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Member Practice Update

13 March 2020 








Welcome to the Member Practice Update


This weekly Member Practice Update is produced by NHS Redditch and Bromsgrove, NHS South Worcestershire and NHS Wyre Forest Clinical Commissioning Groups for circulation in your practice, to provide you with essential guidance, information and useful support.

Your views and feedback are very much appreciated. If you have any comments, suggestions or contributions for inclusion in the Member Practice Bulletin, please e-mail the communications team.

In this issue:


 Find out about local and national events and training here

Redditch and Bromsgrove

South Worcestershire

Wyre Forest 

Herefordshire

  • No Redditch & Bromsgrove news 
  • No South Worcestershire News 

  • No Wyre Forest news
  • No Herefordshire news


COVID-19 Update 

The situation and guidance is changing rapidly and we understand the confusion that this creates especially with information coming from so many different sources.  National policy is what we must follow and implement.

We had a very constructive teleconference with the Herefordshire & Worcestershire LMCs this morning which will take place weekly and we would like PCN Clinical Directors or nominees from the GP Provider Board to also have the opportunity to dial in. The CCG is responsible for co-ordinating and leading the system approach to COVID this includes ensuring Practice and PCN Business Continuity Plans are working, Practices\PCNs are coping and to see what support we might be able to offer.  We agreed on the call today that we need to capture sickness levels in practices including numbers of staff self-isolating.  We’ll be in touch about the best way of doing this.

We also emphasised the need for all COVID enquiries and issues to be emailed to the Incident Room:


A number of quite significant changes to earlier NHSE guidance was published today – Read the full text here

COVID-19 Swab Results

Swab results from screening for possible COVID-19 cases are available on the ICE reporting system. Practices will not be contacted directly with Negative results but Positive results will be communicated directly to practices by the swab taker. Official notification of Positive cases will come from PHE but understandably this might take a few days to come through.

Environmental Decontamination following a possible case of COVID-19 in Primary Care 

Once a possible case has been transferred from the primary care premises, the room where the patient was placed should not be used until decontamination has been completed. The room door should remain shut, with windows opened and the air conditioning switched off. Signage can be displayed on the door until the room is put back in use. Once this process has been completed, the room can be put back in use immediately.

Read more


COVID-19 Breast Service Primary Care Letter

Sent on behalf of Mr J. Taylor, Clinical Service Lead in Breast Surgery

The outbreak of the Covid-19 infection as you will be well aware is expected to become widespread.  We have been required to identify mechanisms we can put in place in order to free up capacity within the Acute Trust but also to reduce the risk of spread of infection to our service users. 

Read more



Advice for Primary and Community Preparation for Covid 19 in Care Homes - On Behalf of Dr Maggie Keeble 

I realise that practices are having an influx of advice regarding the Covid 19 virus but I am aware that there is little detail on how to manage our vulnerable care home patients. There have been discussions over the last two days with CCG as well as Adult Social Care, Public Health and our Health and Care Trust colleagues. We are in unchartered territory but I hope the following thoughts on preparatory actions and patient management will be helpful.

Preparation Phase

As some of the burden of routine management is removed following the CCG letter that has been circulated there needs to be consideration of prioritising the following;

  1. Advance Care Planning:
    All residents should have a robust care plan with a clearly expressed preference for levels of intervention – this needs to be discussed with the resident if they have capacity to decide or a Best Interest decision made by Health Attorney if there is one or anyone ( usually a health care professional )  with appropriate competencies based on awareness of the residents previously stated or likely wishes and preferences. We will be developing some advice for care homes for them to support initiating these conversations if decisions are not already in place.

  2. ReSPECT forms:
    Once level of intervention in the event of deterioration has been agreed all residents must have a ReSPECT form completed. We attach some guidance on potential wording for the ReSPECT form with explicitly states the situation and allows an appropriate response from emergency responders.response from emergency responders.

  3. Just in case medication:
    If the decision has been taken following discussion that transfer should be avoided unless unable to maintain comfort then anticipatory medication must be prescribed so that it is available in the event of a sudden deterioration.

  4. Access to remote consultation:
    Ideally each care home should have access to video consultation equipment on a mobile device to allow a view of the resident. Each GP practice/PCN needs to work up a way to enable this whilst every care home should be able to access on a phone or tablet. Mike Emery and his team are working urgently on suitable options but AccuRx is a possible interim solution. At the moment it is linked to specific patients on EMIS and so the home needs to provide an appropriate mobile phone number which can be added at the point of adding a link for a remote consultation and doesn’t need to be added to every patient notes. I have been trailing this myself and it does work well.

  5. Collaborative Working
    a) PCNs and Community Teams should start to consider cohorting responses to Care Homes to reduce the number of people visiting and to have a central point for queries.
    b) Community teams will need to start to consider how routine work in Care homes could be carried out. It is possible that some of this work could be undertaken remotely with video supervision of care home staff but processes would need to be carefully considered. We are likely to be facing unprecedented situations which will call for unprecedented responses. This has already been raised as an issue in relation to CQC having certain expectations about levels of care and these will be taken to national level.

  6. The CCG/Public Health colleagues need to collate nhs.net email addresses for all care homes to facilitate circular emails and enable video conferencing. We will need to support of Care Home leads in the PCNs to ensure we are communicating with the right people and to promote the use of nhs.net emails for all care homes.

  7. We have agreed with Adult Social Care and Health colleagues to draft a letter to care homes to be shared with residents and relatives to display a united approach and to ask for their help and support as the situation develops. In the early phases it is likely that homes will be closed fairly soon to visitors - at though this is not guidance at the moment.

  8. Subcutaneous fluid administration
    We have been asked to consider interventions that will reduce requirement for hospitalisation. A simple but helpful intervention is the use of subcutaneous fluids to sustain hydration. Saline can be prescribed ( 0.9% Sodium chloride for infusion 1000mls) and there are discussions with the Health and Care Trust about supplies of giving sets. More information to follow as soon as possible.

 

Managing residents who have a temperature and respiratory symptoms in Care Homes

There is a low chance of residents presenting with symptoms due to Covid 19 as things stand. This is likely to change.Face to face assessment in Care Homes is still a reasonable expectation but plans should be in place urgently to facilitate video consultation to protect health care professionals and to ensure reduction in cross contamination amongst homes.


When undertaking video consultation: Homes should be asked to ensure they have equipment to measure a resident’s temperature.

For resident who are mildly unwell – look well and normal Respiratory rate – manage conservatively encouraging plenty of fluids – ensure resident is isolated and staff supporting that resident are kept to a minimum.

For resident significantly unwell – with a temperature, cough and raised  Respiratory Rate review the advance care plan and determine whether transfer appropriate – if transfer is appropriate then contact as advised in national guidance informing them of acute respiratory condition possible Covid 19

If transfer not appropriate, consider prescribing antibiotics to treat other causes of respiratory disorders and ensure having plenty of fluids.  If transfer not appropriate and unable to take enough oral fluids, consider subcutaneous fluid infusion – ensure that Just in Case medication is in place.

Completing Respect Forms

Options for Wording Contingency/ Escalation plans/ReSPECT Forms

  • This terminology is a guide to support conversations and recording in section 4 of the ReSPECT form This is not prescriptive or comprehensive and Clinicians should adopt/adapt and augment  to ensure appropriate for specific situations:
  • Consider all clinically appropriate interventions to sustain life including Cardiopulmonary Resuscitation 
  • Consider all clinically appropriate interventions to sustain life excluding CPR
  • Consider all clinically appropriate interventions to sustain life but do not undertake CPR. If the likelihood of recovery is extremely low and further attempts to maintain life look futile all interventions to sustain life should be withdrawn as long as comfort can be maintained.
  • Consider all clinically appropriate interventions to sustain life in usual/current place of care but avoid transfer to an acute hospital for any reason as long as comfort can be maintained. This applies even if life is at risk.
  • Recommendation is for no intervention at all to sustain life but to allow a natural death.  Care should be delivered in usual/current place of care. Do not transfer to an acute hospital for any reason as long as comfort can be maintained. This applies even if life is at risk.




Primary Care Team contact information update 

With the current COVID-19 situation, the Primary Care Team would like to confirm the following contact arrangements;

  • Please continue to email the new generic Primary Care team email account particularly with anything (NON COVID) that requires a response hw.primarycare@nhs.net, this is monitored daily during working hours by all members of the Team. 
  • Primary Care Team Landlines- please do not use the landline office phone lines. If you have a mobile number for the person you want to speak to, please try this first or e-mail the person direct.




Cancellation of next week’s MSK and Chronic Pain Update – Thursday 19 March 

We are writing to confirm that regretfully we are postponing the MSK and Chronic Pain Update (Red Whale) training event scheduled for next week. This decision has been taken due to the evolving COVID-19 crisis. We are committed to running the update and will be working with Red Whale to reschedule the event later in the year. We have contacted the delegates who have booked a place individually but want to ensure the message reaches everyone. As back-up could we ask that you pass this message on to any of your team who have booked. Thank you.




Access to General Clinical Microbiology Advice - Worcestershire  

The Clinical Microbiology service is currently receiving an extremely high volume of calls for clinical and laboratory advice at all times of day and night from both Worcestershire and Herefordshire. In response to this and in order to maintain a safe and sustainable service going forward, the following changes to the clinical service will apply from 16th March 2020

Read more




GP Academy - Update 

GP Academy opportunity 1 more funded place on the March date due to a cancellation and 3 more funded places on the April date- OPEN TO ALL GPS regardless of qualification

Development of the Herefordshire and Worcestershire GP Medical Education Academy- Funded places open to ALL GPs

The scheme outlined below has been designed to retain existing GPs within the counties whilst enhancing an individual’s skills and knowledge in Medical Education and supporting education and learning needs within Primary Care Networks in Herefordshire and Worcestershire.

Objectives of the GP Medical Education Academy:

  • To develop educational skills of GPs in Herefordshire and Worcestershire to perform small group teaching.
  • To develop the skills and abilities of GPs in supervision, to enable them to supervise in practice to build on the number and quality of local GP supervisors for students. These skills should be transferable to the allied multidisciplinary team e.g. nurses, paramedics and pharmacists.
  • To promote a portfolio career in medical education to help build resilience and promote local recruitment and retention, keeping GPs once qualified and keeping GPs in their jobs as a Portfolio GP.
  • To create a longitudinal informal career mentoring network including a database of GPs who can be called upon to support teaching, training, and supervision opportunities.
  • To discover and develop new medical educators and educational leaders in the area, to identify talent and then to mentor and use that talent to further roll out the GP academy across the STP.

 

To find out more, please see the below flyers which include training dates and application information.

Development of HW GP Medical Education Academy 

GP Academy Expression of Interest 

Teaching the Teachers: Skills for Healthcare Educators 3 day workshop 2020




Cervical Screening Update 

Test kit supplies, laboratory turnaround times and sample taker training guidance  

You will have been made aware of recent stock shortages across the NHS Cervical Screening Programme relating to the supply of Hologic ThinPrep vials and cervex brushes.

Read more




Herefordshire Community Safety Partnership  

Newsletter - March 2020

National Child Exploitation Awareness Day

This month includes ‘Child Sexual Exploitation Awareness Day’ and is a good time to remind ourselves of the risks to children and young people in Herefordshire.

The Community Safety Partnership have developed a Communications Pack, which includes a wide range of awareness raising posters and resources to use within your agency/work setting to help combat Child Exploitation. 

The national campaign highlights the issues surrounding child exploitation and encourages all of us to think, spot and speak out against abuse.  It also encourages people to adopt a zero tolerance to adults developing inappropriate relationships with children or children developing inappropriate relationships with other children.

Please feel free to use these resources and disseminate, where appropriate.

Read more




'Not our Patients Notifications' - Reminder 

Sent on behalf of Lydia Stark, Operations Manager, Worcestershire Integrated Urgent Care Primary Care

All 'not our patients notification' should be sent to:

Care UK
98C. Blackpole Trading Estate West
Hindlip Lane
Worcester 
WR3 8TJ

These should not be sent directly through the trusts postal address to avoid any delays. 




MJog Training 

The last two sessions of MJog training are now available for booking:

Venue:

New Road Surgery
46 New Road
Bromsgrove
Worcs
B60 2JS

Session Date:

Wednesday 8th April

Session Times:

10-12
1-3

To book into a session contact:

Stephen Morgan
Project Co-ordinator | Midland and Lancashire CSU
Mobile : 07776164521
Office : 01562 513029
Email: stephen.morgan6@nhs.net 

 



Live Life Well Programme  

Sent on behalf of Dr Yvonne Thomas, Principle Lecturer Allied Health 

The Live Life Well programme is funded through the Worcester Unit Haven and is free to individual participants.

Starting on Wednesday April 27th 10.00 – 12.30 for 10 weeks.

The programme is aimed at women who have completed, or almost completed, their treatment and are ready to take the next move forward; focusing on healthy eating, good nutrition and being physically active.

Previous participants from across the county have found the programme extremely useful.

Thanks for promoting the programme to your clients or anyone you think might benefit.

Live Life Well 2020




Mid-Career GP Programme Opportunity – Herefordshire and Worcestershire 

Back in December we held an evening for mid-career GPs and talked about potential programmes to support GPs throughout their career. During this evening, we heard from Dr Amanda Webb, Clinical Chair for Swindon CCG and PCN Clinical Director who founded the Phoenix Programme for GPs. We are now in a position, subject to sufficient interest, to run a programme in our area, and be only the third area in the Country to try the programme before it is rolled out nationally. Please see below information on how to register your interest, by 30th April 2020.

Phoenix GP is a career and skills development program specifically targeting mid-career GPs (i.e. more than 5 years post-CCT). It provides a series of 6 evening sessions over 6 months for each cohort of 30 participants, balancing a series of talks from inspirational GPs with dedicated skills workshops developed by the Time for Care team to focus on the challenges faced by mid-career GPs. These include topics such as personal development, fundamentals of quality improvement, change management, group facilitations and increasing personal impact and influence.

Please visit the Phoenix GP website for further details.

The program is free to attend and includes an evening meal and refreshments. It is supported by NHSE and RCGP and would be funded by the CCG. Previous programs have been extremely successful and universally well-received by attendees.

“I’d had a rubbish day & was feeling really disheartened when I arrived. By the end of the evening I felt inspired, enthused & energised - thank you so much”

“Really worthwhile. This can’t change the problems behind the current situation but really good to meet, get support, share ideas & feel better about what I am doing. Thank you.”

“Hugely enjoyable evenings. It is having a big impact on how I feel about being a GP and how I approach things in practice. It might just keep me as a GP”

We would be looking to start the programme in September 2020 but only if we get sufficient interest. If you have any questions or would like more information please do get in touch with the GP Workforce team or visit the website.

Simply email with “I’m interested” to the GP Workforce team to register your interest by 30th April 2020.




Chronic Fatigue Event 

Save the Date 

Worcestershire Health and Care NHS Trust will be hosting a Chronic Fatigue event on the Thursday 14 May 2020. The session will take place between 1pm - 4pm at St Peter's Baptist Church In Worcester.

The event will address 3 key themes;  Awareness Raising, Self-Management (services and activities that may help), and what services are offered after diagnosis. The session is for both clinicians and members of the public.

Further details to follow.

For more details or to book your place in advance, please contact Alex Kumar or Trudy Neal or call 01905 681610.




Primary Care Job Vacancies - Please visit the Primary Care Training Hub

GP Mentoring – The service can be used by any GP who would like to explore ways to develop themselves. This could be personally, professionally or within their career. The aim is to provide mentors to support GPs in fulfilling their potential, whether this is in practice or in other leadership positions. If you’d like a mentor, please email the Workforce Team

GP Support Team –The CCGs and LMC have a well-established GP Support Team in place, whose main focus is to respond to and empower practices to make operational and team changes that directly and indirectly address challenges they are facing in the short to medium term. The GP Support Team can be accessed via the LMC or Sally Everton at the CCGs.