Coventry & Warwickshire COVID-19 Portal

 Warwickshire and Warwickshire North CCGs

Primary Care Coronavirus briefing – Coventry and Warwickshire – 20 March 2020

**Please find below the first daily primary care coronavirus briefing – there’s a lot of detail as this is the first one but we hope future ones will be more succinct.**

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: h ttps://www.england.nhs.uk/coronavirus/primary-care (the page was last updated on: 19 March, 2020 4:06 pm)

Today’s topics – use the links to jump to each section

 Latest national picture

 Communications from NHS England

 Latest local picture

 Local updates

 Latest updates for each PLACE (Coventry and Rugby, South Warwickshire, Warwickshire North)

 Actions for Primary Care

LATEST NATIONAL PICTURE

• As of 9am on 19 March 2020, 64,581 people have been tested in the UK, of which 61,352 were confirmed negative and 3,269 were confirmed as positive. As of 9am on 19 March 2020, 144 patients who tested positive for COVID-19 have died. (Numbers are updated around 2.30pm each day by Public Health).

• The latest government advise on coronavirus has been updated on 19 March 2020.

• The Prime Minister’s speech from 19 March is available here:

 https://www.gov.uk/government/speeches/pm-statement-on-coronavirus-19-march-2020.

• The latest FCO advice is now advising against all but essential international travel.

 

• UK government considering ban of mass gatherings of more than 500 people from next week

Next Steps on NHS Response to COVID-19

A l etter (dated 17 March) from Sir Simon Stevens and Amanda Pritchard has been issued which outlines the important actions that they are now asking every part of the NHS to put in place to redirect staff and resources.

Covid-19, ACE Inhibitors, and ibuprofen

As always, medicines are not immune from misinformation in the event of any health emergency, and two of the latest panics involve ACE-inhibitors and ibuprofen. In both cases, potentially rational but purely theoretical concerns have been translated into hard fact, without consideration of the inconvenient lack of evidence beyond the theory.

A CE-inhibitors

It has been suggested that treatment with ACE-i increases the risk of Covid-19 infection. There is no evidence for this - it has been proposed as a hypothesis, and is one that deserves investigation, but there is currently no scientific evidence to support it. Animal studies actually suggest that treatment with ACE-i may protect against serious lung complications in Covid-19 infection.

There is a UK-wide position on this from two relevant professional organisations, issued on the 16th March, here: h ttps://www.britishcardiovascularsociety.org/news/ACEi-or-ARB-and-COVID-19. They refer to a statement from the European Society of Cardiology, which is here:

h ttps://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the- e sc-council-on-hypertension-on-ace-inhibitors-and-ang.

The Science Media Centre has rebuttals from a range of clinical experts here:

h ttps://www.sciencemediacentre.org/expert-reaction-to-questions-about-high-blood-pressure- d iabetes-and-ace-inhibitor-drugs-and-risk-of-covid-19-infection/

So, the answer at the moment is that this is purely theoretical, and the harms of stopping effective antihypertensive treatment are going to be significantly greater than the potential risks.

I buprofen

There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse.

But until we have more information, patients are advised to take paracetamol to treat the symptoms of coronavirus, unless the GP has told them paracetamol is not suitable for the patient or their child.

If the patient or their child are already taking ibuprofen or another non-steroidal anti-inflammatory (NSAID) on the advice of a doctor, they should not stop taking it without checking first.

Source: h ttps://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/

 

Attached to this briefing is a letter from Professor Stephen Powis covering this subject.

Public Health England COVID-19 update

The latest materials for the p ublic information campaign have been updated with the latest advice

and are available on the C ampaign Resource Centre. Public Health England has also published new

guidance o n staying at home, for households with possible COVID-19 infection and s ocial distancing t o protect vulnerable groups. Other existing guidance is being updated to reflect the latest advice.

ACTION: Please review the material and display where appropriate.

Translated guidance

Public Health England is currently translating the guidance for stay at home, household and vulnerable groups. We expect the guidance will be available in the next 48 hours and will be available as pdfs alongside the current c oronavirus guidance on the gov.uk website.

We will keep you informed when the translated guidance becomes available and where to find it.

COMMUNICATIONS FROM NHS ENGLAND

Please note the latest p rimary care preparedness letter from Dr Nikki Kanani, issued yesterday.

Amends to Messages

NHS111 has asked for GP telephone messages and online booking text be updated to below. The additional ‘or’ word is very important.

Telephone message

If you have symptoms associated with coronavirus including a new continuous cough and or a high temperature, you are advised to stay at home for 7 days. Do not book a GP appointment or attend your GP practice. If you live with other people, they should also stay at home for at least 14 days, to avoid spreading the infection outside the home.

If your symptoms are serious, or get worse, NHS 111 has an o nline coronavirus service that can tell you if you need further medical help and advise you what to do.

Only call 111 direct if you are advised to do so by the online service or cannot go online.

For the latest COVID-19 advice please visit w ww.nhs.uk/coronavirus.

Online booking

If you have symptoms associated with coronavirus including a new continuous cough and or a high temperature, you are advised to stay at home for 7 days. Do not book a GP appointment or attend your GP practice. If you live with other people, they should also stay at home for at least 14 days, to avoid spreading the infection outside the home.

If your symptoms are serious, or get worse, NHS 111 has an o nline coronavirus service that can tell you if you need further medical help and advise you what to do.

Only call 111 direct if you are advised to do so by the online service or cannot go online.

For the latest COVID-19 advice please visit w ww.nhs.uk/coronavirus.

ACTION: Please ensure your practices are updating their messages with the new text.

 

LATEST LOCAL PICTURE

COVID-19 communications in Coventry and Warwickshire is being issued from a single email

address: w arnoccg.covid19primarycarecommunications@nhs.net. By doing so we will help you to

get the right information in a consistent way

Please also send any COVID-19 related queries to this box, as it is being monitored and enquiries logged.

Please add the email address to your safe list

Keep an eye out for and give priority to emails from the email address.

Do check your junk/spam folders to make sure the emails aren’t going there by mistake:

w arnoccg.covid19primarycarecommunications@nhs.net

Local cases

• In the Local Authority of Coventry, there are a total of 4 confirmed cases.

• In the Local Authority of Warwickshire, there are a total of 11 confirmed cases.

LATEST LOCAL UPDATE

We wanted to provide you with an update on a number of important topics, some of which were covered in yesterday’s letter from Dr Nikki Kanani but are worth reiterating. Apologies for the length of the update, but there is a lot to cover.

Moving to a total triage system (whether by phone or online)

We are aware that a number of practices have done this already, but we wanted to highlight the section from the letter for clarity:

“This does not mean not advising/treating patients for other health issues, where there is clinical need, or unilateral closing of practices doors, rather ensuring that patients are appropriately triaged to the right health professional setting. The upsurge in telephone calls to general practice means that providing a reliable and timely response for patients has already become a vital operational priority”.

Locally, if practices have moved to a total triage model they do not need to offer online appointment booking. For those practices which have not moved to a total triage model and who wish to turn off online booking, we can confirm that we will not apply the contractual measures for this requirement.

Agree locally with your CCG which practice premises and teams should be used to manage essential face-to-face services

The CCGs are currently working closely with the GP Federations and PCNs to develop “assessment services / hot hubs” across each Place to manage the general primary care treatment of any patient with fever and/or a cough. This will support practices to manage the essential face to face services.

This work is also being linked with the development of a home management service for COVID-19 category 2 patients, those with underlying health conditions.

 

Undertake all care that can be done remotely via appropriate channels

This must as always be guided by your clinical judgement. See the attachment for further details.

Help staff to stay safe and at work, building cross-practice resilience

This should be done via PCNs and by confirming business continuity plans.

P ractice income

QOF

Payments will be maintained at the higher of the 2018/19 actual or 2019/20 projected out-turn.

LESs

Non-essential LES activity can cease based on clinical discretion, unless the LES services supports the COVID-19 response. Funding, particularly to support staffing, will be maintained and re-directed to the primary medical care COVID-19 response.

The exception to this is the additional support to care home services which should continue taking account of non-face-to-face guidance as clinically appropriate.

COVID-19 related spend

Necessary and critical expenditure related to supporting resilience and continuation of general medical care to patients, incurred as a direct result of COVID related response, will be reimbursable where this is above and beyond that which is reasonably expected to be covered within the terms of your contract or is at a level beyond normal expenditure due to demand or scarcity of resources, or where additional premium costs have been incurred

Practices should keep a simple log of any extraordinary expenditure related to service resilience and continuity associated with COVID-19 and a process for reimbursement will be developed in line with national guidance.

C ontractual Requirements

Remedial actions for GP contractual requirements will not be invoked.

E xtended Hours

Extended Hours capacity can be refocused to telephone or other non-face to face activity without contractual penalties to support resilience and business continuity.

Personal protection equipment (PPE)

We are aware that some practices are asking patients to don face masks on arrival at the surgery to prevent spread of infection. Whilst we understand the logic, we need to ensure all PPE equipment, including face masks, is used appropriately and only by practice staff to ensure stock and availability for when it is needed most. If face masks are given to every patient presenting at the practice, stock will soon be in short supply.

If you have any queries about PPE, you can now direct them to the national PPE telephone line or email address: 0800 915 9964 / 0191 283 6543 / Email: s upplydisruptionservice@nhsbsa.nhs.uk

 

COVID- 19 & Business Continuity Plan Biochemistry – Urine Pregnancy Test

From Coventry and Warwickshire Pathology Services: During today’s business continuity plan meeting it was decided to stop offering urine pregnancy test with effect from today (Friday 20 March). Please note we continue to provide serum hCG assay if required.

We regret any inconvenience that may cause and if you require further details, please do not hesitate to contact ,s ethsiri.wijeratne@swft.nhs.uk

Medicines Supply and Repeat Prescription Requests

Following a teleconference with the National Pharmacy Team, there are significant concerns that some GP practices are increasing prescription quantities and length to deal with the current demand from patients for their repeat prescriptions.

Needless to say, this puts considerable pressure on the medicine supply chain and will cause significant issues further down the line when medicines then go out of stock. May I remind you all that you keep prescribing lengths to 28 days, and instead look to utilise the electronic Repeat Dispensing (eRD) system for eligible patients, which you can authorise patients repeats for up to a year to help mitigate demand.

PCN pharmacists where available can help identify and implement eRD, and in Coventry & Rugby and Warwickshire North I have asked the Medicines Optimisation teams and the NHS POD to help facilitate this process.

Your understanding and patience with regards to the above is greatly appreciated and if you have any questions, please do come back to me via: a ltaz.dhanani@nhs.net

Daily communications

We are going to be providing you with a daily update by 10.30am each day starting today, Friday 20 March.

This update will include the current national picture, the current picture from the Coventry and Warwickshire system, updates from each place, where available, and updates from the providers, again where available. Hopefully you will find this daily communication useful.

Counter fraud newsletter (attached).

This newsletter draws attention to coronavirus scams and what individuals can do to prevent falling victim to them.

LATEST UPDATES FOR EACH PLACE

UPDATES FOR South Warwickshire – 20 March 2020 Acute Physician phone number

If you need advice on a patient with suspected COVID-19, you can access the 24 hours a day 7 days a week on 07917 212535 (the phone will be manned by an Acute Physician 8am to 8pm and the General On call doctor from 8pm to 8am).

 

SWFT is increasing the size of their POD and have robust plans in place to manage actual and suspected cases of Covid-19.

SWFT will start to move to virtual outpatient clinics and are prepared to cancel planned activity. Emergency and cancer procedures will continue.

UPDATES FOR Coventry and Rugby – 20 March 2020 Remote Access for Practices

Practice Managers, with the advent of COVID-19 we are clearly working in very testing times, and CWP IT want to reassure all staff that we are looking at different ways of working to ensure we can remain operational.

To support staff that are having to work from home or in isolation, ITC Services have made remote access available to all staff from Coventry and Rugby Practices using their own personal computers. This is available immediately to Coventry practices. For Rugby practices this will be available from 5pm on Friday 20 March 2020.

Please see the attached instructions on how to on-board and use the remote access facility. Practice Managers should forward these instructions to those staff that have been instructed to work away from the Practice but need access to Healthcare Network resources.

If there are any issues with on-boarding, please contact the Service Desk on 024 7684 4000 / I TServiceDesk@covwarkitc.nhs.uk.

In the meantime, if you have any further questions or queries relating to this please do not hesitate to contact Jaswinder Sian, Interim IT Programme Lead, IT Front Office Services Manager.

UPDATES FOR Warwickshire North – 20 March 2020

No place specific update

ACTIONS FOR PRIMARY CARE

NHS England has produced a patient pathway and patient transfer standard operating procedure. The general advice is to:

• identify potential cases as soon as possible

• prevent potential transmission of infection to other patients and staff

• avoid direct physical contact, including physical examination, and exposures to respiratory secretions

• isolate the patient, obtain specialist advice and determine if the patient is at risk of COVID-19 Please ensure you familiarise yourself with this

information: h ttps://www.england.nhs.uk/coronavirus/primary-care/management-suspected-covid-19/

MEDIA ENQUIRIES

 

If you are approached by the media and do not want to handle it yourself, please forward on to your local communications team: a gem.communications@nhs.net

ACTIONS TO TAKE

• Monitoring the latest updates from Public Health England and GOV.UK

• Ensure your practice websites are updated with the latest advice

• Ensure you promote the key public messages

• Update practice telephone messages

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Please note: This is the designated inbox for all Primary Care enquiries for practices across Coventry and Warwickshire, set up to help support practices and provide a single point of contact to send and receive information about the rapidly developing COVID-19 situation. Please be aware that guidance is changing regularly and we are endeavouring to keep you as up to date as possible.

The inbox is monitored regularly, and we will respond to you as soon as we can. In the meantime, the latest guidance for primary care can be found here:

h ttps://www.england.nhs.uk/coronavirus/primary-care/

. This email has been scanned for viruses; however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire GP Federation unless explicitly stated. If you have received this email in error please notify the sender. The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000. Unless the information is legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed.