NEL 111 NHS Pathway criteria


Dear Colleague,

RE: National COVID-19 Criteria, 19 March guidance

Thank you for your extensive work and support to date that has supported NEL in delivering care during a highly pressured time. I am writing to let you know of the current NHS Pathway guidance and advice that 111 CAS will be providing to the public. As well as guidance and advice for your service.

Over coming days and weeks we are going to need staff and local services to be able to adapt and change how they work to support out patients during this difficult time

111 CAS Criteria and Pathway:

  • The new Covid-19 NHS Pathways criteria has been implemented for NEL 111. The criteria for Covid-19 is an individual that is presenting with a new continuous cough OR a high temperature (37.8 degrees centigrade or higher) only.
  • New coding has been developed to identify these individuals and present an appropriate disposition, avoiding face-to-face clinical contact unless absolutely necessary.

Testing & diagnosis

  • The NHS is no longer testing the general public for Coronavirus. Travel and contact history are no longer important for diagnosis, which is on the basis of symptoms alone
  • Testing for coronavirus is not needed if the individual is staying at home.
  • Currently there is no testing available for staff.

Stay at home guidance

  • Individuals who meet the symptom criteria of a new, continuous cough or high temperature must stay at home and will be advised to do the following by 111:
    • For those that live alone and have a new, continuous cough (however mild) or high temperature, will be advised to not leave their home for 7 days from when the symptoms started.
    • For those that live with others and one of them has a new, continuous cough (however mild) or high temperature, then all household members must stay at home and not leave the house for 14 days. The 14-day period starts from the day when the first person in the house became ill.
    • If individuals can, the advice will be to move any vulnerable individuals (such as the elderly and those with underlying health conditions) out of the home, for the duration of the home isolation period. If they cannot move vulnerable persons out of the home, it is advised to stay away from them as much as possible.
    • After 7 days, if the first person to become ill feels better and no longer has a high temperature, they can return to their normal routine. If any other family members become unwell during the 14-day household-isolation period, they should follow the same advice i.e. after 7 days, if they feel better and no longer have a high temperature, they can return to their normal routine.
    • Should a household member develop coronavirus symptoms late in the 14-day household-isolation period (e.g. on day 13 or day 14) the isolation period does not need to be extended but the person with the new symptoms has to stay at home for 7 days.
    • All individuals concerned about COVID-19 who have online access, will be advised to consult nhs.uk/coronavirus for further information.
    • If the individual feels they cannot cope with their symptoms at home, their condition gets worse, or their symptoms do not get better after 7 days the national guidance signposts to affected individuals to use the NHS 111 online coronavirus service (https://111.nhs.uk/service/COVID-19/) or if there is no internet access to phone NHS 111

General Practice Advice

We ask that in these most challenging times that daytime general practice services in North East London support their own patients in hours and do not refer them back to 111 services.

Remember, 111 does not have its own face to face in-hours appointment service. Patients who present with Covid-19 possible symptoms will also complain of other medical  conditions. Hopefully (and especially at this exceptional time) the majority of patients will be managed appropriately over the phone, email or video, but some will still need face to face review at their practice (with PPE and cleaning etc. undertaken in the usual way as if an unwell patient presented directly to the practice).

Additional capacity across PCNs/localities is being developed, but this will be additional capacity and not be able to completely replace all face-to-face interactions at the individual practice level. All practices are asked to give clear guidance to their frontline receptionists in line with this request.

Downstream Provider Advice

  • As you are aware, we are working with your services to support appropriate referrals for usual urgent treatment needs. Through this, we have advised that GP Practices, GP OOHs and GP Hubs triage patients via telephone prior to attending your services.
  • Patients have been advised to not walk into GP surgeries, GP Hubs, WICs, UCCs, UTC or ED if they are presenting with Covid-19 symptoms.
  • Some services have offered support to 111 at this busy time and we are working to enable technical capabilities to do so.
  • Please utilise the stay at home guidance above if services need to provide advice to patients presenting with Covid-19 symptoms or for patients seeking advice.

This guidance will be updated if and when the national guidance changes.

Please do not hesitate to contact thccg.nelcoronavirus@nhs.net for any queries related to Covid-19 or your Commissioner for further guidance. We will keep you up to date with changes to the pathway once we are made aware.

 

Yours sincerely,

All north east London CCG Chairs.

 

Appendix

General Coronavirus advice

  • Callers/Patients can access ‘nhs.uk’ or ‘gov.uk’ for advice about Coronavirus. This can be found easily by entering the following into an internet search engine ‘nhs.uk Coronavirus’ or ‘gov.uk Coronavirus’ or by entering:https://www.nhs.uk/conditions/coronavirus-covid-19/

https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public