The current situation with COVID-19 is causing unprecedented demand across the entire health and social care system in Northern Ireland.
We need to take steps to ensure that this demand does not overwhelm our ability to deal with patients suffering from other ailments. In general practice, this means we need to protect staff from contact with patients with COVID-19 and direct triage of COVID-related presentations to newly established dedicated COVID centres.
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 that will still arise. 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 will operate
They will be staffed by GPs and helped by other members of staff, including nurses, health care workers etc. More staff may be added from other sectors if necessary.
They will 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 will be told to wait in their car until phoned to come in to prevent any crowding or grouping of patients.
Do we have adequate PPE?
The simple answer to this is yes. We have taken extensive advice on what is needed for this clinical situation.
There will be surgical masks, visors, disposable aprons and gloves provided in the covid centres. You will also be allocated scrubs which you will change into at the beginning of a shift and out of at the end of a shift. FFP3 masks are currently only required for invasive, 'aerosol' creating interventions such as intubation and not for direct patient assessments.
Read our FAQs about PPE.
Where COVID centres will operate
They will be hosted by the Trusts and operate in each Trust area. The actual location and number differs between Trusts depending on geography.
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.
If, as demand rises, the COVID centres require any additional sessions, these will be funded, and where professional goodwill and integrity will hopefully come in.
Is it compulsory to work in the centre?
The expectation is that everyone works together to deliver this. It will be nearly impossible for a practice to deliver the same, safe service without the use of the COVID centre, and there is an inevitability that some practices will begin to struggle considerably and there will need to be a mechanism to support them.
Any practice not participating will need to establish a separate agreement with HSCB with regard to their contract requirements, opening times and assessment facilities.
Why can’t I just see my own patients and then send them to A&E?
The projections show that practices will be overwhelmed very rapidly, and on the current trajectory, hospital beds and ICU beds will be filled in a very short time. Triaging a number of patients to hospital will simply not be possible. If every practice in Belfast was to send one patient to hospital per day that might have been dealt with elsewhere, this will completely overwhelm the system.
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. Every UK country (and beyond) is arranging mechanisms to separate these groups of 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 will be tightly controlled, the spacing and air circulation in rooms and connecting areas will be managed, the cleaning will be frequent, appropriate and robust, and PPE and scrubs will be provided.
Finally, we need to keep the practices clear for other medical need, and to sustain them in the short, medium, and long term. There is little doubt that practices will struggle and look to close in the challenging times ahead, and we need a mechanism to protect and absorb them in the short term so that they are still viable when we get to the end of this.
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.
How coordination will work
Your federation has been asked to create the rota and you should link in closely with them regarding the rota.
How the finances will work
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 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).
Scotland opened their own COVID hub assessment centres on in March and Wales has introduced COVID Local Assessment Centres with the same purpose. 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.
I'm a retired doctor - can I help out?
Retired doctors are very much welcome to help with the current situation and the Northern Ireland Department of Health has set out some guidance on this.
I have a health condition - what should I do?
There are a range of triage roles which will be vital in the work to deal with COVID-19. Speak with your local federation in the first instance about which roles require filling in your area.
If you have any questions about COVID centres in Northern Ireland, please get in touch with us by email.
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