Sent on behalf of the COVID-19 Primary Care Incident Management Team for Coventry and Rugby, South Warwickshire and Warwickshire North CCGs

In today's briefing we include the latest news stories falling into the following categories:

1. Thank you 
Dear colleagues,
 
We hope you are all continuing to keep safe and well.
 
We can all agree that it has been a very challenging few months. The COVID-19 pandemic has been testing for us all, and we have all had to adapt in more ways than one, both in our professional and personal lives.
 
The numerous guidelines, operating procedures, social distancing measures and the myriad of other considerations we have had to make meant dramatic changes to the way we work, overnight. 
 
We would like to take this opportunity, to thank you and all of your staff, for your dedication and resilience through this immensely difficult period. You have all risen to the challenge and we commend you all for all your hard work so far, and the way you have implemented new methods with such speed, care and professionalism.
 
This has not been at all easy, and we are proud of the way practices have ensured that staff and patient safety have been paramount, adapting to new ways of providing appointments, prescriptions and other services. We recognise the huge amounts of time, effort and planning that have gone into maintaining healthcare appointments for patients, while at the same time keeping yourselves safe.
 
The hard work doesn’t stop now as we head into winter, the largest flu programme ever seen in England and the continuation of the coronavirus pandemic, but we are sure that the way you approach these will be just as robust as they have been so far.
 
Thank you again for all your hard work and efforts so far.
 
Dr Sarah Raistrick
Dr David Spraggett
Dr Imogen Staveley

2. Letter and toolkit from NHSEI on access to services
NHS England and Improvement has written to practices this week asking to ensure that patients are aware of the different ways they can access primary care. To support practices in doing this, they have produced a communications toolkit with messages for you to share on websites, social media channels and answer phones. You can access the toolkit here.

3. 2ww Referrals – Lower GI and Breast
Which forms are new?
On the 9th July the Primary Care Cancer Network launched two new revised and updated Two Week Wait referral forms for both Breast (alongside the Breast Pain Pathway) and Lower GI (with a parallel FIT).
 
What is different with the two new forms?
Lower GI:
The referral form has a dual purpose as it will allow the referring clinician to select the appropriate clinical criteria under NG12 and generate a request to order a FIT test (simply by ticking the box). For further information please refer to the Faecal Immunochemical Test section on the form.
 
Please note: to request a FIT test email the referral form directly to uhc-tr.fitbcs@nhs.net and send as e-referral as a 2 week wait.
 
Please see FAQ’s for further information. 

Here are the links to the documents: 
2WW Breast - blank 
2WW Breast - vision
2WW Breast - EMIS - (WeTransfer link - expires 22 September)
2WW Lower GI - blank 
2WW Lower GI - vision 
2WW LowerGI - EMIS - (WeTransfer link - expires 22 September)

You will now need to fully remove any older versions of the Breast and Lower GI forms from your practice systems and replace them with the new forms. You can find out how to do this here. 

4. Maternity services guidance 
Guidance has been issued to help NHS trusts to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services for both inpatient and outpatient services. You can download it here

5. Children returning to school 
Please see below information regarding children returning to school, which may have an impact on primary care.

School attendance over the first few days has been:

• 90% primary school
• 86% secondary school
• 89% special school

There has been an increase in demand to electively home educate children (approximately 58 in a week, compared to 84 over a month during the same time last year). This could lead to a rise in parents approaching GPs to give them medical grounds as a reason why their child shouldn’t be attending school (although they are not legally obliged to give a reason)

If GPs do have parents talking about wanting to electively home educate on medical grounds, please signpost them to:

• https://www.warwickshire.gov.uk/homeeducation
• 01926 736323
• ehe@warwickshire.gov.uk

Headteachers have been asked to give parents a 2 week cooling off period before removing a child from roll

There has also been an increase in parents demanding individual transport to school, which again could lead to a rise in approaching the GP for medical certification

6. Re-commissioning the Warwickshire Domestic Abuse Accommodation and Support Service - Professionals Survey
Warwickshire County Council and Warwickshire Office of the Police and Crime Commissioner are in the process of re-commissioning the Warwickshire Domestic Abuse Accommodation and Support Service. The service is currently provided by Refuge. 

To inform their Domestic Abuse Needs Assessment, they are carrying out a variety of engagement exercises to understand awareness of Domestic Abuse, their current commissioned service offer, whether it meets need and what can be improved. They are keen to hear the views of as many multi-agency professionals as possible across Warwickshire and would be grateful if you could complete the survey and share this survey with your teams / providers that encounter victims-survivors of Domestic Abuse. The survey should only take around 5 minutes to complete.

To contact the Warwickshire Domestic Abuse Service please call the helpline on 0800 408 1552 or alternatively visit the Refuge website. 

7. Warwickshire CAVA newsletter 
The latest edition of Warwickshire CAVA includes information on what to do if you’ve claimed too much or too little under the Coronavirus Job Retention Scheme, guidance for the safe use of community facilities and free training to support communities to be Covid-19 aware.

UPDATES FOR South Warwickshire – 15 September 2020
Urgent / Emergency Ophthalmology Services
Please download an updated roadmap for patients needing urgent or emergency ophthalmology treatment in south Warwickshire.

For low risk/routine patients please continue to refer to Community Health and Eye Care (CHEC) as normal for triage, virtual assessments and the option of referral to a community optometrist where clinically necessary.

For urgent patients needing assessment quickly please call SWFT during the hours 9-5 Monday to Thursday on 01926 495321 ext 5804 where the patient will be triaged and either booked in for an urgent appointment in Warwick or Stratford, stepped up or down appropriately to CHEC or UHCW, or treated virtually as per clinical need.

For emergency patients please refer to UHCW as usual on 02476 964800 or 02476 964802 or 02476 964806 (Monday to Friday 9am to 7pm) (Saturday, Sunday and Bank Holidays 9am to 12pm) 07823 535 863 (Out of hours) Or email uhcw.eyecasualty@nhs.net Or for Advice and Guidance/ Consultant Connect.

Advice of which conditions are deemed urgent or emergency are detailed in the download.

If you have any queries or questions on this pathway please email megan.isaac@southwarwickshireccg.nhs.uk

This process will be fully audited and assessed over coming weeks and any necessary amendments will be made and communicated as promptly as possible.

Administrators Safeguarding training
Administrators Safeguarding training is now available via Microsoft Teams or in the Practice. The training is six hours long which will be split into three sessions. You can find out more about the training and how to book here

UPDATES FOR Warwickshire North and Coventry and Rugby – 15 September 2020
COVID 19 Urgent Eye Care Service
As part of a National response to COVID-19, an urgent eye care service has been put in place across Coventry, Rugby and Warwickshire North. The service will be delivered by local opticians, acting as urgent care hubs. In Coventry and Rugby the service will be delivered by the existing community based NHS Eye Care Service and the new service will be delivered in Warwickshire North by 2 local opticians.

A full list of Providers and opening times is available here

The service will typically see people presenting with recent onset / urgent eye conditions and for advice to support self-management of less complex eye conditions. Presenting symptoms will typically include; loss of vision (sudden or transient), visual distortion, painful eye, flashes and floaters, red eye or double vision. The service will operate in line with the attached service pathway.
 
Patients can self-present (by telephone) or be referred / redirected from other services for clinical assessment and management.
 
The service will provide initial contract, telephone triage, remote consultations and where necessary assessment and management of recent onset symptomatic / urgent ocular presentations. Through the telephone triage the service will identify patients who have an urgent eye care need and offer a telephone / video consultation with an optometrist or a suitable team member (which may result in the offer of a face to face appointment). Where ‘red flag’ symptoms are identified the patient will be signposted to emergency services, as appropriate.
 
It is expected that the patient will have one of the following outcomes following consultation:

• The practitioner decides to manage the condition and offers the patient advice and/or prescribes/recommends medication. Management may include a minor clinical procedure e.g. foreign body removal.  
• The practitioner refers the patient for an eye casualty / emergency consultation at the local hospital eye service, contacting the service in advance of referral to confirm appropriate referral management and booking if accepted. 
• The practitioner determines the condition (and subsequent referral) is non-urgent and can be safely delayed until following the pandemic. A further appointment is recommended e.g. 4-6 months.
• The practitioner has concerns that the patient may have a systemic condition and makes a referral to their GP.
• The practitioner refers the patient non-urgently for further investigation and/or treatment in line with local referral pathways and protocols. Managing the patient expectations relating to appointment availability in the current pandemic.
• The practitioner refers the patient to another Optometrist in the same service, with higher skills or equipment, where appropriate (for example an independent prescriber or an Optometrist with specialist equipment).

Thanks in advance for your help.

Please note all sessions are open to all localities

11. NHS App and Managing Student Registrations Webinar 
This session ran by NHSX is aimed to provide an NHS App refresher for practice staff and other primary care colleagues. There will also be some shared learning from Leeds Student Medical Practice, who actively promoted the NHS App to the registered practice population in 2019 and now have the highest number of registered NHS App users.
 
This is being done with a view to informing practices on how to take on safe and remote patient registration, specifically among university students in view of the imminent new academic year starting in September.
 
The first webinar took place on 9 September but there is still an opportunity to attend:

Webinar 2 – 16 September 2020, 12:30 – 13:30

Click here to register

12. Medical education sessions for all
CCG supported medical education sessions available to all primary care clinicians to watch on a Wednesday lunchtime, the programme can be found on https://www.mededcoventry.com/General-practitioners. The new term starts on 2 September and links to the Zoom talk will be published on the site under flyers 48 hours before the session. Over the summer, if you want to rewatch any episode go to the GP section and then to Presentations, (log in using covgp for both GMC and password). Any queries, please contact gpteachingadmin@uhcw.nhs.uk​

Please note: we are now issuing the briefing once a week (Tuesday) communications via: warnoccg.covid19primarycarecommunications@nhs.net. We would also ask that if you have questions or concerns relating to the current situation around coronavirus and COVID-19 you use the same address: warnoccg.covid19primarycarecommunications@nhs.net. Please keep us updated with any issues that you may be having so we can try to address them.

Please note that the below data does not include care home data.  

Coventry and Warwickshire COVID position up to 14.09.2020

• 4,801 cases now confirmed in Coventry and Warwickshire (+138 / +3.0% from Tuesday)

8 of these are currently admitted (+6 / +300.0% from Tuesday)
Admissions by Trust:

• GEH: 3
• UHCW: 5
• SWFT: 0
• CWPT: 0

• 365 beds still available (-17 / -4.5% from Tuesday)
• 0 ITU bed(s) occupied by Covid patients (+0 /  from Tuesday)
• 536 reported deaths in a hospital setting (+2 / +0.4% from Tuesday)

Download the weekly data pack.

Latest National Picture

• As of Monday 14 September at 6:27pm:
• the total number of COVID-19 associated UK deaths is 41,637.
• the daily total of 2,621 people tested positive for COVID-19 in the UK, a total of 371,125
• there are a total of 34,556 cases in the West Midlands.
• COVID-19: mental health and wellbeing surveillance report here.
• The latest advice is here.
• Find out about the COVID-19 antibody testing programme here.
• The Prime Minister made a statement on coronavirus (COVID-19) on 9 September 2020 - watch the video or view the transcript.