COVID-19 FAQs from members

Please keep your questions coming as they're also helping us populate our COVID-19 FAQs. We have convened a group of GP experts on emergency preparedness to answer these and are also bringing together helpful material from elsewhere to make this the 'go to' resource for GPs. 

Online forum for members to discuss COVID-19

We have setup a discussion forum for all our members where they can talk about all aspects of the COVID-19 (coronavirus) pandemic.

All RCGP members can login with their same member login details they use for the RCGP website and the MyRCGP phone app.

Visit the RCGP COVID-19 forum


Frequently asked questions from our members

Clinical guidance

What do I need to know when interpreting a COVID-19 test?

Read our Testing for COVID-19. What is the current evidence? RCGP, Version 1, 30 June 2020 (650 KB PDF).

The BMJ published Interpreting a COVID-19 test result on 12 May 2020.

What you need to know

Interpreting the result of a test for COVID-19 depends on two things: the accuracy of the test, and the pre-test probability, or estimated risk of disease before testing.

A positive Reverse transcription polymerase chain reaction (RT-PCR) test for a COVID-19 test has more weight than a negative test because of the test’s high specificity, but moderate sensitivity.

Clinicians should share information with patients about the accuracy of COVID-19 tests ensuring patients are counselled about the limitations of tests. This information should make clear that:

  • no test is 100% accurate
  • if your swab test comes back positive for COVID-19 then we can be very confident that you do have COVID-19
  • people with COVID-19 can be missed by these swab tests. If you have strong symptoms of COVID-19, it is safest to self-isolate, even if the swab test does not show COVID-19.

Patients with a single negative test but strongly suggestive symptoms of COVID-19 should be advised to self-isolate in keeping with guidelines for suspected COVID-19.

Read Testing for SARS-CoV-2 antibodies - BMJ, 08 September 2020

When and how do I use PPE?

Read our blog post Infection control and PPE in primary care: summary of new guidance August 2020 - 25 August 2020

Read COVID-19 personal protective equipment (PPE), Public Health England.

See Recommended PPE for primary, outpatient, community and social care by setting, NHS and independent sector, issued jointly by Public Health Wales, Public Health Agency Northern Ireland, Health Protection Scotland, Public Health England, NHS England and the Academy of Medical Royal Colleges, 8 April 2020, Version 1.

Read RCGP Guidance on masks and face coverings in primary care, 3 July 2020 (298 KB PDF).

England 

Infection prevention and control (IPC): Guidance on infection prevention and control for COVID-19, Public Health England.

Guidance on supply and use of Personal Protective Equipment (PPE) and other supplies, NHS England.

Watch Putting on and removing Personal Protective Equipment in Health and Social Care Settings, Public Health England and NHS England, 2 April 2020 (YouTube).

Northern Ireland

Guidance for HSC staff on using PPE, Public Health Agency, Northern Ireland.

Scotland

Review of national and international guidance on infection prevention and control measures for Personal Protective Equipment (PPE) and Aerosol Generating Procedures (AGPs) for COVID-19, Health Protection Scotland. 

Watch Correct order for donning, doffing and disposal of Personal Protective Equipment (PPE) for healthcare workers (HCWs) in a primary care setting, Health Protection Scotland.

Wales

Information for Health and Social Care professionals, Public Health Wales.

Advisory Note - Housing, health, social care and support settings: Examples to inform implementation of the COVID-19 Infection Prevention and Control guidance – including use of Personal Protective Equipment (PPE), Public Health Wales.

Evidence

What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? The Centre for Evidence-Based Medicine, 30 March 2020.

What is the efficacy of eye protection equipment compared to no eye protection equipment in preventing transmission of COVID-19-type respiratory illnesses in primary and community care? The Centre for Evidence-Based Medicine, 3 April 2020.

Rapid Review of the literature: Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings, Health Protection Scotland, 1 June 2020

How can I set up remote consultation and triage systems?

Are NSAIDs contraindicated in cases of COVID-19?

Patients can take paracetamol or ibuprofen when self-medicating for symptoms of COVID-19, such as fever and headache, and should follow NHS advice if they have any questions or if symptoms get worse.
 
The NHS previously advised that, in the absence of evidence, paracetamol should be used in preference to nonsteroidal anti-inflammatory drugs (NSAIDs). However, on 14 April, the Medicines and Healthcare products Regulatory Agency (MHRA) expert working group on COVID-19 concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other NSAIDs, and susceptibility to contracting COVID-19 or the worsening of its symptoms.

Read the government response to the Commission on Human Medicines advice on ibuprofen and coronavirus (COVID-19).

How do I manage patients with musculoskeletal and rheumatic conditions who are on corticosteroids?

Clinical guide for the management of patients with musculoskeletal and rheumatic conditions on corticosteroids during the coronavirus pandemic, British Society for Rheumatology and others, 16 June 2020 (247 KB PDF).

Management of patients with musculoskeletal and rheumatic conditions who are on corticosteroids, require initiation of oral/IV corticosteroids, require a corticosteroid injection. Supported by the British Society for Rheumatology, British Association of Orthopaedics, British Association of Spinal Surgeons, Royal College of General Practitioners, British Society of Interventional Radiology, Faculty of Pain Medicine, British Pain Society and Chartered Society of Physiotherapy, 16 June 2020. 

What should we be doing about Advanced Care Planning and COVID-19?

It is important to ensure that personalised care plans are as up to date as possible, in particular for patients who are frail or have multiple co-morbidities. 

England

Royal College of General Practitioners Joint statement on advance care planning, with the British Medical Association, Care Provider Alliance, Care Quality Commission, 1 April 2020. 

Ethical guidance

Royal College of General Practitioners Ethical Guidance on COVID-19 and Primary Care.

Royal College of Physicians Ethical Guidance published for frontline staff dealing with the pandemic, 31 March 2020.

Clinical indemnity

Existing indemnity arrangements, for example state indemnity schemes, private medical defence organisations or commercial insurance policies, will continue to apply to cover you for any activities connected to the care, treatment or diagnosis of patients in direct response to COVID-19 or as an indirect consequence of COVID-19.

The Coronavirus Bill, passed by the UK Parliament on 24 March 2020, will ensure indemnity cover is provided to you where existing indemnity arrangements do not cover clinical negligence arising from the provision of such services. This includes business-as-usual activities that GPs (included returning GPs) and their teams may be asked to carry out as a consequence of COVID-19, as well as those activities that may sit outside the scope of usual day-to-day practices.

Please refer to NHS Resolution’s website to find out more on the:

 

Specific populations and contexts

Children and young people: What guidance is there?

Read Paediatrics top tips: COVID-19 relating to children and young people (513 KB PDF), September 2020, RCGP.

Read Covid in children: Infection rates, common presentations, transmission via children and symptoms of Atypical Kawasaki disease (PIMS-TS), 26 May 2020, COVID-19 Primary Care. 

England

Read the Shielding update: Letter to the NHS, 8 July 2020, Department of Health and Social Care and NHS England.

Read the letter to parents and guardians about test and trace in schools (PDF), 23 September 2020, PHE and NHS Test and Trace. 

Pregnant women: What do I advise pregnant patients and staff?

Immunosuppressed patients: What do you advise for immunosuppressed patients?

It is likely that those who are immunosuppressed are at higher risk.

If they develop symptoms consistent with COVID-19 then advice should be sought from their specialist team. Patients should continue any current treatment they are on unless advised otherwise (in particular long-term steroids). 

In primary care every effort should be made to carry out consultations remotely to avoid transmission. In secondary care it is likely that many outpatient appointments will be changed to remote consultation, patients should wait to be informed about this. 

Specific Cases

Learning disabilities and autism: How can I support patients with learning disabilities and/or autism in the current pandemic?

The impact of social distancing, isolation and loss of routine is particularly hard for people who rely on additional support, and regular care staff, and people who find it hard to understand why this is happening to them.

Remote consultations

Remote consultations may be appropriate in some circumstances, but people with learning disabilities often have complex health conditions and issues of capacity and consent may mean a face to face consultation is more appropriate.

Advanced care plans

Completing advanced care plans (ACPs) is complicated by the need to assess capacity to consent and the need to involve significant others (such as care staff and family) in any decisions. 

Guidance on capacity and consent:

Deprivation of liberty

An urgent deprivation of liberty (DOL) authorisation can be applied for. It is valid for up to seven days. It must be accompanied by a request for a standard authorisation. DOLs can only be used to safeguard the person to whom it applies, not to safeguard others.

Clinical decision making and the frailty score

NICE updated its guidance on using the Clinical Frailty Scale (CFS) for people with COVID-19 on 25 March 2020.

The guidance states that the CSF should not be used for people with learning disabilities or autism. An individualised assessment should be made, and clinical decisions should be person-centred and in line with shared decision-making policies.

Admissions

People with learning disabilities and autism should be admitted to hospital if there is a clinical need. They should be accompanied by one carer, if needed, in line with local hospital policy. 

To help communicate with the clinical teams, there is a useful grab and go guide to support people who do not have a full hospital passport, to give hospital staff information about the patient’s learning disability.

Learning disability annual health checks

Remote health checks could be used to triage, and assess the need for, and safety, of a face-to-face appointment. Remote reviews are unlikely to be adequate for a full annual health check.

More information

Hearing loss: What do I need to consider when consulting with patients with hearing loss?

When consulting with a patient with hearing loss, be aware that communication is easier when both the patient and clinician can see facial expressions, body language and the context. As hearing deteriorates, these are increasingly important. 

Listening with hearing loss involves more complex processing by the hearing centres, leading to slower responses and increased fatigue. Errors of understanding can be commonplace.

Loss of hearing is usually progressive and subtle. Many people are unaware of their difficulty. By the age of 60, around 30% of people have mild to moderate hearing loss. Between the ages of 70 and 79, the majority of people (60%) have this problem. Most patients in care homes have serious hearing loss.

Telephone versus video consultations
  • Telephone conversations may be difficult for people with hearing loss, particularly when using landlines which usually have a limited range of frequency.
  • Most patients with hearing loss will prefer video consultations over telephone consultations. Ask patients how they prefer to communicate.
Conducting the consultation
  • Does the patient have a hearing aid? If they do, is it switched on and working?
  • Face the patient so they can clearly see your mouth.
  • Speak clearly. Avoid shouting or speaking unnecessarily slowly.
  • Use normal lip movements, facial expression, and gestures.
  • Use plain language and be straightforward.
  • Rephrase what you are saying if the patient asks you to repeat something or does not understand what you have said.
  • Check the patient understands what you have said by asking them to repeat information. Check the patient’s understanding several times during the conversation, not just at the end.
  • Give patients more time to assimilate what you have said, and time to ask you to repeat. 
  • Reduce background noise as much as possible.
  • If requested, speak to a relative or friend.
  • For severely affected patients, use video relay services such as those on the Action on Hearing Loss communication support pages
Other considerations
  • Ensure the patient’s records have hearing loss flagged up for both reception and clinical staff.
  • Making an appointment by phone will be difficult for people with hearing loss. Ensure patients know they can make appointments online.
  • People with hearing loss generally appreciate online access to services. At your practice, publicise NHS 111’s online coronavirus service – it’s not well known to the public. 
Further advice

Care homes: What is the responsibility of GPs delivering care in care homes during COVID-19?

GPs are working hard to care for all our patients during the COVID-19 outbreak. This includes the most vulnerable patients in society, living in their own homes and those in community-based health and social care facilities. 

As GPs, we are still here for them, whether their home is a nursing home, learning disability home or any other type of care home, it makes no difference. We work very closely with this group of patients, and we know them and those who look after them very well.  

As with all patients at the current time, general practice is triaging requests for care from community-based health and social care facilities via telephone and video calls. For the safety of our most vulnerable patients, and to minimise the risk of clinicians carrying the COVID-19 virus into these facilities, we will provide high-quality care remotely wherever possible. Following clinical triage, if any patient needs further assessment, the primary care team will ensure this happens based on the clinical needs of the patient. 

As GPs, we treat all of our patients with the same care, compassion and personalised approach. Discussions regarding individual patient choices over what treatment they want and where they want to receive that treatment are held regularly. Decisions on referring patients into hospital care, both in terms of non-COVID-19 illnesses and COVID-19 (where appropriate) remain a core part of our role during this period. With every illness, including COVID-19, decisions can be made with patients to be treated in their ‘home’ or transferred to hospital if that is necessary.  

COVID-19 does not change these discussions. If their choice is to stay at home, we will continue to look after them, ensuring they are comfortable and cared for throughout their illness, ensuring the best possible care is given to aid recovery or to ease suffering in the event the illness is a terminal one.  
 
The British Geriatric Society (BGS) has issued a clear statement on changes to care for older people living in care homes during the pandemic and the RCGP supports and endorses these recommendations. 

We are working on a joint statement with the Care Quality Commission, the British Medical Association and the Care Provider Alliance, which outlines our position on a number of key issues facing general practice and adult social care. A link will be provided here once this has been published.

More information 

What advice is available to patients for whom English is not their first language?

Asylum seekers and immigrants will have to be advised to self-isolate in the same way as others. We are contacting relevant authorities about how to achieve this. There is translating guidance available in many different languages.

More information

Find further guidance and the latest clinical resources on the RCGP COVID-19 Resource Hub.

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