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COVID-19 guidance round-up: Week ending 26 June

Medeconomics summarises the latest coronavirus guidance changes and useful resources for general practice. This week: new guidance tracker, updated SOP, cancer referrals and shielded patients update.

Sheilding will stop at the end of July in England and Northern Ireland as lockdown eases (Photo: Jeff J Mitchell/Getty Images)
Sheilding will stop at the end of July in England and Northern Ireland as lockdown eases (Photo: Jeff J Mitchell/Getty Images)

Please note: these guidance articles are based on centrally-updated guidance from NHS England, Public Health England and other national bodies. Practices will also be subject to local guidance which may have also changed.

COVID-19 guidance tracker

Medeconomics has launched a new COVID-19 guidance tracker that will be regularly updated as the pandemic continues. The tracker provides a list of guidance relevant to GP practices during the pandemic in an easy-to-search format. You can find the tracker here.

If there is any guidance that you think we should add to this tracker please email Medeconomics editor emma.bower@haymarket.com

Updated SOP

Business continuity plans
NHS England has updated the latest standard operating procedure (SOP) for general practice during the pandemic.

Practices have been asked to update their business continuity plans to factor in local outbreak scenarios that could temporarily disrupt services.

'Plans should consider high levels of staff sickness and self-isolation, call handling, staff and patient communication and, ultimately, denial of access to premises for staff and patients,' the SOP says.

It adds: 'Using clinical judgement and experience of recent months, general practice teams may need to consider how to prioritise their workload to deliver the best possible care to their population.'

Cancer referrals
The SOP also says that GPs may be asked by hospitals to conduct additional tests in their practice when they refer patients with suspected of confirmed cancer in order to help prioritise cases.

GPs should continue to refer patients who meet appropriate criteria, but that secondary care could triage and prioritise patients if capacity is constrained.

As a result, practices may be asked to conduct additional tests on patients if they have access to them, the SOP says.

Practices have also been advised to implement effective safety netting for any patient presenting with symptoms that suggest cancer. However, the guidance also says that, after a patient has been referred, it is hospitals' responsibility to ensure they keep track of those whose assessment may be delayed.

'Post-referral, secondary care will use patient tracking lists where investigations take place at a later date,' the SOP says. 'Clear processes for clinical assessment if there is any change/deterioration in a patient’s condition are vital.'

Any decision by the hospital to downgrade an urgent referral continues to require consent from the GP who made the referral, the guidance adds.

Shielding

Shielding rules in England will be relaxed from 6 July to allow 2.2m patients at high risk from COVID-19 to gather in groups and form a support bubble - with shielding set to end completely from 1 August. Northern Ireland also plans to end shielding from 31 July, but Wales and Scotland have yet to set out their plans for this group of patients.

In Scotland patients have been advised to continue to shield until at least 31 July. Wales has advised patients to continue to shield until 16 August.

In England, from 6 July patients on shielding lists will be allowed to 'spend time outdoors in a group of up to six people' - including people from outside their household - while maintaining social distancing, the government has confirmed.

Shielding patients who live alone or who are single parents with children will also be permitted to form a 'support bubble' with another household - in line with rules already in place for people not on shielding lists.

From Saturday 1 August, high-risk patients will no longer be asked to shield - although the government has said that some support measures for patients in this group will continue.

Support for patients currently on shielding lists from NHS volunteers and local councils will 'remain available' after the end of July the government has said, along with priority booking for supermarket deliveries and help including transport to medical appointments.

The sheilded patient list will be maintained and practices will be expected to continue to update this as appropriate.

The government has also revealed that GPs will be better able to identify patients at greatest risk of serious illness from COVID-19, and who may be required to shield in a second wave of the pandemic, using a new risk prediction model.

Researchers said that the model, which is being developed by a team led by Oxford University, would help GPs and consultants to provide more targeted advice to patients based on their individual levels of risk.

Deputy CMO for England Dr Jenny Harries said that the new model would enable a 'much more individualised way' for patients and their doctors to be able to understand a person's risk.

'In the future, therefore, those we advise to take action may be a slightly different group to those who shielded through this disease peak,' she said

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