In order to prevent spread and reduce demand on practices, there are several measures practices can take to reduce footfall.
- Move to total triage for all patient contacts.
- All routine appointments (provided by all healthcare staff) to be converted into telephone triage appointments or remote assessment (could be online via forms/video), with appropriate follow-up provided at the practice if clinically required.
- Convert all online booking slots into online bookable slots for telephone triage where possible. If not possible, disable the functionality and triage through another route.
- All fit notes/letters requested to be sent electronically. Failing that, they will need to be posted to the patient. Patients must not be encouraged to pick them up from practice. Evidence for COVID-related absence from work will be provided by NHS 111 or will be waived by the employer.
- In England, electronic prescribing is the default method of prescriptions. Patients who do not have a nominated pharmacy should be asked to do this. If rarely paper is required, then it must be collected by the pharmacy. Pharmacies to limit visits to the practice and arrange set visiting time.
- Electronic repeat dispensing should be increased, and practices should not be prescribing more than would normally be prescribed (this might seem perverse but will assist with medication supply).
- Any patients with long term conditions that are concerned about a deterioration in their condition to contact the surgery for telephone or online assessment.
PPE (personal protective equipment)
The wearing of masks by staff and face coverings by the public will play a role in preventing the spread of infection so that patients and visitors can attend practices without fear of contamination. It will also reduce the risk of a whole team within a practice being required to self-isolate should one member contract COVID-19.
All those carrying out face-to-face consultations should have appropriate PPE. No face-to-face consultation should take place with potentially COVID-infected patients if there is no adequate PPE.
PHE guidance recommends that those working in reception and communal areas who are unable to social distance, should wear a fluid repellent mask.
Patients should be encouraged to wear face coverings whenever they attend the practice (with practices continuing to use triage arrangements to keep face-to-face contact to a minimum).
Staff should continue to be enabled to work remotely whenever possible, to create more space for social distancing.
CCGs and NHSE/I should also fund perspex screens wherever needed to protect staff and reception areas.
In Scotland, additional supplies for practices can be arranged as and when required through your board’s single point of contact for PPE.
Supplying face mask exemption letters to patients
Practices are reporting increases in requests from patients for letters of exemption to wearing face masks in various public settings.
In England, you must by law wear a face covering on public transport and in shops and supermarkets as of 24 July 2020.
The Government guidance suggests there is no requirement for evidence for exemption. It should be sufficient for someone to declare that they are eligible for an exemption direct with the person questioning them (eg bus driver).
Practices are therefore not required to provide letters of support for those who fall under the list of exemptions, or to those who do not fall under the list of exemptions.
GP practices need to avoid crowding and minimise opportunities for the virus to spread by maintaining a distance of at least two metres between individuals wherever possible.
Some options might include:
- reducing the number of people in waiting rooms
- spacing out chairs in waiting rooms/staff rooms
- marking off a two metre area around reception and other contact points
- where it is feasible, placing plexiglass barriers at points of regular interaction, such as at reception
- the use of laptops and remote access to practice systems enabling home working for staff
- continued use of telephone and video consulting.
Limiting the spread of coronavirus
GP practices should help reduce the spread of coronavirus by reminding everyone working or visiting the premises of the Government’s public health advice, by the use of posters, leaflets and other materials.
Employees and patients should be reminded to wash their hands for 20 seconds more frequently than normal, while practice staff should frequently clean and disinfect objects and surfaces that are touched regularly.
Where it is not possible to maintain a safe distance (such as in small consulting rooms) practices should consider the use of appropriate PPE for staff and patients.