Briefing: Primary care providers and the coronavirus (COVID-19)

Contents

 

18 February 2020

The case definition for COVID-19 changed on 18 May 2020. See GOV.UK for the latest information.

The NHS and Public Health England (PHE) are well prepared for outbreaks of new infectious diseases. The NHS has put in place measures to ensure the safety of all patients and NHS staff while also ensuring services are available to the public as normal.

The approach being taken by the NHS is to identify potential cases of COVID-19, isolate them and then contain the virus. This model is devised to protect primary care, the ambulance service and our emergency departments so they can operate as usual and assist the sickest patients.

What is the advice to patients and the public?

The advice to the public is to call NHS 111 now if they have been:

  • to Wuhan or Hubei Province in China in the last 14 days (even if they do not have symptoms)
  • to other parts of China, including Macau and Hong Kong, in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • to Thailand, Japan, Taiwan, Singapore, Republic of Korea or Malaysia in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • in close contact with someone with confirmed coronavirus.

Anyone who meets the above criteria is advised not to go to a GP surgery, community pharmacy or hospital. Instead they should call NHS 111, stay indoors and avoid close contact with other people.

Information for the public is available at nhs.uk

Is NHS 111 directing possible cases to GP practices and community pharmacies?

No. If someone calls NHS 111 they are assessed against a clinical pathway. If they are identified as a possible COVID-19 case, NHS 111 will not refer them to a GP or community pharmacy.

However, if someone calls NHS 111 and is assessed against the clinical pathway and they are not a possible COVID-19 case, for example they have not recently travelled to any of the affected areas or been in close contact with a confirmed case, NHS 111 would handle their call as normal. This may mean referring them to a GP, pharmacist or dental practice, based on patient need.

What do primary care providers do if a patient turns up with suspected COVID-19?

PHE has produced detailed guidance for primary care providers which is available here. The key principles are 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 infection.

This guidance also includes information on patient transfers and cleaning your premises following a possible case.

What if I’m a community pharmacist without a consultation room?

If your pharmacy does not have a consultation room, it is effectively a public place. The same advice that would be given to any suspected case should be followed: go home immediately, avoid contact with others, cover your mouth and nose on the way home and call NHS 111.

If I come into contact with a suspected case, should I continue to see other patients?

The guidance for healthcare workers covers those who have travelled or have come into contact with a known case. However, if primary care providers come into contact (using the definition of close contact here) with a suspected case they should continue to practise as normal. Should the case then be confirmed, PHE will undertake contact tracing which may include the practitioner.

Is there any information my practice can share with patients?

Additional resources have been made available for primary care providers. Please ensure that you share and display these as appropriate:

  • posters for primary care settings are available on the PHE campaign resource website.
  • additional resources for telephone systems, SMS messaging systems, websites and online booking systems are available in Annex 1.

What happens if someone self-isolating because of COVID-19 risk calls for a review for another problem – who should handle this?

Patients should call NHS 111 in the first instance and they will be directed to the appropriate resource. If a GP visit is needed, a telephone consultation should be held. If a home visit is needed, speak with your local Health Protection Team (HPT) for advice on personal protective equipment (PPE). If a visit is advised, whoever does the visit needs to keep a minimum of two metres distance from the patient and avoid physical examination.

What Personal Protective Equipment (PPE) is needed when dealing with patients?

If following the above guidance, PPE should not be needed when dealing with patients as patients should be identified on entry and isolated as soon as possible.

Dental teams should continue to comply with existing PPE guidance HTM01 and continue to use the same PPE they routinely do.

Are there supply issues with PPE?

No, there is a large stock of face masks in the UK. PHE manages stocks of PPE, including face masks as part of its Pandemic Influenza Preparedness (PIP) stockpiles. In addition to UK-held stocks, NHS Supply Chain has placed additional orders for PPE and is also working with wholesalers to support frontline services.

In addition to this, NHS Supply Chain manages a ‘business as usual’ stock of face masks and routinely supplies NHS secondary care services with PPE, including face masks. NHS Supply Chain also retains its EU exit stockpile, which includes stocks of PPE.

Who carries out decontamination?

Every General Medical Practitioner (GMP) and General Dental Practitioner (GDP) has to be registered with the Care Quality Commission (CQC) and should be meeting the requirements for the Health and Social Care Act to maintain a clean and safe environment. It is the responsibility of the registered organisation to ensure their staff are appropriately trained and have access to equipment. Details of how to clean are in the primary care guidance.

Other primary care settings should follow the guidance. For additional information you can contact your local Health Protection Team.

What PPE is needed when cleaning?

Use the PPE equipment that would normally be used when cleaning and disinfecting, in the same way as if someone had vomited in the surgery. Cleaners should use disposable plastic aprons and gloves and follow the usual cleaning COSH guidance. You do not need Hazmat equipment to clean. The gloves and disposable aprons should already be available and in supply at primary care providers.

What happens if a provider needs to close?

If providers are following the advice set out in the guidance, they should be identifying patients as soon as possible and isolating them. It is only necessary to clean and decontaminate the areas where a suspected case has been isolated. It is not always necessary to deep clean the whole premises where only one consultation room needs to be cleaned.

If the primary care setting is advised to close by the HPT, normal procedures are to be followed. So, for GPs this would involve alerting the CCG in order for local contingencies to be activated. GDPs are to inform their dental commissioning leads that the practice is closing on advice of the HPT.

If pharmacies have to shut, they must inform the NHS 111 Directory of Services (DoS) helpline (0300 0200 363). If they are likely to be closed for longer than 24 hours then they must be clear that they are requesting a longer term withdrawal from providing the NHS 111 DoS. The local NHS England and NHS Improvement team must also be informed by the pharmacy contractor. This is particularly critical for pharmacies providing the Community Pharmacist Consultation Service (CPCS).

We would expect closure to be temporary for cleaning, and contingency plans by the CCG (or appropriate commissioner) will be activated. Further information is available in the full guidance for primary care settings.

How are people tested for COVID-19?

Most cases will require a single nose and throat swab for the diagnosis of COVID-19 which will be sent to PHE Colindale or identified regional laboratories for testing.

Samples required are:

  • either a combined nose and throat swab in one collection tube containing universal transport medium
  • or a single swab used for throat then nose
  • or individual nose and throat swabs in separate collection tubes.

What further information is available for primary care?

Information published by Public Health England is available here.

NHS England and NHS Improvement have established a primary care working group to address issues that may arise should the virus spread – such as capacity, supply chain, any contracting issues, additional support, etc. Appropriate information will be circulated if and when the situation develops.

Does any of this impact upon indemnity?

At present, this work is considered to be business as usual. However, the primary care working group is examining the impact upon indemnity should the virus spread.

Annex 1

Posters

A series of posters have been created for a number of healthcare settings, including one for primary care. These are available here.

Telephone system

This message should be added to your phone system. Ideally at the front end (so before a call is answered):

If you’ve been:

  • to Wuhan or Hubei Province in China in the last 14 days (even if you do not have symptoms)
  • to other parts of China, including Macau and Hong Kong, in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • to Thailand, Japan, Taiwan, Singapore, Republic of Korea or Malaysia in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • in close contact with someone with confirmed coronavirus

Do not go to a GP surgery, community pharmacy or hospital. Call NHS 111, stay indoors and avoid close contact with other people.

Further information is available on nhs.uk.

SMS info

If you wish to send out messages via SMS to your patient list, please use the following:

If you’ve been:

  • to Wuhan or Hubei Province in China in the last 14 days (even if you do not have symptoms)
  • to other parts of China, including Macau and Hong Kong, in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • to Thailand, Japan, Taiwan, Singapore, Republic of Korea or Malaysia in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • in close contact with someone with confirmed coronavirus

Do not go to a GP surgery, community pharmacy or hospital. Call NHS 111, stay indoors and avoid close contact with other people.

Further information is available on nhs.uk.

SMS for appts

If you send out SMS reminders about appointments, please use the following:

If you’ve been:

  • to Wuhan or Hubei Province in China in the last 14 days (even if you do not have symptoms)
  • to other parts of China, including Macau and Hong Kong, in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • to Thailand, Japan, Taiwan, Singapore, Republic of Korea or Malaysia in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • in close contact with someone with confirmed coronavirus

Please do not attend your appointment, and please call to cancel your appointment. Call NHS 111, stay indoors and avoid close contact with other people.

Further information is available on nhs.uk.

Online booking service

The following message has been shared with providers of online booking services:

Please do not book a GP appointment or attend your GP Practice if you’ve visited or travelled through mainland China, Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan, or Thailand and have symptoms of cough, fever or shortness of breath within 2 weeks of returning, or if you have symptoms of cough, fever or shortness of breath after being in contact with someone with a confirmed case of coronavirus. Please call NHS 111 instead.

You can read more about coronavirus on NHS.UK

Website

The following message can be added to your website:

The NHS in xxx and Public Health England (PHE) are extremely well prepared for outbreaks of new infectious diseases. The NHS has put in place measures to ensure the safety of all patients and NHS staff while also ensuring services are available to the public as normal.

The risk to the general public is moderate. If you have arrived back to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau within 14 days, follow the specific advice for returning travellers.

Call 111 now if you’ve been:

  • to Wuhan or Hubei Province in China in the last 14 days (even if you do not have symptoms)
  • to other parts of China, including Macau and Hong Kong, in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • to Thailand, Japan, Taiwan, Singapore, Republic of Korea or Malaysia in the last 14 days and have a cough, high temperature or shortness of breath (even if it’s mild)
  • in close contact with someone with confirmed coronavirus

Do not go to a GP surgery, community pharmacy or hospital. Call 111, stay indoors and avoid close contact with other people.

Further information is available on nhs.uk.

Like the common cold, coronavirus infection usually occurs through close contact with a person with novel coronavirus via cough and sneezes or hand contact. A person can also be infected by touching contaminated surfaces if they do not wash their hands.

The risk of being in close contact with a person with coronavirus or contaminated surfaces is very low at the current time, as members of the public who have visited Wuhan or Hubei province, China are currently in isolation.

Testing of suspected coronavirus cases is carried out in line with strict regulations. This means that suspected cases are kept in isolation, away from public areas of the hospital and returned home also in isolation. Any equipment that come into contact with suspected cases are thoroughly cleaned as appropriate. Specific guidance has also been shared with NHS staff to help safeguard them and others. Patients can be reassured that their safety is a top priority, and are encouraged to attend all appointments as usual.

Everyone is being reminded to follow Public Health England advice to:

  • Always carry tissues with you and use them to catch your cough or sneeze. Then bin the tissue, and wash your hands, or use a sanitiser gel.
  • Wash your hands often with soap and water, especially after using public transport. Use a sanitiser gel if soap and water are not available.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid close contact with people who are unwell.

You can find the latest information and advice from Public Health England at Further information is available on nhs.uk.