Joint communication to support our local City and Hackney response to COVID-19
Friday 10th April 2020
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Well wishes over the Easter break and thank you
At the end of our another hard week of working in an unprecedented way during this pandemic, we wanted to give you our heartfelt thanks for what you are doing, especially over the upcoming Easter bank holiday, when many of you are stepping up once again to hold the fort for our communities. Please do take time to look after yourself and rest over the weekend when you can.
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In the remainder of this bulletin
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An update on Homerton Clinics during covid-19
This document describes how primary care can access secondary care specialist advice during the current pandemic. We will continue to add to this, but are sharing at this stage so that GPs know how to access services quickly. On Good Friday and Easter Monday the HAMU bleep with run as on normal working days. For any urgent clinical advice out of hours call switchboard and bleep 400 for the acute medical registrar or bleep 900 for emergency department. Read the full update here.
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Homerton paediatric inpatient service
Homerton Hospital has temporarily transferred its paediatric inpatient service (Starlight) to the Royal London (until further notice). This will take effect immediately. This will allow us to care for more adult COVID patients at Homerton Hospital over the coming weeks. For GPs and the community this should have no impact to access:
- Paediatric ED at Homerton remains open (with paediatric medical and nursing team in place as usual).
- During COVID-19 GPs to continue to refer Urgent paediatric referrals directly to the Paediatric Consultant via the existing GP Urgent Paediatric phone line – 07795 390715. Please note that this number is not for use by patients and is operational from 9:00 to 17:00 on weekday
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Requirement of primary care on ‘shield patients’
The aim of this guidance that we have produced is to ensure City and Hackney practices understand guidance on the NHSE-generated ‘shield list’ for primary care, and understand what is expected of them now (and that further guidance will be released in time). Please find the full guidance here.
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Community support update
Hackney Council, Volunteer Centre Hackney and local voluntary and community organisations are working in partnership to set up a local support system for those affected by COVID-19. Coordination of this support is being overseen by the City & Hackney COVID-19 Operational Command. Update as of 9 April The Hackney Council helpline/ online form (020 8356 3111) process has been re-designed to ensure patients get essential support more quickly. The form now asks about urgency and for clarification that the patient doesn’t have other support networks they can access to deliver medicines and food (it’s essential that these are explored first). Some further clarifications:
- This form/process isn’t the new access route into all Council services. Please encourage patients to liaise in the usual way with adult social care, children’s social care and raise safeguarding concerns through the usual procedures.
- URGENT/EMERGENCY REQUESTS
- Food requests can be delivered within 24 hours for extremely urgent cases, otherwise this process can take up to 3 days.
- For the delivery of medicines, this should first be requested via community pharmacies directly. If a volunteer is needed to deliver medicines this can be actioned within 24 hours for extremely urgent cases, otherwise this process can take up to 3 days.
- See further details on the processes below.
- Food and prescription needs are being prioritised at the moment but we are developing a more holistic support offer. This includes a process to connect patients to statutory and voluntary services (e.g. housing, mental health, social prescribing etc) when additional needs are surfaced via this process.
Any questions please contact kate.wignall@hackney.gov.uk orlaura.westwick@nhs.net Medicine delivery Community pharmacies are extremely busy at the moment, please encourage patients who are able to (and are not shielding, vulnerable or self-isolating) to collect their prescription. Wherever possible, family, friends or trusted neighbours who are well known to the patient should be encouraged to collect and deliver medication on their behalf where they are fit and able to do so. Where this support is not available, the patient should contact their community pharmacy directly to arrange for delivery. Update as follows:
- Work is underway locally and nationally to support pharmacies with the increased demand for medicines delivery to patients who are shielding or self-isolating.
- If the pharmacy is unable to help or the patient cannot get through to the pharmacy, residents can fill out this online form or telephone 020 8356 3111 (8am – 5pm, Mon – Fri) to request support from a volunteer (Volunteer Centre Hackney) to collect and deliver their prescription. This form can also be completed on behalf of the resident.
- Controlled Drugs will not be included in volunteer delivery of medicines and must be organised directly through the patient’s pharmacy.
- Patients who are not shielding, vulnerable or self-isolating and able to collect their prescriptions from the pharmacy themselves should be encouraged to do so.
- This process is the same for patients on the “shield” list and those that aren’t
Food provision For patients who are on the ‘shield list’:
(Central government is coordinating a free weekly food delivery to those that have been asked to “shield” and can’t get food (irrespective of whether they can pay for it or not). To guarantee food for someone that has been instructed to shield you need to select “Yes, I have one of the medical conditions on the list”). If your sheilding patient ALSO needs a medicine delivery that specific request needs to be logged using the Hackney form as outlined in the “Medicine delivery” process above. For all other patients:
- Complete this online form. Free food is currently being delivered for clients that can’t access food (irrespective or whether they can or can’t afford it). The Council is developing a payment scheme for those that can afford but residents should exhaust commercial delivery services first.
- For children who are eligible for free school meals - most Hackney schools haveset up systems which include meal vouchers/cards and collections from the child’s school. The Government has announced provision, which means eligible children, will benefit from a national voucher scheme launched for the Easter holidays.
Other support needs If the patient has other support needs in addition to food and medicine delivery please detail this in the final comments box on the online form or speak to the call handler on 0208 356 3111. The Find Support Service map shows over 80 services that are providing help to people in Hackney in response to coronavirus (COVID-19). Most are providing an online or phone alternative to their usual activities. Categories include benefits and employment advice and feeling lonely. You can download a snapshot at any time - please note that the organisations on here are checked twice a week. NHS Responders offer This is a national NHS scheme that is running alongside our local Hackney offer. We have been unable to find out key details about how the scheme is operating in the longer term. We are asking those referring to this scheme to keep a record of which patients are being supported so we can monitor the effectiveness of the scheme. We recommend this NHS scheme is used for types of support the local Hackney offer cannot, for example transport for patients leaving hospital. If you are currently using this scheme we would welcome feedback. Please contact laura.westwick@nhs.net NHS Responders allows professionals (only those with an nhs.net or gov.uk email address) to make a referral here or calling 0808 196 3382. You can indicate on the referral if this is a frequent request (e.g. weekly) and choose from the four options. Please read the information and guidance before making your first referral. It takes up to 72 hours for a referrer to be approved. Priority will be given to those identified as most at risk from COVID-19 including people who need to “shield.”
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Primary Care and Community Respiratory Resource pack for use during COVID-19
The above named document has been updated to reflect further national guidelines. The new version of the document is now available on the GP intranet page here, and supersedes the earlier version of the document shared. The purpose of the document is to provide guidance to assist staff from primary care and the community with the organisation of services during COVID-19, advice on triage and pathways for monitoring and signposting patients, as well as suggesting treatment and palliative care. The document is likely to be updated regularly and we will endeavour to update the version available on the C&H GP intranet page as soon as possible after updates become available. The latest updates that have been made include;
- Clarified that Roth Scores are not advised for use in the assessment of COVID-19 symptoms
- Updated antibiotic prescription advice in line with NICE guidelines
- Updated hot and cold site/zoning principles to support implementation
- Included a note that consideration should be given to making reasonable adjustments when providing remote services.
- Aligned pathway diagrams and content to national symptom assessment categories used by 111 services.
- Included signposting into the national primary care SOPs and emphasised building links with local acute advice and guidance mechanisms.
- Aligned guidance with BTS guidance where required
- Emphasised the need to discuss and complete Advance Care Planning and preferred place of care, including additional signposting to CMC resources.
- Updated PPE guidance as per most recent PHE guidance.
- Aligned and updated palliative care to new NICE guidelines.
- Included references to ethical decision-making and palliative care resources
- Provided further clarity and guidance on the supply and provision of oxygen in primary care, community care, on discharge and within nursing/care homes.
- Additional appendix on CMC resources and breathlessness leaflet
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Pausing the NHS complaints process
Due to the ongoing COVID19 pandemic NHS England and NHS Improvement are supporting a system wide “pause” of the NHS complaints process which would allow all health care providers in all sectors to concentrate their efforts on the front-line duties and responsiveness to COVID19 this means that:
- All providers should ensure that patients and the public are still able to raise concerns or make a complaint, but that the expectation of an investigation and response in the near future is managed.
- All providers would continue to acknowledge complaints, log them on their respective systems, triage them for any immediate issues of patient safety, practitioner performance or safeguarding and take immediate action where necessary. All complaints would then remain open until further notice, unless an informal resolution could be achieved, or the complainant chooses to withdraw their complaint.
- In secondary care where PALS offices still operate, they could still provide support by email and telephone and this should be encouraged for patients and the public to engage with the organisation.
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- CCGs should ensure that they continue to have open channels of communication with patients and the public.
- We would advise the system that consideration should be given to complainants who, at the time of the “pause”, have already waited excessively long for their response (specifically those who have waited six months or more) these should be reviewed to ascertain if and how these can be resolved to the complainant’s satisfaction.
- The initial “pause” period is recommended to be for three months with immediate effect. All health care providers can opt to operate as usual regarding the management of complaints if they wish to do so and this “pause” is not being enforced.
Please note that of 26 March, the Parliamentary and Health Service Ombudsman has stopped accepting new NHS complaints and has stopped work on open cases.
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Ethical Guidance on COVID-19 and Primary Care
During the COVID-19 Pandemic, primary care staff will be working under considerable pressure, will be required to work differently and will be making challenging decisions. We will all need to consider our responsibilities to our patients, our practices, ourselves, our family and friends and the public. Guidance from RCGP that can be found here, is intended to support with such decisions. It does not seek to replicate or replace national guidance. It seeks to answer frequently asked questions (FAQs) by members using an ethical prism.
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