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.

Questions and feedback from members

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

If your practice has experienced any difficulties in implementing the current guidance or protocols, please let us know so we can provide feedback to the relevant authorities.

Email: COVID19@rcgp.org.uk 

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?

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.

How do I deal with a patient who has flu symptoms and needs an appointment?  

Where possible, telephone or video assessments should be a first step in a risk assessment.

Please see our FAQs on setting up video consultations and triage systems for further advice on this. 

There is guidance on triage and new ways of consulting in our COVID-19 Resource Hub. Learn more on triage and new ways of consulting for clinical management in primary care.

If a face to face assessment is considered necessary, refer to the latest guidance for primary care in your area.

England

Read NHS England's Coronavirus: Standard operating procedures for primary care settings.

Scotland

Read the latest version of Health Protection Scotland's COVID-19 - guidance for primary care.

Wales

Read (COVID-19) Interim Guidance for Primary Care, management of patients presenting to primary care, published by Public Health Wales.

Northern Ireland

Read NHS England's Coronavirus: Standard operating procedures for primary care settings.

When and how do I use PPE?

In suspected cases that meet case definition (read the guidance from Public Health England and guidance from Health Protection Scotland) then face-to-face assessment in primary care (including out-of-hours centres and GP hubs) must be avoided if possible. 

If contact is unavoidable, with confirmed or suspected cases, the appropriate PPE should be worn at all times. (See below for latest guidance on use of PPE.)

It should be noted that Public Health England states that:

“For primary care, ambulatory care and other non-emergency outpatient settings (including hospital outpatient clinics) plastic aprons, FRSMs [fluid resistant surgical masks], eye protection and gloves should be used for any direct care of possible and confirmed cases. Such PPE may be indicated for work in such settings regardless of case status, subject to local risk assessment.

Latest guidance on use of PPE

Latest joint guidance on COVID-19 infection prevention and control has been produced by the Department of Health and Social Care, Public Health Wales, Public Health Agency, Northern Ireland, Health Protection Scotland and Public Health England.

England 
COVID-19 personal protective equipment (PPE), Public Health England.
COVID-19: infection prevention and control (IPC) Guidance on infection prevention and control for COVID-19, Public Health England.
– Watch the video COVID-19 acute respiratory disease: putting on and removing personal protective equipment (PPE) - a guide for health and social settings, NHS Public Health England (YouTube).

Northern Ireland
COVID-19: What is the situation in Northern Ireland? Public Health Agency, Northern Ireland.

Scotland
Coronavirus (COVID-19), Health Protection Scotland.

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

For further specific devolved nation guidance please refer to the latest guidance in your area.

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.

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.

Download Rapid Review of the literature: Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings, from Health Protection Scotland, 3 April 2020.

Research: review of personal protective equipment provided in health care settings to manage risk during the coronavirus outbreak, Health and Safety Executive 

Ramadan and COVID-19. What should I tell patients and staff members?

Ramadan began on Thursday 23 April and ends on Saturday 23 May 2020. There are many questions raised by patients and colleagues regarding advice during Ramadan relating to COVID-19. 

For clinicians


The British Islamic Medical Association has produced a rapid review of evidence and recommendations on fasting for people with respiratory and cardiovascular disease. 

The Oxford Centre for Evidence-Based Medicine (CEBM) has reviewed evidence on the effect of fasting with symptoms of COVID-19.

Its report concludes that there are: “No specific studies on fasting in the context of COVID-19. There is no evidence to suggest an adverse effect of fasting on healthy individuals who have previously fasted safely. However, patients with fever and prolonged illness due to COVID-19 can become severely dehydrated. Such patients should be advised to discontinue their fast and ensure adequate hydration”. 

For patients

Derbyshire General Practice task force has a patient information video with 5 Top Tips for Ramadan and a version of the video in Urdu.

What do you advise for immunosuppressed patients?

It is likely that those who are immunosuppressed are at higher risk. Because of this they would fit into the category of people who should take particular care to minimise social contact, regardless of age. Current government guidance is that such people should be largely shielded from social contact until the 11 May 2020. As for everyone, these patients should adhere to normal precautions as advised by their national public health body for avoiding transmission. 

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

What do I advise pregnant women?

Because COVID-19 is a new pathogen, its effect in pregnancy is not fully understood. As a precaution, current government guidance is that all pregnant women should be largely shielded from social contact until the 11 May 2020. There is currently no evidence of increased risk to mother or baby.

Is there any guidance as to whether steroids are harmful-or useful-in the initial stages of infection with COVID-19?

Patients on long-term steroids are likely to be at 'high risk'. Should a patient on long-term steroids become unwell then these should not be stopped abruptly and advice should be sought from their specialist team.

  • Advice on long-term steroids appears under the heading 'Should patients cease their medication as a precaution?' The British Society of Rheumatology.

What guidance can you give on seeing children?

From the evidence we have so far, children with COVID-19 appear to be less severely affected compared to adults. As with all patients, children should be triaged prior to any face to face consultation. Every effort should be made to avoid a face to face assessment if clinically appropriate to avoid transmission. If a face to face assessment is unavoidable and a case of COVID-19 is suspected then usual infection control measures should be employed. Extra care should be taken to assess for symptoms in any accompanying adults before seeing face to face. Parents should be advised that the child and their household should follow self-isolation guidance as usual and as best they can.

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).

What should I do if a patient requests a longer prescription?

We know patients may be concerned about access to regular medication. We encourage you to move patients to electronic repeat dispensing (eRD) where possible, as this gives colleagues in community pharmacies more flexibility in managing the medicines supply chain, as well as helping to reduce workload.

Please do not increase the length of prescriptions, as this is likely to undermine the medicines supply chain.

Should I carry out tonsillar examination in children, if so do I need to wear PPE?

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.

Read Top tips for GPs caring for care homes (634 KB PDF).

Find resources on care homes on the RCGP COVID-19 Resource Hub

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

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

The consultation

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.

Practice management

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

RCGP have released a joint statement with the British Medical Association, Care Provider Alliance, Care Quality Commission.

Ethical dimensions of COVID-19 for front-line staff

The Royal College of Physicians has published (31 March) ethical guidance for frontline staff dealing with the COVID-19 pandemic, supported by more than a dozen other health organisations including RCGP.

What about staff who are pregnant?

Where epidemiology identifies special risk groups we will expect GPs to receive bespoke advice and that may include protective isolation.

Currently there is no indication that pregnancy carries any additional risk to the mother to be. Coronavirus (COVID-19) infection and pregnancy advice from Royal College of Obstetricians and Gynaecologists

What guidance can you provide on staff who become unwell or who are following social distancing?

Any staff member who has possible coronavirus should follow the normal stay at home guidance:

Staff who become unwell and are self-isolating should be supported in working from home if they are able/willing/well enough to do so.

We advise that staff who are following social distancing SHOULD NOT be working in patient facing roles and priority should be made for them to work remotely if possible. Some staff, such as those with severe underlying conditions such as cancer or previous transplant, are at particular risk and they are advised to stringently follow the latest social distancing rules. It is likely that this group will be contacted individually in the coming weeks with further guidance.

At what point should I consider closing my practice? 

This should only be done in consultation with the local CCG or Health Board, or relevant national public health body depending upon the reason you may think this appropriate, for example, lack of clinicians or mass contamination.

Staff and wellbeing

How do I reduce the risk to NHS staff at risk of COVID-19 infection?

Read the Faculty of Occupational Medicine Risk reduction framework for healthcare staff.

The framework supplements the risk assessment of staff, particularly of high risk and vulnerable groups, to ensure staff safety, and is to be used in conjunction with the NHS Employers guidance.

Should I self-isolate if family members are?

Current guidance is that if a member of your household develops symptoms consistent with the case definition of COVID-19 then the entire household should self-isolate for 14 days.

Will there be access for healthcare staff to be tested if they become symptomatic or have contact with a suspected case?

The College appreciates there is a legitimate demand for testing of staff to reduce the need for self-isolation. The College is working with the government to make this possible however due to capacity for testing this is unlikely to be in place in the next few weeks. It is possible that a new point of care test may become available in the future. Current guidance is that you should continue working unless you develop symptoms, in which case you should adhere to the latest guidelines on self-isolation.

Training and licensing

What is the RCGP's policy on appraisals?

The RCGP has created resources related to the impact of COVID-19 on appraisals.

Will the College allow me to take my exams?

Updates will be posted on our main MRCGP page.

I’m retired, working in a non-clinical capacity, or working less-than-full-time. How can I provide (more) clinical care or support those doing so?

As a fully-qualified and experienced GP who has either temporarily or permanently left the primary care workforce, your expertise and experience will be valued beyond measure at this challenging time. Wherever and however you can help, you are needed.

The GMC has contacted doctors who have come off the GP register within the last three years, regarding emergency re-registration. More information on this process, including how to contact the GMC if you have not heard from them, can be found on the GMC website.

Devolved healthcare bodies have begun contacting GPs who are not currently on the Medical Performers List, or who are on the MPL but not working in a clinical capacity, or working less-than-full-time (e.g. as a locum or retainer), to ask them whether they would be willing to provide (additional) clinical care, or to support those providing clinical care in some other way.

More information on the process for returning doctors, and on what roles could look like, can be found by following these links.

We expect the process of contacting possible returners may take some time, and that some doctors who wish to contribute may not have been contacted (for example because they have been retired for more than three years, or because their contact information has changed). If you wish to support these efforts in any way, and have not been contacted by Friday 27 March, please contact the relevant national body.

We know national bodies are processing many enquires at the moment, so please be patient.

Each of doctor must decide how they wish to respond to this request, if at all. The College will continue to support all its members, whether or not they feel able to offer additional service at this time.

As a trainee, if I need to self-isolate, how will I be able to make up time?

It is important that trainees, as with all staff, strictly follow self-isolation guidelines. The College will be working closely on issues related to COVID-19 and its impact on training with other bodies including Health Education England and the General Medical Council. We will update trainees when we are able to provide more information.

Money and Indemnity

If as a locum I need to self-isolate, is there a way to protect my income?

As a locum GP you are self-employed which means that you are responsible for covering your own sick pay, unless you have negotiated this in your terms and conditions. If you have an income protection plan or critical illness cover then these may be relevant so be sure to check your policy. If you have an independent financial advisor then you may want to contact them for individual advice.

The government announced in the budget some changes for those that are not eligible for statutory sick pay. For example, the self-employed or people earning below the Lower Earnings Limit of £118 per week, can now more easily make a claim for Universal Credit or Contributory Employment and Support Allowance.

Will I need to adjust my indemnity arrangements?

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 about the Clinical Negligence Scheme for Coronavirus.

You can also find further guidance on indemnity cover during this period on the NHS England website. 

 

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