net. Please keep us updated with any issues that you may be having so we can try to address them.
Local picture (up to 14 April)
• 1,019 cases now confirmed in Coventry and Warwickshire (+74 / +7.8% from yesterday)
• 302 of these are currently admitted (-3 / -1.0% from yesterday)
• 803 beds still available (+111 / +16.0% from yesterday)
• 30 ITU beds occupied by Covid patients (+3 / +11.1% from yesterday)
• 189 reported deaths in a hospital setting (+8 / +4.4% from yesterday)
Care Home Cumulative Position up to 14 April
• 416 Care Home residents affected (+121 / +41.0% from yesterday)
• 100 confirmed cases in care homes (+39 / +63.9% from yesterday, note this number will always be lower than residents affected as once a care home has 2 cases confirmed testing stops and residents with symptoms are assumed positive and reported in the number of residents affected)
• 56 Covid related deaths in care homes (+4 / +7.7% from yesterday, note these are in addition to the hospital deaths detailed above)
• 88 Care Home deaths in total (+26 / +41.9% from yesterday)
LATEST LOCAL UPDATE
1. Urgent and emergency musculoskeletal conditions in children (under 16) requiring onward referral
The guidance will help primary or community care practitioners recognise serious pathology which requires urgent or emergency referral to secondary care in children who present with new or worsening musculoskeletal symptoms.
2. Pathology Update for Primary Care
Pathology Courier Service
The Pathology Courier, QE Transport, continues to collect samples from practices. Please note the service is stretched and there is no capacity for additional or changed routes or collections at this time.
3. Phlebotomy Update
CWPS Phlebotomy Clinics which remain open for appointments
Patients can book appointments at www.uhcw.nhs.uk/bloodtests or through their usual channels. Patients from practices across Coventry and Warwickshire are able to attend any of the clinics:
• Atherstone Memorial Hall
• Bedworth Health Centre (accessed by church side door, not the main entrance)
• Newtown Centre, Nuneaton
• Rugby St Cross
• Stratford Hospital
• UHCW
• City of Coventry Health Centre – this site implemented appointments for blood tests on 9 April – bookable through the website above, patients who attend without an appointment will be slotted into the next available appointment
Approx. 50% of the phlebotomy clinics in GP/Pharmacies in Coventry continue to operate. Information is updated on the map at www.uhcw.nhs.uk/bloodtests.
Domiciliary Phlebotomy (Warwickshire)
The domiciliary service continues to operate for essential blood tests only for housebound patients.
4. Safety netting templates
The COVID-19 pandemic means that GPs and patients may decide that a test or referral is not warranted at this time and would benefit from a delay until the worst of the pandemic has passed. This safety netting template is an excellent way to keep track of those patients. It is accompanied by an easy search which can be run at intervals to find those patients who can then be reviewed and a decision made about when to refer/investigate at a date chosen by the clinician and the patient together.
If you do decide to still make a test request or referral, please put as much clinical detail as possible in each referral to enable clinicians at the acute trusts to triage these if required. As you know the 2ww pathway is still very much active and should be used when required. However, if a patient cannot be referred on this or another pathway for any reason such as patient choice, this template can be used to keep track of them.
This attached documents are useful templates to manage these delayed treatments safely in EMIS. (Attachment: EMIS Tips 5 Creating Deferred Treatment.docx)
5. Advance Care Planning (ACP) and ReSPECT
The importance of patients and families having the opportunity to share their priorities for their future care is crucial at this time. To assist you with this an electronic ReSPECT has been developed (see details below). Also please find some helpful updates/reminders that may be of use.
Training
Remember if you would like some reminders about ACP there is some helpful information on the CASTLE website: http://www.c-a-s-t-l-e.org.uk/planning-ahead/what-is-advance-care-planning.aspx
RCUK statement on COVID19: https://www.resus.org.uk/media/statements/resuscitation-council-uk-statements-on-covid-19-coronavirus-cpr-and-resuscitation/covid-crisis-conversations/
Online training under EOLC COVID tab: https://portal.e-lfh.org.uk/Catalogue/Index?HierarchyId=0_45016&programmeId=45016
ReSPECT online training: https://www.resus.org.uk/respect/learning/
Useful Resources
Having conversations around ReSPECT regarding COVID19 is clearly very difficult when an aim could be to get a cohort of vulnerable patients with significant multi-morbidities to agree to no hospital /hospice admission even though non-invasive ventiliation (NIV) and oxygen might save them. Please see some FAQs from the Resuscitation Council for further details and guidelines (Attachment: Attachment 1- COVID ReSPECT FAQs .pdf).
Following these conversations what to write on ReSPECT forms can be tricky as well.
To help you, some examples of wording on forms see (Attachment: Attachment 2- sample forms April2020.pdf).
Electronic ReSPECT Forms
To assist you all an electronic version of the ReSPECT form has been developed for both EMIS and VISION. (Attachment: Respect form v2.0.docx). For support on importing a document into EMIS: https://www.emisnow.com/csm?id=kb_article_view&sysparm_article=KB0018662
We are looking to increase the amount of EOLC planning wherever possible so please consider undertaking a ReSPECT discussion during a remote consultation. Then the new electronic form can be completed remotely with an electronic signature (this is simply a typed name) and your GMC number. In order to be IG compliant the document needs to be saved as a PDF in the patient notes. For EMIS the process is this: https://screencast-o-matic.com/watch/cYfi6Xa2aJ
If required the pdf version can then be printed at the practice (or in the future in one of the resilience hubs) to then send on to a patient/Care Home. Alternatively the completed electronic PDF form could be emailed to a Care home using a secure NHS.net account.
A suggested flow diagram explaining the process is attached. (Attachment: Attachment 3 -Final Flow chart options for completion of ReSPECT forms during COVID v1.3.pdf)
We will be informing other key stakeholders regarding the use of electronic ReSPECT forms and that forms will also be in black and white with an electronic name on them.
6. Patients who need support whilst staying at home
In yesterday’s bulletin we highlighted the NHS Volunteer Responders and how primary care can access this service. With that in mind, we wanted to bring to your attention a section in yesterday’s COVID-19 Primary Care bulletin which has details on the wider help and support that is available to patients whether they are in the shielding group or note.
LATEST UPDATES FOR EACH PLACE
UPDATES FOR Coventry and Rugby and Warwickshire North – 13 April 2020
7. Pharmacy agreement to carry extended EOLC drugs
Coventry SPCT has negotiated with two local pharmacies to carry extended stocks of EOLC drugs enabling all GP prescriptions for the drugs attached to be fulfilled. This will operate for the duration of the pandemic only. The pharmacies are Lloydspharmacy at Stoney Stanton Road (City of Coventry Health Centre) and Lloydspharmacy at Kenpas Highway. Community nursing have already been informed of the service which is up and running. (Attachment: EOLC drug list.png)
8. Coventry GP lunchtime meeting
UHCW Update and Microbiology Update on Wednesday 15 April between13:00 – 14:00. Deepika Yadav, Clinical Director of Integrated care UHCW and CRCCG and Justine Richards, Chief Strategy Officer, UHCW will update on the changes that have happened at UHCW in response to the Covid-19 pandemic. Natasha Ratnaraja, Consultant Microbiologist, UHCW will then guide attendants through the use of antibiotics in respiratory illness at this time. This meeting is brought to you by ZOOM, please log in using the following link: https://zoom.us/j/91114560653 Meeting ID: 911 1456 0653.
UPDATES FOR South Warwickshire – 13 April 2020
No updates this issue.
UPDATES FOR Warwickshire North – 13 April 2020
No updates this issue.
LATEST NATIONAL PICTURE
• As of 9am on 13 April 2020, 367,667people have been tested in the UK and 88,621 were confirmed as positive. As of 5pm on 12 April 2020, of those hospitalised in the UK, 11,329 have died. (Please note: the figures for test results and for deaths are compiled from different sources. This is why the figures for deaths are reported from an earlier point in time than the figures for test results.)
• The most up to date government advice on coronavirus is available online.
• The Foreign Secretary, Dominic Raab, statement on coronavirus (COVID-19) delivered via a press conference on 13 April 2020, detailing the government’s response to coronavirus. The briefing is available to view online and a transcript can be read here.
• The press conference slides and datasets used by Sir Patrick Vallance, Chief Scientific Advisor, in the daily coronavirus press conference on 13 April 2020 can be accessed online.
COMMUNICATIONS FROM NHS ENGLAND
9. NHS England Primary Care Bulletin – new edition – 13 April
COVID-19: latest guidance for general practice is issued in the NHS England Primary Care Bulletin (13 April) and includes GPs in practice supporting NHS 111 and dates for the next primary care webinar. This regular COVID-19 Primary Care Bulletin is from Dr Nikki Kanani and Ed Waller and you are encouraged to sign up here: https://www.england.nhs.uk/email-bulletins/general-practice-bulletin/.
10. Primary care webinar
If you missed the last webinar, it is available to view online (login required). The next primary care webinar, with Dr Nikki Kanani and Ed Waller, will be this Thursday 16 April between 5pm and 6pm (via Microsoft Teams), the link to access is here.
11. Media enquiries
Our communications team is here to support you if needed. If you are approached by the media, please forward on to your local communications team: agem.communications@nhs.net. Outside of working hours the communications team can be reached via 01522 537887.
ACTIONS FOR PRIMARY CARE
Review the details of the staff testing procedure.
Familiarise yourself with the details of the electronic ReSPECT forms.
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In the meantime, the latest guidance for primary care can be found here: https://www.england.nhs.uk/coronavirus/primary-care/
