6 May 2020
Dear colleague
Please find below the latest GP update regarding Covid-19.
You can view the North West London password-protected GP extranet homepage using the details below.
As always, you are advised to review the full list of Covid-19-related service changes on a regular basis, to ensure you have not missed any notices.
Website: https://www.nwlondonccg.nhs.uk/professionals/coronavirus-clinical
Password: NWLCovid-19
- Paediatric referrals to the Royal Free London
- Cancer communications update: 2nd edition
- Message from DHSC re Changes to the Misuse of Drugs Regulations 2001
- Message from NHSEI re priority medicines for palliative and end of life care during a pandemic
Paediatric referrals to the Royal Free London
ACTION: Note service change
As a result of the Covid-19 (coronavirus) pandemic, the Royal Free London NHS Foundation Trust will only be accepting urgent paediatric referrals.
We ask that GPs submit a clinical advice and guidance (CAG) request via e-RS before sending a referral. One of our paediatricians will review the request and confirm if the patient requires an urgent appointment. If there is no visible CAG request in the patient’s UBRN history, the referral will be sent back. We aim to respond to all CAG requests within the nationally agreed two working days.
GPs can also refer urgent patients by calling the on-call paediatrician on 07983 637 686 Monday to Sunday (including bank holidays), between 8:30am and 5pm. If advised to by the on-call paediatrician, referrals can be emailed to rf-tr.paedsreferralsbcf@nhs.net. Any referral that is emailed will not be accepted unless discussed with the on-call paediatrician first.
Covid-19 Cancer Communications Update: 2nd Edition
ACTION: Ensure you have read the cancer communications in full
It is important that during the response to the Covid-19 pandemic, appropriate clinical priority is given to the diagnosis and treatment of cancer, with service provision needing to flex as part of infection control. The following update details key changes, any actions required by Primary Care and Provider Trusts and information useful to you and your patients as the recovery period starts. This cover note provides the key points for general practice to refer to in all of the attached documentation.
1. Cancer Two Week Wait Pathways
Important Action – New Referral Forms: As guidance is updated and pathway changes are authorised referrals forms will be updated to reflect new temporary processes. These changes are being managed centrally by TCST. For FIT, Practices using DXS will have their LGI referral form automatically updated.
Practices not on DXS can download the latest version forms from either IT system, EMIS, Vision, Systm One, and upload to their practice systems via: https://www.healthylondon.org/suspected-cancer-referrals/.
It is important to check this link and update as soon as available.
STATUS UPDATE ON CHANGES:
- Please visit https://www.healthylondon.org/resource/covid-19-cancer-referral-resources/ for all forms.
- LGI referral form live and distributed to all IT leads in London, is available on the HLP website.
- Breast and Lung forms updated and distributed to all IT leads in London (this includes C the signs), also available on the HLP website.
- Pan London patient information leaflet, LGI patient information leaflet and LGI FAQ available on the HLP website.
General: 2WW Appointments Reminder: During the current Covid-19 crisis, a first outpatient appointment in secondary care may be via telephone triage.
If after triage, the clinician feels;
i) They are able to reassure the patient they don’t have cancer, or their symptoms would not justify a diagnostic at this stage (irrespective of Covid-19) then they can discharge the patient
ii) The patient will be offered a diagnostic at a later date and will be held on the Trusts PTL until an appointment becomes available/or it is safe to carry out the specified diagnostic.
Trusts may contact GP practices via email to discuss individual referrals so please ensure you check your practice inbox on a daily basis as a minimum GP practices must continue to check their worklists for patients referred on a 2WW and safety net as necessary. The guidance that 2ww referrals cannot be downgraded without prior discussion with the referring GP remains unchanged.
2. Patient Safety Netting
Primary Care
Safety Netting templates have been created for both EMIS and S1 (see attached guidance). As a minimum, practices are encouraged to commence coding of patients who have a referral deferred (due to patient choice, isolation etc.) even if they choose not to utilize the templates.
Codes as below:
Suspected malignancy (162572001)
Suspected breast cancer (134405005)
Suspected gynaecological cancer (397682005)
Suspected gynaecological cancer (397682005)
Suspected cervical cancer (315266007)
Suspected endometrial cancer (315267003)
Suspected haematological malignancy (315275009)
Suspected leukaemia (315262009)
Suspected lymphoma (315264005)
Suspected head and neck cancer (315277001)
Suspected neuroblastoma (315265006)
Suspected kidney cancer (315270004)
Suspected lower gastrointestinal cancer (315274008)
Suspected lung cancer (162573006)
Suspected malignant mesothelioma (518611000000107)
Suspected pancreatic cancer (247591000000101)
Suspected prostate cancer (315268008)
Suspected sarcoma (315261002)
Suspected skin cancer (315276005)
Suspected testicular cancer (315272007)
Suspected upper gastrointestinal cancer (315273002)
Suspected urothelial cancer (315271000)
Suspected bladder cancer (315269000)
Patient information
Patient information: Patients must also continue to be provided with up to date information about what to expect during this time, including any likely delays due to reduced diagnostic capacity and having telephone, rather than face to face appointments in secondary care. The latest pan-London patient information leaflets are now available:
COVID-19 Suspected Cancer Patient Information Leaflet
COVID-19 Urgent Suspected Bowel Cancer Patient Information
Following the release of new guidance (by speciality), practices should not hand out any other versions or previous copies of patient leaflets to avoid confusion.
Please read these documents in full for further details on specific cancers.
Message from DHSC re Changes to the Misuse of Drugs Regulations 2001
The Government has amended the Misuse of Drugs Regulations 2001 (MDR), providing Ministers with emergency powers concerning the supply of controlled drugs in specified circumstances during a pandemic.
These changes give Ministers the option to switch on additional flexibilities during a pandemic to:
- Allow registered pharmacies to supply substances in Schedule 2, 3 and Part 1 Schedule 4 to the Misuse of Drugs Regulations 2001 (‘the 2001 Regulations’) without a prescription, where the patient has been receiving them as part of ongoing treatment;
- Allow supply of Schedule 2, 3 and Part 1 Schedule 4 substances under a Serious Shortage Protocol. These allow on-going treatment with alternative products where prescribed items are unavailable or are in short supply; and
- Allow pharmacists without prescribing rights to change the frequency of instalments on instalment prescriptions without the immediate need for a new prescription from a prescriber. Any changes MUST be agreed with the prescriber or an appointed representative.
The proposed measures are enabling and will only be used when switched on by Ministers. It is anticipated that these provisions will be used in infrequently, and would only be used if demand and workforce pressures during a pandemic meant that local health services were at imminent risk of failing to fulfil their duties.
There is no change in practice until the flexibilities introduced by the legislation are activated by an announcement from the Department of Health and Social Care. Guidance will be published as soon as possible and professionals will be notified if the new measures are switched on. The announcement relating to the supply of controlled drugs in these circumstances will include the area to which the arrangements will apply, the circumstances involved and the period during which the arrangements may be provided.
A copy of the Statutory Instrument can be found here.
Message from NHSEI re priority medicines for palliative and end of life care during a pandemic
In order to manage additional demand for end of life medicines, and ensure safe, equitable and compassionate care for patients, the Association of Palliative Medicine, Royal College of GPs, Hospice UK and the Association of Supportive and Palliative Care Pharmacy, working with NHS England and NHS Improvement, have published:
• Priority medicines for palliative and end of life care during a pandemic
This clinical guidance for essential end of life medicines, which sets out the first and second choices for these medicines, will enable the NHS to conserve supplies, switch to alternatives drugs when required and minimise waste. This is also being used to guide the purchasing of medicines for the UK.
The clinical guidance aims to support healthcare professionals working in palliative and end of life care across hospital, community, social care and hospice settings to work together in managing additional demand on end of life medicines due to Covid-19.
During the Covid-19 pandemic, across many clinical specialties, there is a need to adapt clinical practice to respond to the situation and ensure patient care guidelines are
consistent, equitable, safe and appropriate.
CCGs have already been asked to work with providers to establish local hubs to ensure rapid access to priority end of life medicines for patients. These hubs can be in community pharmacy, GP practice, community hospital, acute or other settings where palliative medicines (including controlled drugs) can be safely and legally stored and rapidly released when needed.
A standard operating procedure for Running a medicines re-use scheme in a care home or hospice setting was published by the Department for Health and Social Care on 28 April 2020.
