Primary Care Update Letters
CChub human resources
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Patient risk levels
infection control and PPE
During Covid19-related restriction in face-to-face contact with healthcare professionals, the provision of effective contraception (this may be a bridging method in the short term) and emergency contraception are considered priority services (FSRH).
Emergency contraception (EC)
FSRH CEU recommends that remote assessment of requirement for EC is prioritised so that it can be made as soon as possible after unprotected intercourse.
Insertion of a Cu-IUD for EC should continue to be offered first line, where this is possible, to qualifying individuals; if there is a delay prior to Cu-IUD insertion, immediate oral EC should be offered in addition.
Individuals who do not meet the criteria for emergency IUD insertion, or who decline an emergency IUD should be assessed remotely as to the most appropriate oral emergency contraception, receive both oral EC and a 3 month supply of POP and be given clear written/digital advice about additional contraceptive precautions, when to start the POP, and follow up pregnancy testing. Where possible delay associated with postal delivery of oral EC should be avoided by facilitating collection by the individual.
Combined hormonal contraception (CHC) If the provider documented all relevant medical history at the time of last CHC provision, and no contraindications were identified, provision of a further supply of CHC without review of medical history can be considered. Remote prescription to cover the next 6-12 months. Phone consultation is recommended.
Progestogen only pill (POP) users – reasonable to allow a further 12 month supply to be given without review Phone consultation is recommended. POP is advocated as a bridging method if existing method is not available.
See FSRH guidance for (DMPA) Depo Provera, Etonogestrel Implant (ENG-IMP), IUS & IUD guidance https://www.fsrh.org/standards-and-guidance/documents/fsrh-ceu-clinical-advice-to-support-provision-of-effective/
New contraception starters
FSRH CEU suggests that, as standard, individuals requesting to start contraception can be assessed remotely and a 6-12 month supply of Desogestrel POP provided via remote prescription.*Please note contra-indications.
Please do not give any medicines in excess of what you would normally prescribe for patients.
– the use of repeat dispensing for patients with stable medicinal needs
– maximising the use of ePS
– suspending medication reviews in patients taking medicines that are unlikely to cause frequent significant adverse reactions
Any shock to supplies chains will disrupt normal medicine supplies..
Advise people to make sure they have all have supplies of usual medications.
There is no evidence to use or not to use oral or inhaled corticosteroids outside usual guidelines in COPD patients with COVID19.
Antibiotics should be issued only if suspicion of secondary bacterial infection.
Please do not give “rescue packs” for asthmatics. Asthma should be managed in the usual way.
During the current situation with Covid-19 there are inevitably going to be shortages of various pharmaceuticals. All sectors of the healthcare system are seeing an unprecedented workload and so it is imperative that all sectors appreciate the difficulties that each other are having. There are a long list of medicines that patients receive that do not have an easily substituted alternative and so all possibilities should be explored, before a prescriber is forced to make a change. Examples include, but are not limited to, antipsychotics, DMARDs, anti-hypertensives, antiglyceamics etc.. Patients will often have been stabilised on these medicines over a period of time and so switching will involve both considerable work and also multiple contacts with patients who are ideally self-isolating.
In order to reduce the impact of these stock shortages we would ask both pharmacies and surgeries to work together to bring about a satisfactory solution.
1) Find out how urgently the patient requires the medication. Shortages are often only temporary and if a patient has sufficient stock at home, the product may become available before there is a need.
2) Obtain sufficient information from all suppliers. Do alternative suppliers have products in stock? When is the stock likely to be available?
3) Find out if there is an easy solution. Is a brand or alternative brand available? Are different strengths of the product available that can be doubled-up, cut in half, taken more or less frequently? Is a different suitable formulation of the medicine available? Eg liquid.
4) Do other pharmacies have stock available? This includes pharmacies from other companies, who may use different wholesalers and can order the product.
5) Speak to the prescriber directly. It is not acceptable to send messages with patients who will not have a full understanding of the situation and be unable to answer questions.
1) Talk to pharmacy when contacting about stock shortages.
2) Alter prescriptions accordingly to enable the legal supply of Prescription Only Medicines.
3) Change medicines to suitable alternative brands, formulations, strengths.
The Minor illness Service at Mexborough Urgent Treatment Centre (UTC) has moved temporarily to Doncaster Royal Infirmary (DRI) UTC.
The service can be accessed by calling 111 or by calling 0300 123 3103
The Minor Injuries service will continue, at present, to be provided at Mexborough and can be accessed via attending Mexborough hospital – please note this service is for urgent same day treatment only.
– CPR should NOT be performed on a patient with suspected Covid-19 without appropriate PPE.
– CPR should be treated as an aerosol generating procedure.
– In practice, CPR in primary care will comprise of continuous chest compressions only at a rate of 100-120/min or chest compressions with bag and mask ventilation.
Make sure an ambulance is on its way. If Covid-19 is suspected, tell them when you call 999.
If there is a perceived risk of infection, rescuers should place a cloth/towel over the victims mouth and nose and attempt compression only CPR and early defibrillation until the ambulance (or advanced care team) arrives. Put hands together in the middle of the chest and push hard and fast.
Early use of a defibrillator significantly increases the person’s chances of survival and does not increase risk of infection.
If the rescuer has access to personal protective equipment (PPE) (e.g. FFP3 face mask, disposable gloves, eye protection), these should be worn.
After performing compression-only CPR, all rescuers should wash their hands thoroughly with soap and water; alcohol-based hand gel is a convenient alternative. They should also seek advice from the NHS 111 coronavirus advice service or medical adviser.
Mental Health Services
All referral routes available; including SPA with triage and connection to appropriate services; telephone 01302 566999.
IAPT – Talking Therapies
Remains open; including self-referral routes though telephone 01302 565556
Moved to a revised model of telephone and video support – positive feedback and uptake from patients
Non-geographic model focusing on prioritised need and any wait time variance across Doncaster
Additional on-line resources made available to complement therapy session and support self-care and motivation; alternative approaches to group sessions developed including Doncaster filmed podcast group support sessions; additional capacity coming on stream throughout the year.
Self Help & Staff Support Resources
Existing and new resources are available; both locally and nationally for those in need of Mental Health support
For patients and staff, a range of Mental Health top tips and useful links to websites and services including IAPT, Samaritans and Every Mind Matters are available here
AMPARO are offering online Self-Referral Bereavement services or by calling 0330 088 9255; or Listening Ear South Yorkshire and Bassetlaw Bereavement helpline service on 0800 048 5224 / email@example.com
The NHS has launched a mental health hotline as part of a package of measures to support NHS staff; 0300 131 7000 is open between 7am and 11pm every day, with a text service available 24/7 by simply texting FRONTLINE to 85258
Further staff resources available at https://people.nhs.uk/help/.
Crisis / Unplanned
Crisis Resolution and Home Treatment continue to operate and bolstered by recent investment; including face to face assessment
Third sector support continues to operate – Safespace complements and supports first line crisis response and The Haven provides telephone support (contact Rethink on 0808 801 0442) and step-up bed capacity for patient crisis plan management
Enhanced acute psychiatric liaison team in place at Doncaster Royal Infirmary, including additional resource across psychiatry, psychology, nursing and drug / alcohol therapy.
Mental Health Inpatient Care
Mental Health Acute adult and older adult capacity remains available to support planned and unplanned admission for functional and organic Mental Health care
All admissions are swabbed and isolated in line with guidance, with an enhanced focus on patient flow between health and adult social care.
Remote telephone monitoring linked to patient prioritisation in place to limit face to face exposure; face to face support and assessment still available where necessary
Community clinic operation continues for necessary face to face contact e.g. clozapine
Third Sector structured Mental Health Delivery
A range of non-commissioned Mental Health counselling and support services continue to operate with modified delivery to remove face to face COVID risk
Additional national and local funding sources have been made available for third sector organisations to access, such as increased counselling capacity, extended peer reach.
Dementia Post Diagnostic Support
Third sector collaborative of six local third sector organisations continues to provide support
Group sessions ceased with resource redirected to provide telephone support, advice and guidance; Dementia Post Diagnostic service is operating via telephone; 01302 796066, direct email for referrals can be sent to firstname.lastname@example.org.
Suspended / Partial operation
ASD and ADHD assessment is currently suspended – service recovery date being considered
Physical assessment locality clinics for people with a diagnosed psychosis – direct face to face clinic predominantly suspended; suspension recovery commencing, initially with telephone support and education
Dementia Diagnosis – non urgent diagnosis suspended with full service recovery linked to availability of imaging diagnostics.
Doncaster LMC – Essential Covid 19 resource hub