23 December 2020

Action: Note the pause of all planned procedures and out-patient appointments across NW London, further information included below. Share the public facing messaging in your GP newsletters, on your websites, and all patient facing staff.

Dear GP Colleagues,

The number of patients with Covid-19 in our hospitals across NW London is now at a level close to that seen during the peak in April 2020, with hospital admission rates still rising.

In response to the on-going Covid-19 (coronavirus) pandemic and the increasing need for us to care for patients requiring urgent, emergency or Covid-19 care, we have taken the difficult decision across NW London to temporarily pause the majority of non-urgent, planned procedures/operations and out-patient services.

All time critical cases, urgent cases including TIA and Rapid access Chest Pain clinics and two week wait cancer referrals will continue to be seen.

Patients who are affected will be contacted directly by the relevant trust. Patients whose out-patient appointment or surgery is postponed will be held on the trusts patient treatment list and will be contacted when services resume.

For clarity, patients who are postponed will NOT be referred back to their GP.

At this time we do not have details of when patients will be rescheduled, we will provide further updates as soon as we know more.

GPs can continue to refer patients for access to specialist care and diagnostics in the usual way using advice and guidance.

Please can all GPs let patients know that for routine, non-urgent and non-time critical care they are likely to encounter a delay following the referral. We know many patients have already been waiting a long time for their procedure and we are sorry for this further delay.

It’s very important that patients receive consistent messaging in this important area and attach the public messaging.

With this in mind, we’ve shared the latest public messaging around this (as a word document that can be easily copied into public facing newsletters), and used by patient facing staff. Please can we ask that you share the messaging with all staff clinical and non-clinical who are patient facing for them to use in patient contacts. As mentioned, please also use on websites and newsletters etc.

Action: Share with your patients the shielding advice below with those who are clinically extremely vulnerable - advice re-introduced into tier 4 areas - from Sunday 20 December

From 00:01 on Sunday 20 December, the government has introduced Tier 4 restrictions to some areas (London and parts of the South East). The DCMO has confirmed that shielding advice for Clinically Extremely Vulnerable (CEV) individuals will be reintroduced in these Tier 4 areas. This shielding advice is identical to that which was in place nationally from 5 November to 2 December.

Those at highest risk in Tier 4 areas and advised by government to shield are eligible for support including free delivery of medicines (where friends, family, or local volunteers are unable to provide help) and statutory sick pay where unable to work from home. CEV individuals in Tiers 1-3 should continue to follow the government advice for those at highest risk specific to each of these tiers.

The government is writing to all CEV patients affected by the shielding advice in Tier 4 areas to inform them of this guidance. Letters will be sent in the week commencing 21 December and will be published here. These letters will emphasise the importance of CEV individuals continuing to engage with the NHS, and confirm that they will be prioritised for the COVID-19 vaccination in advance of the general population (as per current JCVI guidance).

Action: Please share the COVID-19 vaccine messaging with all staff clinical and non-clinical who are patient facing for them to use in patient contacts. Please also use on websites and newsletters etc.

With the Covid-19 vaccination programme underway – it’s important that the public and patients receive consistent messaging about in this important area. We understand that patients are likely to be contacting practices to ask when they will be receiving the vaccine – but we need to be clear that the NHS is following the Government priority list and that the NHS will be contacting patients when it is their turn to be vaccinated.

The public messaging that has been developed sets this out and also advises that the phased vaccine means that the bulk of patients in high risk groups are likely to be vaccinated between January and April. Please can we ask that you share the attached public messaging with all staff clinical and non-clinical who are patient facing for them to use in patient contacts. Please also use on websites and newsletters etc. We have attached the messaging as a word document, so it can be easily lifted into other formats.

Action: Read the National protocol for COVID-19 mRNA vaccine BNT162b2 (Pfizer/BioNTech) on how to deliver the COVID-19 vaccine safely

This protocol is for all staff appropriately trained to deliver covid vaccines, and details the process from assessment through to post-vaccination. The protocol covers delivery by one individual to the patient, who would deliver first and second vaccination doses.

Alternatively, it also outlines the protocol for multiple persons undertaking stages in the vaccination pathway in accordance with this protocol.

Any questions or concerns regarding the content of this protocol should be addressed to: immunisation@phe.gov.uk

Action: Read the  Covid-19 vaccine mobilisation update, which includes information on:

• Learning from wave 1 and 2 delivery sites
• Vaccination in care homes update
• PCN Demand Planning Tool
• Questions about Patient Specific Directions (PSD) and Patient Group Directions (PGD)

This guide focuses primarily on the delivery, ordering and IT around the covid-19 vaccine for primary care providers.

A note that this material was published week beginning 14 December, and therefore some guidance included is now out of date - e.g. links to webinars for week beginning 14 December.

When an updated version of the protocol is available, we will circulate this with you.

Action: For those who need training on delivery of the COVID-19 vaccine, read the training update  and note the points of contact for each borough

To book onto these sessions please contact your local training hub, the names and contacts are as below:

Action: If you are a wave 2 covid-19 vaccine delivery site, and ordered additional boxes of 975 Pfizer / BioNTech vaccines, these should be arriving on Tuesday 29 December. You will receive your corresponding vaccine delivery for dose 2 on Tuesday 19 January 2021.   

All wave 2 sites were invited to order additional boxes of 975 Pfizer / BioNTech vaccines by 18 December. These are to be delivered to your site on Tuesday 29 December for you to use to vaccinate patients that week. 

You should use this to continue vaccinating patients aged 80 years and over in line with advice from the Joint Committee for Vaccinations and Immunisations (JCVI). This excludes any patients within this cohort who are totally housebound. Where there is residual supply, you can also vaccinate care home workers who are able to travel to your site, as well as practice and PCN staff within the PCN grouping. To minimise vaccine wastage, you should be sure that you will be able to use the vaccine supplied. We suggest that those PCN groupings with more than 3,000 people aged 80 years or over within their combined registered population should be able to do so, but you will be able to judge this.

Deliveries are made between 08:00 and 18:30 on weekdays. You should receive 24 hours notice for this delivery, which will come to the named lead contact for your PCN grouping so please ensure that they are contactable.

Vaccines need to be used quickly in the days following delivery and you should start your vaccination clinic as soon as possible. We expect the remaining vaccine shelf life once delivered and stored at 2-8°C to be in the range of 86 hours (3 days 14 hours) to 99 hours (4 days 3 hours).  Shelf life will be clearly marked on the vaccine box label.

We will let you know about any further vaccine resupply opportunities as they arise.

Many thanks,

National Primary Care COVID-19 Vaccination Programme

Action: Read the latest covid-19 vaccine mobilisation guide for care homes, from the Regional Vaccine Operations Cell

This guide was published 22 December 2020, and includes a support pack and checklist for staff, as well as patient facing materials that can be shared, and post vaccination guidance.

The next national webinar for care home vaccine rollout is confirmed as

Tuesday 29 December, 1.30pm - 2.15pm. Join the webinar here: COVID-19 Vaccinations webinar for the PCN rollout to care homes

Action: Read the update from Royal Free London Hospital, which explains the recent changes to their non-urgent procedures and outpatient appointments

In response to the on-going COVID-19 (coronavirus) pandemic and the increasing need for us to care for patients requiring urgent, emergency or COVID-19 care, the Royal Free London has taken the difficult decision to temporarily pause all non-urgent, time critical planned procedures/operations and out-patient services.

Action:  Read about the Christmas arrangements for the PPE portal, and how to access equipment over this period

Key highlights:

• The DHSC PPE Portal will be operational over Christmas.
• The portal delivery partners (Royal Mail and their Pallet Carrier) will not be delivering on Christmas Day and Boxing Day.
• Orders made during this time should still be delivered within 5 days.
• PPE portal order limits have been increased to provide cover over the Christmas period (will be lowered in early January)
• Please make sure you order up to your weekly order limit, ideally in a single order.
• The DHSC portal team have also created a useful video guide (https://www.youtube.com/embed/kBFlukkEnk4?feature=youtu.be) on how to order covid-19 related PPE from the portal.

Action: Read the latest information for about the COVID-19 testing for primary care staff, and learn about the process for ordering tests. Information includes a Standard Operating Procedure, FAQ document, staff leaflet, and letter from NHSE

Lateral flow antigen testing are now being rolled out to asymptomatic patient-facing staff delivering NHS services across all four primary care contractor groups (Medical, Dental, Optometry, and Community Pharmacy) in England.

When testing it is important that staff in the GP practice test in a staggered way throughout the week and not all on one day and at one time.  This allows the impact of potential positive tests to be managed and help the practice to build service resilience. 

A standard operating process has now been published, together with a staff leaflet and FAQs. A training video is also available on the Health Education England website Link to training video COVID-19 self-swab for healthcare staff (learninghub.nhs.uk)..  

A letter was sent out on 16 December 2020 to all primary care contractors outlining the process for ordering testing kits. Primary care contractors began to receive invitations to order test kits from Primary Care Services England, during a window beginning from w/c 14 December.

It is essential that organisations should log on and complete their order as quickly as possible. The final closing date for orders across all contractors will be Wednesday 30 December 2020.

For further information, please contact Fiona Sutcliffe, Covid Testing Programme Lead, North West London CCGs. fionasutcliffe@nhs.net

Action: Patients in the 50-64 years old cohort for seasonal influenza (not in an at risk group) should be coded with “Administration of first inactivated seasonal influenza vaccination (985151000000100)” to ensure CQRS payment.

This code needs have been recorded in the patient record after 1 December 2020. These patients should not be associated with any other code, e.g. “needs influenza immunisation” as this flags the patient as part of the at risk cohort. Patients who have had this code entered into their records may still receive payment but will be incorrectly labelled as belonging to the 6-64 years old at risk cohort.

Action: Share with staff and patients alike the COVID-19 leaflet which explains what to do if you or a family member display symptoms of covid-19 (titled COVID isolating at home safety netting)

The leaflet is for patients with suspected coronavirus who have not been admitted to hospital and will be isolating at home.

Action: Direct patients to the COVID-19 vaccine page of the government website if they have vaccine related queries

Patients are contacting 111 with queries regarding the Covid-19 vaccine.  This is not the correct process and patients should instead go to the government website for more information on the vaccine. 

For further information contact candice.clark@nhs.net