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Practices told to cancel routine appointments and move to ‘total triage’ as Covid-19 chaos continues

by Costanza Pearce
16 March 2020

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Primary care leaders are advising general practices to cancel routine appointments and online bookings amid unprecedented demand during the Covid-19 pandemic.

This comes as NHS England suggested practices start ‘moving to TOTAL triage system (whether by phone or online)’ and ‘undertaking all care that can be done REMOTELY through remote means’.

LMCs in Cambridgeshire and Derbyshire issued advice to their practices on Friday (13 March) to suspend routine appointments.

Lancashire and Cumbria LMC is advising practices to triage patients remotely, but is not advising practices to suspend routine appointments.

Peter Higgins, chief executive of Lancashire and Cumbria CCG, told Management in Practice’s sister publication, Pulse: ‘I’m not doing it and it’s not because I don’t think they should do that, but what I’m pressing for is a local tactical operational group working across the whole health system that will advise when it’s appropriate to do what.’

Meanwhile, Doncaster CCG authorised practices in its locality to ‘completely’ switch off online bookings if that was their ‘preferred approach’.

In an email the CCG sent to practices, which was seen by Pulse, it said measures could include:

‘Switching off online appointment booking completely if this is the practice’s preferred approach

‘Accepting prescription requests by telephone where the patient isn’t willing to register for/able to use online services

‘Moving an increasing amount of clinical care to telephone/video/online consultations where this is safe to do so and within the competence of clinicians

‘Changing your Proactive Care service to a predominantly telephone-based service alongside suspension of routine face to face external MDT meetings. As well as releasing capacity this should help reduce risk of rapid spread to a particularly vulnerable cohort of patients who don’t have a pressing clinical need

‘The previous point also relates to other proactive in-reach work such as routine ward rounds with care homes for the same reasons. Practices will need to agree with the care home managers how clinical input and support to these homes will continue during this period.’

The chief medical officers of all four UK countries said that expectations on routine GP services will be relaxed if the spread of coronavirus becomes a ’significant epidemic’ in the UK.

Meanwhile, GPs have been forced to draw up their own emergency plans amid a lack of guidance from NHS England on how to manage patients turning up with respiratory symptoms.

As of 9am on 15 March 1,372 cases of Covid-19 had been confirmed in the UK. Thirty-five patients who tested positive had died.