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24 April 2020
Dear Colleague
This weekend NHSE&I will be launching a national campaign to raise awareness that our GP and hospital services are still there for patients who need care – need being the key word. This is very timely as we are all of us concerned to ensure that fear of being infected by Covid-19 does not get in the way of patients receiving appropriate care and onward referral for other significant conditions. Our publication General Practice During The Pandemic: The Role of the General Practitioner and Practice Team makes specific reference to this and many other aspects of care which, with the inevitable oscillations of Covid-19, will define what we will be doing in London for the foreseeable future.
Meeting need is the new normal now, and balancing demand and capacity to meet that need at patient and practice level will be key to the way we come out of this in the months and years that follow. We cannot go back to the old wants-driven paradigm.
Item 6 below highlights the specific areas of our role that the authors, Dr Lisa Harrod-Rothwell and Dr Elliott Singer cover in our publication General Practice During The Pandemic: The Role of the General Practitioner and Practice Team. Please, if you can, try to make it essential reading for the practice.
In addition I have a veritable pot pouri of items for you.
1. Verification of death – Update
Our message remains unchanged.
2. Early May Bank Holiday – Update
NHSE is treating this as a working day under the Emergency Regulations. Please liaise with your PCN and CCG. If you need advice contact gpsupport@lmc.org.uk.
3. Covid-19 testing – Online for staff and household contacts with symptoms
The online application system for essential workers to book coronavirus tests has already temporarily closed following huge demand. It is expected to reopen tomorrow (Saturday 25 April).
4. Supplies of clinical and other consumables for Londonwide LMCs' practices
Practice supplies of practice equipment, particularly PPE remains of great concern due to levels of availability being mismatched to need. The Londonwide LMCs’ Buying Group works closely with our trusted supplier MidMeds for many practice consumables including PPE. They have availability of a number of key items such as hand sanitiser, face masks and gloves and have orders coming in the next few weeks for other key lines such as FFP2 masks, gowns, non-contact thermometers and pulse oximeters. MidMeds advise us that stock for high demand items is moving quickly, so it is best to place orders in anticipation of delivery as to ensure that you have sufficient PPE protection for your staff. Delaying an order is likely to mean that when supplies arrive they will already have been pre-ordered by other practices. MidMeds can be contacted on 0207 471 2626 or online via our Buying Group.
5. Our Londonwide Covid-19 Living Guide Edit 4 includes:
- A template letter for employers for patients who are shielding.
- Information on referrals pathways.
- The dentistry referral pathway in London.
6. Areas of the GP and Practice Team role covered in General Practice During The Pandemic: The Role of the General Practitioner and Practice Team include:
Emergency/urgent care
- Diagnosis and management of patients presenting with acute illness.
- Risk assessing and triaging these presentations into those suitable for advice only, prescription, further investigation, referral for specialist advice or acute hospital referral.
- Referring cases of suspected cancer to specialist services in accordance with revised 2WW pathways.
Long-term conditions (LTCs)
- Diagnosis and management of many LTCs in general practice.
- Referral for secondary care for the diagnosis and/or initial management with referral back to GP for the long-term management.
- Referral to secondary care for the diagnosis and/or initial management and then ongoing joint management of the patient.
- Referral to secondary care for the diagnosis and ongoing management of patients.
Prevention and health promotion
- This includes vaccinations, immunisations, lifestyle modification (diet, exercise, smoking and alcohol).
End of life care
- Increasing numbers of patients with end stage disease or malignancy or choosing to die in the community with the GP being part of the multi-disciplinary team supporting them and their families through this event.
Patient and local community advocacy
- Identifying and referring vulnerable individuals, especially where there may be a safeguarding concern.
- Understanding the local communities being served.
- Providing holistic care, for example assistance with benefits.
- Linking with voluntary organisations.
- Providing patient support forums within the practice.
- Contribute to community cohesion.
7. Ramadan
Please be aware of the following message from the system in North East London which I hope we will all find useful:
"Please enjoy Ramadan but follow the guidance on social distancing. If you have a medical condition such as diabetes, high blood pressure, heart disease or lung disease, or you are on medication, or pregnant, or elderly, or in the highest risk group that are asked to stay at home for 12 weeks, please choose alternative options to fasting, in order to protect yourself from Covid-19. The NHS Muslim Network and the British Islamic Medical Association are advising that missed fasts can be made up at a later date in the year."
And in this year of all years, may I wish colleagues Ramadan Mubarak, and may God be generous to all as we do our deeds of care, compassion and loving kindness.
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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