Living Guide

Immediately life threatening

1. Practices need to continue to diagnose non-Covid-19 life threatening conditions. This should be carried out remotely wherever However, examination may be required and, if so, this should be arranged according to our key principles (Ways of working).
2. There are clinical indications for calling 999. However, with increased demand on ambulance services, and consequent likely increases in wait We would suggest that clinicians utilise the LAS health care professionals line (London Ambulance Service).
3. The Resuscitation Council has produce guidance for cardiac arrests in the general practice setting stating that chest compression can take place wearing non-AGP PPE but ventilation should not take place without AGP PPE. Please review the full guidance here.

Conditions for which delay in investigation or treatment would be clinically unacceptable

1. Practices will need to continue to be distinguish between serious and benign illness, through remote consultation wherever possible.
2. Patients should limit their journeys and If face to face appointments and urgent bloods are required, practices should consider offering this during single visit, limiting any wait times, wherever possible.
3. If there is doubt whether a referral is warranted during this time of suspension of routine care timely advice and guidance should be sought.
4. GPs should continue to make two week wait (2WW) and urgent referrals.
5. The policy remains that providers receiving referrals may not downgrade urgent cancer referrals without the consent of the referring primary care professional.
6. Cancer referral pathways have been amended in some areas with GPs being encouraged to undertake some investigations prior to Healthy London Partnership has a cancer resource with the latest guidance.
7. As part of the response to fewer people being diagnosed with cancer due to the pandemic both the QOF and PCN DES early cancer diagnosis modules have been reinstated, please see our guidance for more information.

Febrile children

1. Children presenting with febrile illness will present a unique challenge to practices this winter.
2. Current data suggests that the number of febrile children who are suffering with Covid is low in comparison to the numbers presenting with febrile illness.
3. Practices need to consider how to safely remotely assess febrile children and how they determine who needs further assessment and whether this should be in primary or secondary care.
4. Please review the full guidance here which includes a practice presentation and useful links for both clinicians and parents.
5. This has been summarised as a quick reference flow chart.