Resuming services and delivering face to face care

Dear Colleague, 

Resuming services and delivering face to face care

Thank you for keeping your practice open during the C-19 pandemic, we recognise the efforts you and your teams are making to manage the care of your patients throughout this time and the new ways of working you have adopted so rapidly.   There has been significant progress over the past few months in delivering online, telephone and video consultations and where possible this type of care should continue by default.  

In addition to remote working, it is also a requirement that practices remain open and continue to deliver face to face care where clinically appropriate, this was also referenced in the national GP contract letter 9 July.  Where some face to face services may have been paused during the height of the C-19 pandemic they need to resume as soon as possible. These include the management of pre-existing conditions (including care of patients with LTC), urgent demand and undertaking vaccinations, immunisations and cervical screening. To support the delivery of face to face care practices should undertake risk assessments and, consultations must be undertaken with due regard to the correct infection prevention and control protocols.  

It should be made clear to patients that all practice premises, including branch surgeries, are open to provide care, with adjustments to the mode of delivery.  No practice should be communicating to patients that their premises are closed. Nor should they be redirecting patients to other parts of the system, except where clinically assessed as appropriate.   We will be monitoring this and undertaking work locally to get feedback from patients on their ability to access services, where their clinical need meant they needed to be seen face to face. 

We have provided some information and signposting to useful resources to help practices ensure that you are well-prepared to provide safe face to face services to patients, where appropriate. 

Preparation of sites for COVID-19 face-to-face consultations

  • Use clear signage to direct patients to the appropriate site/space.
  • Ensure alcohol gel/handwashing facilities are available for patients and staff.
  • Cleaning the consultation room after every patient.
  • De-clutter communal spaces and clinical rooms to assist decontamination.
  • Ensure clinical rooms have the necessary equipment for patient examination readily available, and adequate and accessible provisions of personal protective equipment (PPE) and clinical waste bins.
  • Wearing PPE when assessing all patients and donning and doffing the PPE appropriately before and after every patient contact.
  • Advising at the initial telephone/video assessment that the patient should not bring in relatives/friends into the appointment unless it is essential to do so.
  • Guidelines on messaging for patients, zoning v designated assessment room and entering and leaving the practice can be found in Londonwide LMC’s guide to a safe practice policy, which can be found here
  • Guidelines around delivering specific services such as immunisations and smears can be found in this Londonwide LMC guide here

Further guidance on PPE

Guidance on  requirements for PPE and how to use it correctly can be accessed here and information on accessing the national PPE E-Commerce portal can be found here

Further guidance on infection, prevention and control

The London principles on managing infection prevention and control in general practice during the covid 19 pandemic can be found here

NEL CSU Infection Prevention and Control Team are putting on regular webinars every Tuesday between 2.00 and 3.00 during July and August Book your event tickets here.  They are also organising drop-in clinics every Monday between 11.00 and 1.30 for 1-1 support, with the option to submit questions beforehand. Book your event tickets here

Face covering for patients in the surgery

Asking patients to wear a facial covering is not currently part of the national Infection Prevention and Control guidance (under regular review) but we strongly advise practices to request patients do wear a face covering.

Patients requesting exemption for wearing face covering.

Government guidance suggests that there is no requirement for evidence for medical exemption from wearing face coverings and that it is sufficient for a person to self-declare they are eligible for exemption in instances where a face covering is required.  TFL have instructed passengers who believe they are exempt from wearing a face covering for a reason on the TfL exemption list, to print out an exemption card from their website and display it on clothing or a lanyard. It is also acceptable to display it on a mobile phone.   Londonwide LMCs have also recently produced a section on face coverings in their London wide living guide.

If you are experiencing difficulty in ensuring that your premises are open and face to face services are being offered to patients, please discuss this with your primary care team. They are there to help you.

 Yours sincerely 

Dr Mark Rickets        

Ceri Jacob