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NHS advises ‘total triage’ for practices

NHS England has issued advice for practices to move to a 'total triage' service and undertake care remotely wherever possible.

Dr Nikita Kanani, NHS England director of primary care, wrote to practices last week, in an email, seen by Pulse, saying practice staff should go home and isolate if a well coronavirus case appeared in their surgery.

If an unwell coronavirus patient comes into a practice, staff should use personal protective equipment (such as gloves, an apron and mask), as per the Public Health England guidance, Dr Kanani urged. The patient should also be isolated, treated if acutely unwell or asked to leave the room and ring 111 if they are not acutely unwell.  

She wrote: ‘Practices should start moving to TOTAL triage system (whether by phone or online); undertaking all care that can be done REMOTELY through remote means, being guided clinically and we will support those decisions.’

Practices should also agree which sites and staff could manage face to face assessments of any possible Covid-19 cases, Dr Kanani said. 

The NHS England director finished her letter saying: “Thank you for your incredible commitment and patience in this rapidly evolving situation.”

See the full email below: 

Advice for today

[12 March]

As you can imagine the new case definition has meant a huge amount of guidance needs updating. This will follow over the course of today and the weekend.

The following from the information commissioner is helpful.

For today, and the weekend please use the following as a crib:

⁃ anyone with a continuous cough OR fever (>37.8) must self isolate for 7 days (this includes children)

⁃ travel history is now irrelevant

⁃ anyone with these symptoms who is WELL can just stay at home and does not need to ring 111 or be tested

⁃ anyone with these symptoms who is UNWELL should go to 111 online for advice, they must NOT go to the GP, 111 will assess and advise

⁃ information on new testing policy to follow

⁃ this applies to staff as well as patients

If a possible case appears at the surgery :

WELL

⁃ go home immediately and self isolate

UNWELL

⁃ use PPE as per PHE guidance for possible cases i.e. gloves, apron, mask

⁃ isolate the patient

⁃ if acutely unwell treat

⁃ if not then ask them to ring 111 from the room and leave

⁃ decontaminate as per the SOP

In the meantime, practices should start:

⁃ Moving to TOTAL triage system (whether by phone or online)

⁃ Undertaking all care that can be done REMOTELY through remote means, being guided clinically and we will support those decisions

⁃ Agreeing locally which sites and staff could manage face to face assessments of any possible COVID-19 cases

⁃ Agreeing locally a plan to support patients who are particularly at risk of COVID-19 complications, including considering co-ordination of their care if in future advised to stay at home

⁃ Confirming business continuity plans, with a view to cross practice resilience

Again, thank you for your incredible commitment and patience in this rapidly evolving situation. Nikki

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