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2 April 2020
Dear Colleague
Our GP clinically led teams at Londonwide LMCs, always by your side, have produced a substantial new Living Guide to help you through the Covid-19 emergency. We distributed it yesterday in our newsletter, it is live on our website, and I am sharing it with you again right here. Please see this guide as your companion. We are constantly reviewing it to bring you the most up to date information on the key clinical issues and discussions happening in London right now, and many of the questions we’ve been receiving from practices over recent days and weeks are addressed within, and more details will be added as we go through the coming challenges we all face. Our Londonwide LMCs’ Covid-19 Living Guide has been developed with contributions from across the NHS, both in London and nationally. Please read it, share it, promulgate it among your staff, especially your clinical staff, and refer to it when you have questions that need answers. Those answers are probably contained within, or shortly will be.
And so my MWord today covers the following:
- Covid-19: The Londonwide Living Guide
- Bank Holiday opening
- Don’t take cervical smears for now
- Don’t use Roth Score in remote assessment of Covid-19 patients – latest evidence from Oxford CEBM
1. Covid-19: The Londonwide Living Guide
This living document has been produced by the GP Medical Directors of Londonwide LMCs in collaboration with clinical colleagues within the NHS system in London to guide London’s GP practices to best help our patients. We have produced this guide in the early stages of an unprecedented Covid-19 pandemic, during which the imperative is to flatten the curve to enable NHS services – emergency, hospital, community and primary care – to work together to beat the consequences of a novel infectious disease which has no vaccine, in the context of substantial risk that services might become overwhelmed.
Such times demand rapid learning and change in practice. The balance of power between our ability to prevent disease versus end of life care has, for now at least, shifted. Given time this will change. But during this period where drastic social distancing appears to be the main defence, we must park our accustomed practices and give permission to ourselves to concentrate on the task at hand. That task is defined by safely caring for our patients’ most pressing needs - be they Covid-19, or related to other key disease - maintaining immunity against diseases preventable by immunisation, preventing practice staff from being vectors of disease and caring for ourselves so that we remain fit to care for our patients.
We draw on available evidence and information from multiple sources, including real-time examples from China, Italy and elsewhere, and we recognise that, as in all times of trouble, there will be innovations and advances in both clinical practices and in the systems to support them. These may well challenge decades of traditional practice but our hope, as we work through this coming period, is for us all to get through and come out the other side safely, armed with those new solutions and ways of providing the care that will enable us to meet our patients’ whole person needs for the rest of the decade and beyond.
Download ‘Covid-19 - Supporting Safe Care In General Practice - A Londonwide LMCs Living Guide’ from our main Covid-19 page.
2. Bank Holiday opening
NHS England have communicated that they expect practices to open as normal on the Friday and Monday of the Easter weekend (10th and 13th) and will likely make the same requirements for the May bank holidays (8th and 25th). We are trying to clarify expectations of what ‘open’ means with GPC and in due course with commissioners, but for sure there isn’t clarity on staffing payments. However, this falls within contractual requirements, so it’s a breach notice if you don’t. Until clarity is issued, it is important that practices keep a clear tab of all additional costs associated with additional opening, albeit with no guarantee that these will ever be recovered.
3. Don’t take cervical smears for now
NHS London has asked practices not to take smears for now.
4. Don’t use Roth Score in remote assessment of Covid-19 patients – latest evidence from Oxford CEBM
We are now advising against the use of the Roth score to assess lung function in patients with suspect Covid-19, because reports have come in of critical events and near-misses where GPs have been falsely reassured by a ‘normal’ Roth score. Thank you to Prof Trish Greenhalgh for her advice on this and other aspects of coronavirus consults.
As ever I welcome your feedback at mword@lmc.org.uk, and know that my team of experts and leaders here at Londonwide LMCs will always be by your side.
Keep well. Stay safe.
With best wishes
Dr Michelle Drage MBBS FRCGP
CEO, Londonwide LMCs
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