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Primary Care guidance

6 April 2021

Guidance for Primary Care Professionals on the Isle of Man

All primary care practices are to remain open for the provision of health care until further notice but operating with a closed door policy. This is to prevent patients from accessing the health services without first being asked the relevant Covid-19 questions below. This guidance updates previous guidance and sets out the processes that GPs, dentists and opticians should follow during this phase of the Covid-19 response.

During this phase:

  • Primary Care Practitioners should continue to be vigilant for potential cases of Covid-19
  • Ensure that they work to the current SOP which details the specific ways in which Practices should work for each area of Primary Care.
  • Consistently comply with the PPE guidance provided by DHSC

Contents

General guidance

Social distancing, workplace hygiene and good hygiene practices 

Practices will be expected, within their premises, to adhere to the guidelines currently in place. Guidance is available on the Social distancing and good hygiene page

Providing treatment to patients

Every patient within GP Practices, Optical Practices and Dental practices should contact their Practices initially by phone. Patients will need to be asked the Covid-19 questions, set out below, to identify whether the patient is high or low risk, and dealt with accordingly as below.

A record of every patient/visitor to the practice must be kept which includes the patient/ visitor’s name, contact telephone number, arrival and departure time.

The approach for each of the profession is set out below:

Dental Services

  • Practices should remain open with a closed door policy and continue to telephone triage every patient prior to offering appointments.
  • All services can continue but clinicians and nurses should wear the appropriate PPE for every patient contact as per the PPE guidance.
  • Guidance to be followed and Covid-19 questions asked on initial triage and upon entering the dental practice for their planned appointment and for any parent/guardian also attending.
  • All staff to wear a mask and to ensure patients entering the building also wear a mask, with social distancing and handwashing facilities in place.
  • Each practice should be working with the appropriate and safe fallow times for their individual surgeries when delivering any treatments via AGP (Aerosol Generated Procedure).
  • Stringent cleaning schedules should be undertaken in line with Infection control guidance
  • Service provision – Business as usual. 

Orthodontics (Hospital)

  • Consultant Orthodontist will continue to travel to the Island on a monthly basis under exemption and conditions.
  • Guidance to be followed and Covid-19 questions asked on initial triage and upon entering the practice for their planned appointment and for any parent/guardian also attending.
  • Full PPE will be worn by Consultant, measures already in place and daily testing
  • Administrator will be in attendance during clinics and will wear a mask at all times
  • Parents/Guardians attending with children are to wear a mask and be made aware of social distancing and handwashing before and after appointments
  • Stringent cleaning schedules should be undertaken in line with infection control guidance
  • Service provision - Business as usual.

Orthodontics (Primary Care)

  • Orthodontic treatment will continue as normal. Practice should remain open with a closed door policy and continue to telephone triage every patient prior to offering appointments.
  • Guidance to be followed and Covid-19 questions asked on initial triage and upon entering the dental practice for their planned appointment and for any parent/guardian also attending.
  • The appropriate PPE will be worn by the Specialist Orthodontist as per the PPE guidance.
  • Parents/Guardians attending with children are to wear a mask and be made aware of social distancing and handwashing before and after appointments.
  • Stringent cleaning schedules should be undertaken in line with infection control guidance
  • Service provision - Business as usual.

Dental Laboratories

  • Can open for the provision of health care services but operating with a closed door policy.
  • Maintaining social distancing, wearing a mask at all times with any patient or staff contact.
  • Guidance to be followed and Covid-19 questions asked of any person prior to entering the dental laboratory to ensure they are low risk.

Opticians 

  • Opticians to remain open with a closed door policy with the appropriate social distancing in place.
  • Opticians to be vigilant to ensure that a limited number of patients are allowed in the Practice at any one time and that can safely socially distance.
  • Guidance to be followed and Covid-19 questions asked on initial triage and upon entering at the optician practice for their planned appointment and for any parent/guardian also attending.
  • High risk patients should not be seen but if a high risk patient has an emergency there is a route via Nobles Emergency Department and patients should be redirected accordingly.
  • All staff to wear a mask and to ensure patients entering the building also wear a mask, with social distancing and handwashing facilities in place.
  • There is no requirement for fallow time between patients.
  • Stringent cleaning schedules should be undertaken in line with PPE guidance.
  • Service provision – Business as usual.

MEDS

  • Out of hours GP service will run as normal with a closed door policy with relevant measures in place for staff.
  • Guidance to be followed and Covid-19 questions asked on initial triage and upon arriving at the practice for their planned appointment and for any parent/guardian also attending.
  • All admin staff that are not front facing, including the MEDS Manager, will work remotely where possible.
  • High risk patients should be treated by a AAA approach.  When a high risk patient needs to be examined, facilities will be available to do so.
  • A record of every patient/visitor to the practice must be kept which includes the patient/visitor’s name, contact telephone number, arrival and departure time.
  • Service Delivery – Business as usual.

General Medical Services

  • Practices should remain open with a closed door policy.
  • Guidance to be followed and Covid-19 questions asked on initial triage and upon arriving at  the  GP  practice  for  their  planned  appointment  and  for  any  parent/guardian  also attending.
  • Patients should be seen either by phone, VC or in person in each of the individual GP Practices. If there is still a requirement for a patient to be physically examined the GP practice can request that the patient is referred for examination in the high risk site (see DHSC Position statement for further information on GP consultations).
  • Any required home visits will be delivered by the GP practice responsible for the patient.
  • Running of the CATCH sites will be subject to GPs being prepared to man them or GP practices will take responsibility for operating solely from their own practice.
  • Service Delivery – Provision of general medical services 

GP Action follow up after covid questions

  • GP’s will be able to refer patients directly for swabbing if they fit the appropriate criteria. The process for this will be re-circulated to GPs this week. 111 will confirm that they’ve received the referral email. When a patient is referred for a swab by the GP the GP should request that the patient goes/stays home and isolates until further information from 111 regarding their swab.

Covid-19 Questions 

To update the current guidance to reflect the above and update the Covid Questions

suggestion as follows: 

  1. Do you have a new or persistent cough?
  2. Do you have a fever or temperature over 37.8C?
  3. Do you have a change in your sense of smell or taste?
  4. Are you suffering with new shortness of breath?
  5. Have you had contact with a person who has tested positive for COVID-19 in the last 21 days?
  6. Have you travelled off-Island in the last 21 days?
  7. Is there anybody currently in your household isolating? 

Supplementary Questions for dental and optical:

  • Have you had a Covid Test on days 1, 6 and 13? 
  • Negative results? Can be seen as ‘low risk’ from Day 14 onwards if the answer is yes,  consider  as  ‘high  risk’  if  the  answer  is  no  and  treat  via  AAA  approach  where possible. If high risk patient needs to be seen appropriate facilities are already available to ensure patients are seen safely.

Risk Assessment 

Each Practice will carry out and document their own risk assessments in line with their insurance and regulator guidance for all elements of the Practice.

PPE & Further General Guidance

Appropriate PPE will need to be used as per the Primary Care, Community and Social Care settings for PPE (link available at the top of this guidance).

  1. Make safe arrangements for patients to collect any prescriptions, or assisting with getting medications to a patient if they are unable to collect their prescription themselves (or have someone collect it on their behalf).
  2. Keep appropriate records of all patient contacts, including care management and onward referrals.
  3. Ensure any onward referrals are made via the appropriate electronic referral template. This will require patient details, medical history, medications and COVID-19 status plus the presenting complaint, diagnosis and treatment request.
  4. Ensure, if face to face consultations take place at the practice, that strict decontamination policies have been followed and adhered to, before and after every patient has attended who has or is suspected to have (after examination) Covid symptoms.
  5. Ensure all staff are equipped with the appropriate and correct PPE if undertaking any face to face consultations with Covid symptomatic patients. 

Primary Care Back Office Functions

Will continue unaffected with most staff being required to work from home. Contact telephone numbers and email remain unchanged. 

Key worker status / on Island health and social care staff

All clinicians and staff working in the above primary care environments should be identified as key workers and therefore afforded support, for example by the hub schools.

Also see the following guidance on our Public Health Guidance page:

  • GP standard operating procedure (SOP) – During potential COVID community Spread
  • Procedures for Operating Dental Services
  • Dental high risk patients – standard operating procedure (SOP)
  • Optical standard operating procedure (SOP)