COVID 19

Please take care of yourselves, families, colleagues, and patients. The GPST Team are here to do what we can to support you, so be in touch if needed. The information on this page was updated today 27th April 2020.

This page includes advice about working during the COVID 19 Pandemic

1. Changes to GP Training and MRCGP
2. Sources of information you should be aware of
3. Advice for patients who think they have COVID 19
4. Guidance for remote consulting
5. Assessing and managing patients who may have COVID
6. Having better discussions about ACPs and DNACRP
7. Palliative Care
8. Other useful clinical guidelines for use during COVID
9. Practical Advice
10. Websites with good general resources for clinical care
11. Employment issues
12. Resources for maintaining health and wellbeing
13. Interesting articles and media programmes about COVID
14. Copies of our news-email
15. Information from Zoom 5 minute skills sessions

1. Changes to GP Training and MRCGP

COVID is resulting in regular changes to GP Training and the MRCGP, for up-to-date advice please read our weekly news-email and refer to the MRCGP and HDR pages of this site.

There is a scheme WhatsApp Group and a national trainee phone group that can be joined via this link https://t.me/joinchat/Oq304EghBIVlaJms9C6oPg

HEE are organising a regular webinar for all trainees at 1pm every Tuesday, you should receive information about this directly

2. Sources of information you should be aware of

Please ensure you receive email updates from your Trust and if you are in Primary Care your CCG. Trainees working in Primary Care in the Vale of York CCG will find a comprehensive list of up-to-date resources on the CCG Website.

HEE (national advice)

HEE (Yorkshire and Humber advice)

RCGP advice

Like us you are probably suffering from anxiety about COVID and information overload. It’s important not to forget your normal clinical skills and knowledge and become overwhelmed with wondering if you are following the right piece of research or guidance. These resources are ones local local clinicians have found useful, we will keep the list updated. Please keep asking your colleagues and CS questions and sharing problems.

3. Advice for patients who think they have COVID 19

• Symptoms of COVID
  • A new high temperature – 37.8 deg or fever symptoms
  • A new dry continuous cough
    • Continuous means
      • Coughing continuously for >1 hour
      • 3 or more paroxysms per 24 hours
  • Other symptoms can include
    • Loss of smell and taste
    • Significant Malaise
    • Coryzal symptoms in children

• Self care advice to patients if are concerned about symptoms
  • DO NOT LEAVE HOME
  • Use NHS 111 Website to assess
  • Only Call 111 if can’t get help online
  • Self Isolate
  • Isolation Med 3 Patients who are self-isolating because of COVID 19 can issue themselves with an isolation note.

4. Guidance for remote consulting

Remote consulting is challenging for the most experienced GPs, so take time to consider what new skills you might need and how you ensure your consultation is safe and effective.

Saying no with confidence An interesting read recommended by Prena ST3

5. Assessing and managing patients who may have COVID

Guidance is changing regularly. You should make sure you keep up to date with current guidance. These resources are listed in order of ones that people have found most useful.

COVID 19: a remote assessment in Primary Care BMJ Article 25 March 2020 Used and recommended by Prena ST3

Red Whale – Clinical Assessment and Management of COVID in the Community (updated 8/4/20)

Red Whale – COVID-19: Standard operating procedures (SOPs) for primary care (updated 15/4/20)

URT examination of children – RCPCH guidance

Managing breathlessness at home a guide for patients recommended by Nicola TPD

Managing patient’s with COVID in General Practice NHS (SOP) Recommended by Chris TPD

6. Having better discussions about dying, ACPs and DNACRP

Talking about death and dying is so important, please watch this short film to understand why.

Remember the distinction between Advance Care Planning and DNACPR. ACP and ceilings of care are ALL about understanding the patient’s wishes, helping them to make informed, realistic decisions about each aspect of care, and doing our best to offer care in line with their choices.  DNACPR – is one aspect of ACP. 

The question is not ‘Do you want to be resuscitated?’  The choice we have is, if CPR might help, would we want it or not?

‘Why we need to think about DNACPR before we talk to patients‘ is such a useful and compassionate article on why we need to talk to our patients about DNACPR, it was written by Dr Kathryn Mannix, a Palliative Care Physician who is passionate to get us all better acquainted with the idea of dying well.

Dr Helen Ward, Leadership Fellow who is currently working to support Palliative Care service in the community in York has written this helpful guide to having difficult conversations

If you want to learn more about good end of life care, ‘With the end in mind. How to live and die well’ by Kathyrn Mannix is the one book you should read and on her facebook page she shares more about her wealth of palliative care experience. 

There are also helpful resources on the CCG website

7. Palliative Care

You only need to remember one phone number to get you through to excellent Palliative Care support in York 01904 777770

8. Other useful clinical guidelines for use during COVID

RCPCH Guide to remote assessment of children this is a really useful guide recommended by Clare TPD

Vale of York CCG advice on COVID and secondary care referrals

Contraceptive Guidance and flow chart recommended by Emma ST2

Radiology Guidance for York Trust Vale of York CCG Website recommended by Chris TPD updated 2/4/2020

9. Practical Advice

Government advice about COVID 19

Med 3 can be created in an electronic format Click for guidance

Indications for wearing PPE Updated 8th April 2020

PPE and how to safely put it on and take it off.

And here is a video guide from RCGP about using PPE

Prioritising GP work

10. Mandatory training resources & websites with good resources for clinical care

Primary Care Pathways

BMJ’s Coronavirus (covid-19) Hub This now has free access to all

RCGP COVID 19 eLearning resource hub

Red Whale are giving free access for 3 months to GPCPD.com to all clinicians.
If you are not currently a GPCPD member, go to gpcpd.com/login_register and enter the activation code RWGIFT
If you are already a GPCPD member, go to gpcpd.com/my-account, choose the ‘Manage your membership/subscriptions’ and enter RWGIFT into the ‘Top up and upgrade codes’ box.
For step-by-step video instructions of how to redeem the code please go to: www.gpcpd.com/activate-your-code.

Resuscitation guidance and e-learning modules can be accessed through e-lfh

Safeguarding – Red Whale CPD online e-lfh and Future Learn all run online courses for Adult and Child Level Three Safeguarding

11.Employment issues

If you work for York Trust and you and/or your household show symptoms of COVID 19 please self-isolate and contact your care group manager to arrange a COVID test. Trainees in a GP post should contact care group 1 manager Vicki Mallows vicki.mallows@york.nhs.uk 07766 990433 to arrange a test. You should also report your sickness absence through the normal reporting process to Medical Staffing and your practice/department.

Medical Indemnity during COVID 19 (NHS Employers)

Advice from NHS Resolution about indemnity during COVID

Pregnancy and COVID 19

• Pregnant Women who work in healthcare should be offered the choice of whether or not to continue in a patient facing role
• Under 28/40 gestation
  • Support women who wish to work in patient facing roles
  • Carry out risk assessments
  • Wear PPE
  • Try to avoid working in areas such as operating theatres, respiratory wards, ICUs with patients with suspected COVID 19 infection 
• Over 28/40 gestation or any gestation with underlying health problems
  • Pregnant women 28/40 or over, or with underlying health problems eg lung disease, heart disease should be recommended to stay at home
  • They may be able to work in a non-patient facing role from home eg telephone triage or administrative duties

Tier 2 Visas

HEE advice for trainees working from home

12. Resources for maintaining health and wellbeing

Taking care of your health and wellbeing is so important that we have created a whole page of ideas and resources to help you cope better in such extraordinary and challenging times. Link

13. Interesting articles and media programmes about COVID

RCGP learning module – Ethical Guidance on COVID-19 and Primary Care recommended by Helen ST3

Radio 4 Inside Health There are 4 further episodes about COVID 19 starting 31/3/2020 and then available on BBC Sounds

Radio 4 More or Less A special programme about COVID 19

14. Weekly news-emails

15. Information from Zoom meeting 5-minute skills sessions