COVID-19 - Practical things for general practice to do

12 March 2020

Over the next few weeks and months the NHS and general practice in particular are likely to be considerably challenged by the large number of patients with COVID19 (Coronavirus). Information from our Italian GP colleagues is that hospital services are under considerable pressure and the same applies to general practice. RCGP is working hard to support, members, practices and NHSE England and equivalent in Devolved Nations in preparing for what may be around the corner.

Understand the science

The science of COVID-19 is that the R0 (reproduction number) is thought to be 3, so every person infects 3 people and they each infect a further 3 etc. This is why it is such a problem. Seasonal flu is 1.6 and measles (probably the most infectious) is between 12 and 18. The Case Mortality Rate (CMR) is thought to be around 1% as compared to seasonal flu of 0.1%. There are considerable concerns regarding patients who are elderly, have co-morbidities or are on immunosuppressive treatment. CMR for patients who contract COVID19 and are over 80 years old is thought to be around 15%, compared with seasonal flu of around 10%. 

Covid-19 BMJ inforgraphic for primary care staff
BMJ visual summary: COVID-19 in primary care (UK) - Download the latest version from the BMJ website

Practical things general practice can do

In the surgery:

Hygiene is key

Everyone needs to wash their hands on entering the building, between patients and before examinations. Desks need to be cleared of clutter and cleaned. Use disposable ear pieces and thermometer covers. Taking measures on hygiene is probably the most important message.

Telephone triage/video consultations will be really important

Surgeries that do mainly face to face should access the training that is available on how to do safe telephone consultations. Test the equipment now and make sure everyone knows how to use it.

Work as a group of surgeries

Liaise with other surgeries in your neighbourhood and work out how you might support each other if a significant number of members of staff become unwell.

Test remote working for staff

This will be key for GPs in particular if they are in self isolation as it will allow them to work. Ensure that remote prescribing is possible as well as consulting.

Advise the patients to ring the surgery, not come in if they have flu like symptoms

Consider whether you might be able to bring patients who need a face to face assessment through a different entrance to a different consulting room. 

If you have a branch surgery, could you use that location?

Identify staff members who have long term medical problems such as on immunosuppressives.

As best as possible move them to non-patient facing roles.

Triage all requests for home visits as requests are expected to rise

Utilise electronic prescribing as much as possible to reduce the “footfall” through the surgery.

In accordance with CCG/Health Board guidance consider doing any chronic disease management remotely if possible.

This would be especially those with respiratory conditions such as COPD or asthma.

Don’t over prescribe

If everyone gives out long prescriptions we will run out!

Appoint a COVID19 lead for the surgery

A key role is keeping up to date on developments and making sure that everyone is aware of guidance. This is regularly updated on the basis of changes in patient numbers etc.

For the patients:

Identify those who would be at highest risk now

These maybe those in nursing or care homes or the housebound or on high doses of immunosuppresants such as oral steroids. As appropriate, ensure that special patient notes used by GP out of hours and ambulance services are completed, that as needed ReSPECT/DNCPR procedures are filled in and as needed prescribe “just in case” medication.

Consider stopping on line booking

Patients will likely ask about what they can do to prevent becoming unwell

Actions can include:

  • Advise on hygiene including regular hand washing in accordance with national guidelines.
  • Advice on routine immunisations such as seasonal flu and pneumococcal vaccine and potentially shingles, depending on the patient’s level of immunosuppression.
  • Advice on how viruses and bacteria are frequently transmitted and how to avoid them.
  • Provide advice on when and how to access medical care, if needed.

Dr Jonathan Leach, Joint Honorary Secretary

Dr Jonathan Leach is a GP in Bromsgrove Worcestershire. Jonathan originally pursued a military career for 25 years and worked around the world in the Army, being promoted to the rank of Colonel in 2002. Posts included clinical, managerial and academic roles including Professor of General Practice and Director of GP Education as well as providing medical support for UK operations overseas. Since returning to the NHS in 2008, he has had senior executive positions including medical director and director of primary care for Worcestershire and associate medical director for NHS England.

Contact us

RCGP members can email our dedicated Covid-19 inbox with feedback and questions.

Email: Covid19@rcgp.org.uk

Latest updates

Have a look at our dedicated Covid-19 page for the latest news, updates and resources.

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