Community health services prioritisation framework

Contents

Community services prioritisation framework

Classification: Official
Publication approval reference: PAR1257

11 January 2022

Given the increasing pressures on the health system due to the Omicron wave of COVID-19 this winter and the need to provide booster jabs as quickly as possible, local decisions will need to be made about how to prioritise use of the community health workforce. Redeployed community workforce should be used first to ensure there is adequate community health provision to support as many patients as possible out of hospital. The capacity in community services will need to be extended to enable this including, but not limited to, supporting discharge pathways and urgent community response provision, mobilising virtual wards and supporting end-of-life care at home.

This framework sets out national advice in relation to the relative priority of community health services. It aids decision-making on community heath workforce redeployment locally and regionally between 11 January 2022 and 28 February 2022. The expectation (currently) is that all services should resume from 1 March 2022.

It may be helpful to review the Age UK report findings on the implications of stopping services following the first wave of COVID-19. Building on the learning from this wave, decisions to delay or pause service provision for specific services lines or groups of patients should be risk assessed locally for:

  1. impact on patients’ outcomes
  2. consideration of patient complexity and the impact of stopping any one service as part of an integrated service offer for Adults or an EHCP plan for Children
  3. impact on health inequalities
  4. safeguarding responsibilities/opportunities
  5. the need for timely interventions and assessment
  6. consideration of length of time patients have been waiting
  7. impact on the wider system and the ability for the system to ‘catch up later’.

Service prioritisation decisions will need clinical leadership and local sign off from the local chief nurse and chief medical colleague.

Summary of services that could temporarily be paused

# Services  Commissioner Location Suggested prioritisation if needed during January and February 2022 Details
Children and young people services
1 National child measurement programme Local authorities Home and school Pause Changes to services commissioned by local authorities should be agreed with local directors of public health
2 Friends and Family Test NHS England Provider based Pause
3 Vision screening Clinical commissioning groups Home and clinic based Pause (including pre-school checks), except:

  • newborn visual checks (within 72 hours of birth) cannot be stopped as neonatal cataracts need to be spotted early
  • 6-week check can safely be conducted at 8 weeks, except as part of an integrated approach for assessment of complex needs
  • when an issue with vision has been identified
  • children under care plans.
Adult services
4 Friends and Family Test NHS England Provider based Pause
5 NHS health checks Local authorities Community based Pause Changes to services commissioned by local authorities should be agreed with directors of public health.
6 Non-acute outpatient clinics Clinical commissioning groups Clinic based Pause, except:
• review of post-surgical high-risk cases, eg diabetic foot
• follow-up appointments following community hospital admission
• support for readmission avoidance in older people
7 Weight management and obesity services Clinical commissioning groups Home and clinic based Pause behavioural interventions for weight loss:

  • For Tier 3 weight management services where teams are also providing management of associated co- morbidities (eg Type 2 diabetes, obstructive sleep apnoea), clinicians should appropriately triage clinic lists to assess which patients may need ongoing support, ideally remotely.

These services may also need to be prioritised if obesity is impacting on quality of life or other risk factors such as pre-diabetes, mental health problems or disability.

Services that should continue or continue with prioritised waiting lists

# Services  Commissioner Location Plan during December and January 2022 Details
Children and young people services
8 Pre-birth and 0–5 service (health visiting) Local authorities Home visits: virtual and clinic based Continue.
9 School nursing Local authorities/ clinical commissioning groups for specialist school nurses Home visits, school and clinic based Continue.
10 Therapy interventions (physiotherapy, speech and language, occupational therapy, dietetics, orthotics) Clinical commissioning groups and/or local authorities Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
11 Looked after children’s teams Clinical commissioning groups and/or local authorities Home visits, school and clinic based Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
12 Child health information service NHS England Office base Continue.
13 Community nursing services (planned care and rapid response teams) Clinical commissioning groups Home or clinic Continue.
14 Nursing and therapy teams support for long- term conditions Clinical commissioning groups Home or clinic Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
15 Community paediatric service (including autism diagnostic services) Clinical commissioning groups Home visits, school and clinic based Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
16 Wheelchair, orthotics, prosthetics and equipment Clinical commissioning groups and/or local authorities Home and clinic Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity. Consider use of private providers/shops to supply.
Changes to services commissioned by local authorities should be agreed with directors of public health.
17 Immunisations (school-aged services) NHS England ‘Clinics’ in schools, community clinics Continue. Deliver service in line with the priorities set by NHS England.
18 Safeguarding Clinical commissioning groups and/or local authorities Home and clinic Continue.
19 Continuing care packages Clinical commissioning groups Home or clinic Continue.
20 Children palliative and end-of-life care Clinical commissioning groups and/or local authorities Home or hospice Continue.
21 Rapid response service Home or clinic Continue.
22 Sexual assault services Clinic and police stations Continue.
23 Antenatal, newborn and children screening and immunisation services NHS England Maternity units, clinic, general practice and home Continue.
24 Newborn hearing screening NHS England Maternity unit clinics and home Continue
25 Audiology Clinical commissioning groups Clinic based Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity
26 Emotional health and wellbeing/ mental health support Clinical commissioning groups and/or local authorities Home visits, school and clinic based Continue.
Services Commissioner Location  Plan during December to January 2022  Details
Adult and older people services
27 Audiology services Clinical commissioning groups Clinic based Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
28 Podiatry and podiatric surgery Clinical commissioning groups Clinics, inpatient wards and home Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
29 Wheelchair, orthotics, prosthetics and equipment Clinical commissioning groups Clinics, inpatient wards and home Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
30 Nursing and therapy support for LTCs including: heart failure, continenc e/ colostomy, tissue viability, TB, Parkinson’s, respiratory /COPD, stroke, MS, MND, falls, lymphoedema, diabetes Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
31 Rehabilitation services (integrated and unidisciplinary) (physio, OT, speech and language therapy, etc) Clinical commissioning groups and/or local authorities Continue.

Focus on rehabilitation and recovery for those discharged from hospital-based care and those whose functioning is deteriorating at home.
Also consider prioritisation of patient lists where demand exceeds capacity.
32 Neuro- rehabilitation (multidisciplinary)
– stroke, head injury and neurological conditions		 Clinical commissioning groups Continue.

Focus on rehabilitation and recovery for those discharged from hospital-based care and those whose functioning is deteriorating at home.
Consider extending early supported discharge arrangements.
33 Therapy interventions (physio, speech and language, occupational therapy, dietetics, orthotics) Clinical commissioning groups and/or local authorities Continue.

Focus on rehabilitation and recovery for those discharged from hospital-based care and those whose functioning is deteriorating at home.

Also consider prioritisation of patient lists where demand exceeds capacity.
34 Contraception NHS England and local authorities Clinic based Continue Changes to services commissioned by local authorities should be agreed with directors of public health.
35 Sexual and reproductive health services
36 HIV services NHE England
37 Musculoskeletal service Clinical commissioning groups Clinic based Continue services that aligned with orthopaedic and rheumatology planning to enable continued referral of emergency and urgent MSK conditions to secondary care services (see clinical guide for management of patients on MSK).

Serve patients who have had recent elective surgery, fractures or those with acute and/or complex needs, including carers with a focus to enable self-management.

Triage services to inform shared decision-making with regard to complex patients, diagnostics (MRI and ultrasound) and timely onward referral.
Where possible, provide capacity to support other community resources focused on rehabilitation and recovery for those discharged from acute care and those whose functioning is deteriorating at home, and/or the administration of vaccines.
All other rehabilitation work could be deprioritised with patients enabled to self- manage (this includes rehabilitation groups).

 Guidance to support recognition and management of urgent and emergency conditions available via http://arma.uk.net/wp- content/uploads/2021/01/Urgent- emergency-MSK-conditions-requiring- onward-referral-2.pdf
Guidance to inform decision-making with regard to corticosteroid injection and timing of COVID-19 vaccination available via (see section 13) http://arma.uk.net/covid-19- vaccination-and-msk/
Decision support tools with regard to onward referral are available https://www.versusarthritis.org/about-arthritis/healthcare- professionals/musculoskeletal- decision-support-tools/
Resources to support self- management; these are being worked up and are likely to be an update to www.csp.org.uk/MSKadvice
38 Specialist dentistry NHS England Clinic and home visits Continue.
39 Minor oral surgery Clinic based
40 Day case surgery
41 Primary dental work
42 Urgent dental
clinics
43 Alcohol and addiction service Local authorities Home and clinic based Continue.
44 Drug and addiction service
45 NHS continuing healthcare packages Clinical commissioning groups Home and care homes Continue.
46 Community nursing services (including district nurses and homeless health) Clinical commissioning groups Home and clinic based Continue.
47 Urgent community response/rapid response team Clinical commissioning group Continue.
48 Out-of-hours GP services Clinical commissioning groups Home and clinic based Continue.
49 111 service Clinic based Continue.
50 Walk-in centres Continue.
51 Urgent treatment centres Continue.
52 Palliative and end- of-life and hospice care (including
non-specialist end- of-life care delivered by community/district nursing teams)		 Clinical commissioning groups Home, registered care home or clinic based, bed- based care, hospice Continue.
53 Rehabilitation bed- based care Clinical commissioning groups and/or local authorities, NHS England Home, registered care home or clinic based, bed- based care, hospice Continue.
54 Intermediate care and reablement Clinical commissioning groups and/or local authorities Continue.
55 Adult safeguarding Clinical commissioning groups Home Continue.
56 Phlebotomy Clinical commissioning groups Home/clinic Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
57 Home oxygen assessment services Clinical commissioning groups Home Continue.
58 Clinical support to social care, care homes and domiciliary care Local authorities and clinical commissioning groups Home and care home Continue.
59 Sexual assault services Clinical commissioning groups and/or local authorities Clinic and police stations Continue.
60 Smoking cessation Local authorities Community Continue, but with prioritisation of patient lists. Deferral of provision could be considered for low priority cases to free up workforce capacity.
Smoking cessation services for pregnant woman should not be deferred.
61 Abortion services Clinical commissioning groups Hospital, clinic, home Continue.