At the beginning of the pandemic we needed to take steps to ensure that COVID demand did not overwhelm our ability to deal with patients suffering from other ailments. In general practice, this meant we needed to protect staff from contact with patients with COVID-19 and direct triage of COVID-related presentations to dedicated COVID centres.
All practices will have received a letter from HSCB updating the position and the commitment expected of practices in relation to the COVID centres.
Practice commitment will now be only in core hours and at a much reduced number, consistent with the very welcome reduction in cases presenting. The level of OOH cover will vary depending on the base, but is entirely optional.
The initial plan and timing of setting up the COVID centres was a response to an emergency situation and the response from primary care across Northern Ireland was impressive. There is now also a plan to explore the option of practices providing their own cover which will initially be explored with a small group of practices.
What is a COVID centre?
A COVID centre is a separate facility created as an extension of primary care to help direct suspected COVID positive patients for assessment.
This keeps practice free to deal with any other medical problems. Triage will still occur at the practice most likely via phone and enable referral to the centre if required.
There are three categories of patient that might be assessed at a COVID centre:
- COVID positive and clinically worsening patients needing assessment: there will also be direct pathways for investigation and/or admission from the centre
- diagnostic uncertainty: symptoms similar to COVID but might be something else ranging from tonsillitis to meningitis but need an assessment to exclude or confirm
- patients being discharged from hospital: this group will grow with time but on many occasions will still have a need for clinical assessment and follow up.
How COVID centres operate
They are staffed by GPs, helped by other members of staff, including nurses, health care workers etc.
They run from 8am to 10pm and see patients after triage and referral (by CCG) from the practice.
Patients can either be seen in their car outside the centre if a straightforward examination is needed, or brought into the centre for assessment. They are told to wait in their car until phoned to come in to prevent any crowding or grouping of patients.
Centres are hosted by the trusts and operate in each trust area.
What PPE is supplied?
Surgical masks, visors, disposable aprons, scrubs and gloves are provided in the COVID centres. FFP3 masks are currently only required for invasive, 'aerosol' creating interventions such as intubation and not for direct patient assessments.
Read our guidance on PPE.
How practices should contribute
Practices are expected to commit to providing support to COVID centres as part of their contracted healthcare delivery, from 8am to 6pm, Monday to Friday. In addition, general practice needs to provide cover in COVID centres at weekends and also in the evenings from 6pm to 10pm. This is the delivery of necessary healthcare but provided centrally as this is felt to be safer.
Each practice will contribute one session per 1000 patients per week, which will be allocated across the entire 7 day period. For sessions which fall at weekends, or on Monday to Friday evenings, practices will receive funding. If a practice is unable to fulfill its allotted position, it can arrange a local arrangement with another practice or engage a locum to do it.
You should link in closely with your federation regarding the rota.
There is an expectation of the practice ‘donation’ as described above as this will take a significant amount of work out of the practice and all other elements of our contract have been stopped to help facilitate this. Any additional sessions will be paid separately.
Why can’t I just see my own patients and then send them to A&E?
The projections showed that practices could have been overwhelmed very rapidly.
Also, and crucially, we have a duty to provide safe practice. Mixing 'hot' and 'cold' patients has been shown to be unsafe for doctors, staff and patients. We have a duty to protect our doctors and our patients, and every practice seeing positive, or potentially positive, patients does not do this.
In a COVID centre, the flow and number of patients is tightly controlled, the spacing and air circulation in rooms and connecting areas is managed, the cleaning is frequent, appropriate and robust, and PPE and scrubs are provided.
Finally, we need to keep the practices clear for other medical need, and to sustain them in the short, medium, and long term.
HSCB is developing a plan to pilot a model of in practice assessments. More detail will be available on this soon.
Back-filling time or sessions at the COVID centre
Local flexibility is key. There is no expectation that you will leave your practice without any doctors. Any shifts should be worked out around the times that suit you and your practice. There will be an inevitable reduction in staff in the practice at a given time, but this will be outweighed by the reduction in workload and risk.
Why has Northern Ireland adopted this approach?
The COVID centres have been a collaboration between the Northern Ireland Department of Health, the Health and Social Care Board, the RCGPNI and NIGPC. It has followed recommendations as issued by the WHO (World Health Organisation 2020 - Operational considerations for case management of COVID-19 in health facility and community).
Wales and Scotland also opened their own COVID hub assessment centres. There is flexibility in how each practice can contribute their element to it, which we have insisted on with the board.
By directing patients to COVID centres we can enhance the facilities, staffing with MDT and ensure that training and equipment levels (especially for PPE) are maximised.
If you have any questions about COVID centres in Northern Ireland, please get in touch with us by email.
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