Frequently Asked Questions


Please see below a list of frequently asked questions we have received from practices, along with the most up to date responses:

Easter Opening

Easter Opening Funding Update 6th April 2020

As you are aware the Primary Care Cell wrote to practices on Friday 27th March with the following message about Easter Opening:

Dear Colleague,

As you will know, the United Kingdom is expected to see a peak in COVID-19 cases over the Easter Period and there are very serious concerns surrounding what impact Bank Holiday closures will have on the system.   It is understood but not confirmed that a decision will be made nationally asking practices to open on Good Friday (10th April 2020) and Easter Monday (13th April 2020) and we wanted to provide as much notice as possible to allow you to plan rotas and source staff.

We anticipate that the national guidance will include the funding arrangements for practices to cover the additional days. We would therefore ask that practices start to make arrangements to open for core hours on Good Friday and Easter Monday.

Once again we understand the strain on General Practice at this time is significant and thank you for your co-operation and understanding in these challenging times.”

This was followed by the NHS England and NHSE Improvement (NHS/I) GP Preparedness letter (27th March) confirming the national decision to class Good Friday and Easter Monday as “ordinary working days”. The letter stated that practices needed to be prepared and aligned with the rest of the NHS, which will be treating these as ordinary working days and cancelling staff annual leave to ensure services are able to be maintained.

The letter also confirmed there would be changes to the GP contract meaning the April dates will now be identified as normal working days for GP practices and further guidance would follow.

To date we haven’t received any further guidance therefore the Primary Care Cell have put together the following proposal of payment to cover the two additional days not already reflected within the GMS funding.

Method

We have used the new 2020/2021 global sum (£93.46) and divided it by the number of GMS working days (254 days) to give a rate of £0.37 (rounded up) per patient. This will then be multiplied by your weighted list size as at 01.01.20.

As a guide, for a practice with a weighted list size 10,000 patients this would equate to £3,740 per day totalling £7,400 for both days.

We are not making any other recommendations other than these days should be operating as normal working days (within the current COVID-19 context). The Home Visiting Service will continue to operate for this period and Out of Hours services have been stood down. You will receive further detail about the COVID-19 ‘Hot Sites’ throughout the week.

We hope you find this useful in providing some much needed certainty on the funding to support the additional ask that is being placed on General Practice for these days.

What Next

This payment is being processed so that you should see this within your accounts within the next two weeks. Any issues please email nccg.primarycare.covid19@nhs.net.

Please can you confirm what the practice is to do if a patient receives a positive COVID19 test?              

The latest guidance can be found here from http://gp.neneccg.nhs.uk/downloads/COVID-19/Managing-coronavirus-COVID-19-in-general-practice-SOP_19-March.pdf  from page 6.  Once a patients is confirmed as having COVID-19 the practice will receive a notification via ICE.  The CCG have requested that the Acutes call practices if a patient dies with confirmed COVID-19.  Details of the new home visiting service are attached to the email.

Is the practice to suspend cervical smear recall?              

Unfortunately the national team have confirmed that the guidance in regards to cervical smears is not yet available.  If you can please carry on as normal for now until we hear otherwise.  Any guidance received will be sent out to practices and we will continue to chase the national team for this.

What is the position with extended hours service, due to continuing and increasing staff absence?

We are currently reviewing the extended access provision and what this will look like going further.  This is an agenda item of the Primary Care Cell so once a decision has been made we will contact all practices to let them know.

Is there any guidance as to whether practices should be inviting; pregnant ladies for their pertussis vaccinations, Children that have missed their childhood vaccinations and Pneumococcal vaccinations. Are these to continue as normal?        

As it stands these patients should continue to be called for their vaccinations – no national guidance has been issued or published to state otherwise. The practice should aim to prioritise their at risk patients and call for immunisation in accordance to their BCP and the Green Book. Please where possible continue to undertake these immunisations

Please can you clarify what the current processes are on GP home visits for patients with conditions other than symptoms indicative of COVID-19?        

To our best knowledge, Practices within Northamptonshire are still conducting GP home visits to their own patients who do not present with any symptoms relating to COVID-19. A separate Community Home Visiting Service for Primary Care was recently commissioned to carry out home visits where there is an acute clinical need to housebound patients who have/potentially have symptoms of COVID-19.  Further information on this service is attached.

Can other providers have the GP Practice Bypass numbers?      

The request of the GP practice bypass numbers will be reviewed on a case by case basis and if provided we ask that these numbers are to be used only when the practice cannot be reached by the normal number and for emergencies only.  This is to ensure that we don’t overload the bypass numbers which could result in providers struggling to get through for urgent queries.

How do we go about obtaining more pulse oximeters?               

Sorry for the delay in responding to you. Pulse Oximeters are on the national list of equipment that is being provided therefore you are able to order through the national supply chain as you normally would. See link below. https://www.supplychain.nhs.uk/covid19/ordering/

Are timescales available for more PPE to be delivered?              

This link will help with registering and forms to complete https://www.supplychain.nhs.uk/covid19/ordering/

Will GPS be compensated for income lost from Out of Hours work that they can no longer complete due to the overwhelming workload at practice level?         

The national guidance provided from central government outlines exactly what reimbursements or revenue costs will be met as a result of COVID-19 activity. Please see information for this at the link below: https://www.england.nhs.uk/coronavirus/publication/next-steps-on-nhs-response-to-covid-19-letter-from-simon-stevens-and-amanda-pritchard/

Is there anything that can be done to help facilitate remote working? In particular gaining access to the Swivel accounts working.             

This service is for current laptops that has been provided previously and, not in connection with COVID-19. This account needs to be updated every 30 days, therefore the following needs to happen to reactivate your account:

  • You would have received an email to let you know this account would have expired; this would have been approximately 7 days before the password expired.
  • Once you have located the email, please follow the instructions in the email, where your user name and password is.
  • Once you have completed this, you will need to connect with your smart phone, which will connect to your account.
  • You will need to click on the ‘S’ icon on your desktop, click on enter detials, input your user name and password.
  • You will need to input a second authentication which will be sent to your smart phone as a number.
Can clarification be provided as to what is happening locally and when will we have some additional IT support to get our non GP staff accessing whatever they need from home?            

We are currently awaiting supplies of further laptops to be delivered to us, as I am sure you will appreciate that demand for these are high at the moment. Therefore im afraid we can only provide laptops to your GP who is self-isolating. To request a laptop please see details below:

For queries please contact the NEL Service Desk as follows:

  • Service Desk telephone: 01604 978 089
  • Email: nelcsu.itservicedeskanglia@nhs.net
  • Self Service Portal: https://selfservice.nelcsu.nhs.uk/

In regards to a N3 dongle, this enables remote working access, which may support your PM and ANPs working from home on a NHS laptop, to receive this, please contact the service desk on one of the methods above.

Please can you advise if additional Away from My Desk subscriptions are available due to more staff members self-isolating.           

Please be assured that we are working towards enabling you and others to have access to the away from my desk subscription and, an update in respect of this and other IT related issues, which be issued over the next few days.

Please can you advise us if there is a list of pharmacies who have altered their opening times?              

As the responsibility of commissioning pharmacy services lays with NHSE they will be in charge of the Easter rota.  Whilst we sometimes get this information sent down to us we haven’t had it as yet.  If you would like to email NHSE direct the email address for the team is england.eastmidspharmacy@nhs.net.

Please can you advise us if there is a list of pharmacies in and around Kingsthorpe/Northampton who have altered their opening times?

In light of the current pandemic crisis a new guidance was issued earlier last week for Pharmacies operating under contract NHS England. The guidance outlines new operating hours for all community pharmacies who are expected, on every day, to be open to the public between 10am and 12 noon and 2pm and 4pm as a minimum with a sign at the door providing information for urgent help if needed.

Boots confirmed their opening hours as 09:00 – 16:00 Monday to Friday with an hour lunch break between 1-2pm in line with the standard operating procedure. A sign on the door must give information about how to contact the pharmacy if urgent help is needed.

The NHS website also provides up to date information on Pharmacy opening hours https://www.nhs.uk/ and those within close proximity to the preferred area.

Please can practices be advised if they can obtain safety goggles since they were not in the central delivery?

In regards to safety goggles for PPE, the best solution would be to contact the newly set up 24/7 NHS Supply Disruption Line number is 0800 915 9964 or email supplydisruptionservice@nhsbsa.nhs.uk.  This is set up on an e commence based solution, similar to ebay and amazon.  We have contacted the number and they have stated that any practice that are having difficulties in obtaining PPE should ring them and they will assist.  

Use of Own Laptops or practice computers in cases of self-isolation

If GP’s have home devices the EMIS N3 Connect solution will be of benefit, this works both in EMIS and SystmOne practices, and works over HSCN, not just N3. This solution works much like a VPN and allows access to clinical systems plus Spine applications such as EPS. The user accesses their clinical system via their home PC, and must be prepared to download the correct client for EMIS or SystmOne onto their PC before using the solution. If required, for practices without this solution the CCG will fund ONE instance of EMIS N3 Connect per practice, and only if the practice doesn’t already use this solution. In addition to this we have made a number of laptops available to use on a short-term loan basis to enable GPs who are self-isolating to continue to work. To use one of these laptops the GP must have access to WiFi at home, and a Smartphone as the VPN is accessed via an app. To be considered for a loan laptop you will need to log a call with the Service Desk (details at the bottom of this email) and request a ‘loan laptop’. The users details, including email address and mobile contact telephone number must be included in the request. Please also let us know if the user already has a VPN. The Service Desk will pass the call to the local NEL GP IT Team, who will allocate a laptop to the user and arrange for it to be couriered to the user’s address. Both the loan laptop and VPN will be available at no charge. Please be aware that the loan-laptops are only available to GPs and will need to be returned at the end of the isolation period. Further details of how to return a laptop will be given when a loan laptop is issued. This can be logged either by phone: 01604 978089; Email to nelcsu.itservicedeskanglia@nhs.net or you can use the Service Desk Self Service Portal to log your query via https://selfservice.nelcsu.nhs.uk The NEL Service Desk operates from 7am – 8pm Monday – Friday. Please be aware that the supply of laptops is limited whilst the CCG attempt to source further laptops. Unfortunately there are lengthy lead times on delivery times for additional laptops as these are in high demand across the whole country. Unfortunately at this current stage we are not allowing practice PCs to be used from home.

Guidance on online and Telephone Triage:

Please see the link to the NHSE/I SOP for primary care, which contains further detailed guidance on online and telephone triage:

 

https://www.england.nhs.uk/coronavirus/primary-care/

 

Infant paracetamol and primary immunisations

 

We have received a number of enquires asking for advice about infant vaccination as a result of some parents having difficulties in obtaining infant paracetamol suspension.  Given the risk of the serious infections that the vaccines protect against, PHE are recommending that the routine primary immunisation schedule should not be delayed. Whilst parents should continue to try to obtain and administer infant paracetamol if possible, infant vaccines can and should still be given even if it is not possible to give prophylactic paracetamol.

 Parents who have been unable to obtain infant paracetamol should be advised as follows:

 

  • Fever can be expected after any vaccination but is more common when the MenB vaccine (Bexsero) is given with the other routine vaccines at eight and sixteen weeks.
  • In infants who do develop a fever after vaccination, the fever tends to peak around six hours after vaccination and is nearly always gone completely within two days.
  • Ibuprofen can be used to treat a fever and other post-vaccination reactions. Prophylactic ibuprofen at the time of vaccination is not effective. We are aware of the “concern” about using ibuprofen in patients with a fever from Covid-19, but it is still a recommended alternative choice to paracetamol for treating a fever post-vaccination.   
  • Information about treating a fever in children is available from the NHS UK webpage “Fever in children” at www.nhs.uk/conditions/fever-in-children/  
  • If an infant still has a fever 48 hours after vaccination or if parents are concerned about their infant’s health at any time, they should seek advice from their GP or NHS 111.
  • The diseases that the vaccines protect against are very serious and therefore vaccination should not be delayed because of concerns about post-vaccination fever.

 Cause of fever following immunisation

We have also been made aware of concerns that parents will not know whether a fever in their infant following immunisation is due to their immunisations or to COVID-19. Indications to date suggest that COVID-19 causes mild disease in infants and children. As has always been recommended, any infant with fever after vaccination should be monitored and if parents are concerned about their infant’s health at any time, they should seek advice from their GP or NHS 111. 

 Teenagers and routine vaccinations

The same advice applies to teenagers who are due their routine adolescent immunisations. Teenagers are less likely to develop vaccine reactions such as fever and if they do, these are generally short lived and resolve quickly.  COVID-19 is associated with a more prolonged course of illness with respiratory symptoms, especially cough, which would not be expected following vaccination. As with the infant primary immunisations, PHE are recommending that the routine adolescent immunisations should not be delayed. 

 

Indemnity for GMC Representation:

Any GP who has current professional protection via their MDO will continue to be covered fully.  They have to do nothing more than is already in place.  There is a secondary question however, related to retired GPs and possibly students who may be brought into the workforce.  To pre-empt questions about those, govt is including these in emergency legislation.

The emergencyCOVID Bill being hastily drafted has many clauses to enable appropriate responses to coronavirus.  One of the clauses will provide govt indemnity to all clinicians working in the service in response toCOVID.  This is a belt and braces approach in England and Wales as all clinicians will be covered in any event byCNSGP.  However, professional indemnity is another matter.  Moves are being taken to ensure that retired doctors coming back into practice have free professional cover via their previousMDO (the one they were with  when they retired).  The Bill  should become law very soon and we hope to be able to confirm professional cover then.

CCG Local Services Claims and Payments:

Please can practices be aware that until further notice no claims or invoices for any of the services listed below need to be sent to the CCG.  Payment will continue for all the services listed below and calculations for this payments has been devised using standard monthly payments and average activity figures.  The CCG wants all practices to be reassured that cashflow will continue whilst freeing up practice staff to concentrate on the continuing COVID crisis:

PMS Reinvestment (under the new years scheme and payment allocation)

Peer to Peer

Warfarin

Near Patient Testing

General Practice Engagement

Anti-Coagulation

Pro-Active Care

Leg Ulcer Dressings

Demand Management

Hypertension

Long Term Conditions

Same Day Access

Complex Care

Aural Toilet

ECG

Neo-Natal

Phlebotomy

LUTS

DVT

Sleep Apneo

Gluten Free

ONPOS Dressings

AQP Contracts (Carpel Tunnel, Minor Surgery, BCC and Vasectomy)

Extended Hours

(Please note that not all of these services will relate to every practice.  However please be reassured that payment will be made for all services you have previously claimed for.)

Personal Protective Equipment (PPE):

We appreciate that these are extremely challenging times for everyone. Information is being updated regularly and we are aware that some of you have had some confusion regarding the Infection Prevention guidelines and which personal protective equipment (PPE) is required.

We hope the information links below enable you to be able to identify which procedures are aerosol-generating procedures (AGPs) and be able to risk assess the appropriate PPE required for the care you and your teams are providing.

Key links for information:

As of 19 March 2020, COVID-19 is no longer considered to be a high consequence infectious diseases (HCID) in the UK. https://www.gov.uk/guidance/high-consequence-infectious-diseases-hcid#status-of-covid-19

National IP guidelines: All healthcare workers managing possible and confirmed cases should follow the  national infection and prevention (IPC) guidance for COVID-19. This guidance includes instructions about different personal protective equipment (PPE) ensembles that are appropriate for different clinical scenarios and also includes the list of agreed aerosol generating procedures (AGPs).

The doffing and donning posters are located here:

https://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-aerosol-generating-procedures?utm_source=3fb1a3a5-4eaf-49ec-86a8-e8cd10029201&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

The SOP for GPs is located here

https://www.england.nhs.uk/coronavirus/publication/managing-coronavirus-covid-19-in-general-practice-sop_19-march/

Primary Care guidelines are located here

https://www.gov.uk/government/publications/wn-cov-guidance-for-primary-care/wn-cov-interim-guidance-for-primary-care

NHS staff information is available on the NHS England EPRR website:

https://www.england.nhs.uk/ourwork/eprr/coronavirus/

Public health information is available on the PHE.gov website (includes all government advice): https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public

Patients/public is available on the nhs.uk website: https://www.nhs.uk/conditions/coronavirus-covid-19/

Personal Indemnity:

Any GP who has current professional protection via their MDO will continue to be covered fully. They have to do nothing more than is already in place.

The government are currently drafting the Emergency COVID Bill that will cover queries relating to retired GPs and students who may be brought into the workforce. One of the clauses of the bill will provide government indemnity to all clinicians working in the service in response to COVID. This is an approach in England and Wales as all clinicians will be covered in any event by CNSGP.

In addition moves are being taken to ensure that retired doctors coming back into practice have free professional cover via their previous MDO (the one they were with when they retired). As soon as the team have any further information on this bill being published we will notify practices.  

 


Last updated: 09/04/2020