New guidance has been issued for the use of the Oxford AstraZeneca Covid-19 vaccine.

This follows further reviews by the independent regulator, the MHRA, and the Commission for Human Medicines, of a very small number of people in the UK who have developed a rare blood-clotting condition since having the Oxford AstraZeneca Covid-19 vaccine.

The MHRA and Joint Committee for Vaccinations and Immunisations have emphasised that the risk of this condition is extremely small and that the benefits of the vaccine outweigh the risks for the vast majority of people.  They have recommended that:

• Everyone who has had the AstraZeneca vaccine should still have a second dose of the AstraZeneca vaccine, irrespective of age, unless they have had a blood clot or have an existing risk of thrombosis (blood clotting)
• People aged 30 and over or who have a health condition that puts them at higher risk of severe Covid-19 disease should still be offered the Oxford AstraZeneca vaccine. The benefits in protecting them against the serious consequences of COVID-19 outweigh any risk of this rare condition.
• People aged 18-29 who do not have a health condition that puts them at higher risk of severe Covid-19 disease will be offered an alternative Covid-19 vaccine where available. (This has been recommended as a precaution as people under 30 are at less risk from Covid-19 and not because they are considered to be at particular risk of developing the rare blood clot.)
• People under 30 can still choose to have the Oxford AstraZeneca vaccine if this will mean they can be protected more quickly and they have been made aware of the guidance.

 Please see the leaflet below that has been produced by Public Health England and the NHS to answer any questions you may have

 Leaflet on COVID-19 vaccination and blood clotting

We have been having increasing numbers of calls from patients wishing to book for the COVID vaccine which is tying up our already busy phone lines for patients trying to arrange an appointment with a clinician.

Vaccinations in England started on 8 December and across Staffordshire, care home staff, those aged 80 years of age and over, as well as NHS staff considered to be a risk will be offered vaccination in line with JCVI recommendations, and we are now rolling out vaccines in care homes.

We’re working hard to roll out the vaccines to priority groups and we ask people not to contact the surgery or any other part of the NHS directly to arrange a vaccination, our teams will contact those who need one when the time is right.

If you feel your employment in health or social care puts you in a higher risk category then please email the surgery on tustall.primarycare@nhs.net with details of your employer and job role and we will update your records accordingly.

In the meantime, please continue to follow all the guidance to control the virus and save lives

We are expecting a high demand for flu vaccinations this year and so we encourage people to get vaccinated as early as possible.

Our clinics for adults over the age of 18 will be held from Saturday 3^rd October 2020 onwards.

WHO IS ELIGIBLE FOR THE FLU VACCINATION THIS YEAR? 

• People under the age of 65 with certain medical conditions
• Adults 65 and over (as of 31st March 2021)
• Pregnant women
• Children aged 2-11 years - Children aged 4-11 years will be vaccinated in school settings
• Unpaid carers
• Family members of people who have been shielding from coronavirus - We do not yet have vaccines for this group. We will contact this group of patients when we receive further information from NHS England regarding this.
• Over 50 and under 65 without a long-term condition - We do not currently have vaccines for this group. We understand that vaccines for this additional group are being organised by NHS England. We await information on when these will be available. This is outside of our control but we will communicate with this group of patients as soon as we receive further information about this.

  BOOKING YOUR APPOINTMENT

• Please contact the practice to make your appointment. You can do this as follows:
• Please call the practice on 0300 123 0978 after 12pm to make your flu vaccination appointment.
• Appointments will be offered when the surgery is closed to other patients or at the surgery quietest times
• Appointments will be offered at Tunstall Primary Care Centre on the ground floor
• There will be a one way entry and exit system in place
• Appointment times will be spaced to ensure social distancing can take place
• We will be providing a barcode for each patient who has an appointment; this will either be sent by text, email or by post after your appointment has been made

KEEPING YOU SAFE  

• Staff will be wearing personal protective equipment (PPE)
• Please wear a face covering
• Please arrive promptly, at your appointment time
• Please wear clothing that ensures your arm is ready for the vaccination e.g. a short sleeve top, with any jacket / coat / jumper removed whilst you wait
• Please cancel your appointment as soon as possible if you are unable to attend – these clinics are extremely popular and this means we can offer the slot to someone else
• Please do not visit the practice if you have a fever, cough or have lost your sense of taste or smell Please cancel and rearrange your appointment if you have any of these symptoms
• Please note you will not be able to use our toilet facilities when attending your flu vaccination appointment
• Please bring an umbrella with you as you may be required to wait outside of the practice
• Please note the practice will be unable to deal with any other matters e.g. prescription requests, appointments etc. during the flu clinics

As of the 24th of July wearing a face covering in shops and supermarkets in England will become mandatory. Please ensure that when wearing a face mask or face covering that you are wearing it correctly and covers your mouth and nose. 

Practices are reporting increases in requests from patients for letters of exemption to wearing face masks in various public settings. 

The Government guidance suggests there is no requirement for evidence for exemption. It should be sufficient for someone to declare that they are eligible for an exemption direct with the person questioning them (eg bus driver). 

Practices are therefore not required to provide letters of support for those who fall under the list of exemptions, or to those who do not fall under the list of exemptions. 

Some transport providers are providing evidence of exemptions themselves; see for example this information from First Bus and Arriva using the links below: 

https://www.firstgroup.com/help-and-support/coronavirus-information/face-coverings 

https://www.arrivabus.co.uk/travel-help-and-accessibility/how-to-obtain-assistance-cards/

The wearing of face masks and coverings will be mandatory in our GP practice from Monday 29th of June.

Anyone entering the building for an appointment is required to wear a face covering. This can be anything from a surgical mask to a scarf wrapped to cover the mouth and nose.

Please only attend the surgery if you have been asked to by a member of staff, ensure that you attend your appointment on time and not early and remember your face covering!

Please click this link  or on the picture opposite for advice on how to make a cloth face covering https://tinyurl.com/ybf6rawr

Looking after your mental and physical wellbeing during these difficult and worrying times can be difficult.

This page lists some resources which might be helpful, whether you already have a mental health condition or are just feeling the strain of recent events. Please click on the links for further information.

Please note this is not an exhaustive list.

• Mental health support for our NHS colleagues dealing with the Coronavirus Outbreak – NHS England
• Every Mind Matters: How to look after your mental wellbeing while staying at home - NHS
• Looking after your mental health during the coronavirus outbreak – Mental Health Foundation
• Coronavirus and your wellbeing – MIND

• Coronavirus information for people affected by dementia – ­Alzheimer’s Society
• Coronavirus and young onset dementia – Young Dementia UK

• Resources about Coronavirus – Mencap
• Explaining Coronavirus for people with Learning Difficulties – Surrey & Borders Partnership NHS Trust
• I think I have Coronavirus – Surrey & Borders Partnership NHS Trust
• Explaining social distancing for people with Learning Disabilities – Surrey & Borders Partnership NHS Trust
• Anxiety and your body – Surrey & Borders Partnership NHS Trust
• Five things to do when feeling anxious – Surrey & Borders Partnership NHS Trust
• Five seconds breathing exercise – Surrey & Borders Partnership NHS Trust
• Balloon breathing exercise – Surrey & Borders Partnership NHS Trust
• Breathing exercise using your imagination – Surrey & Borders Partnership NHS Trust
• Explaining mindfulness and the 5 things exercise – Surrey & Borders Partnership NHS Trust
• My relaxing place exercise – Surrey & Borders Partnership NHS Trust

• Advice for parents during coronavirus - Royal College of Paediatrics and Child Health
• Children's guide to coronavirus - the Children's Commissioner
• Talking to your children about coronavirus – Young Minds
• Looking after your mental health while self-isolating – Young Minds
• Supporting young people's mental health during periods of disruption - Anna Freud National Centre for Children and Families
• Guidance for parents and carers on supporting children and young people’s mental health and wellbeing during the coronavirus (COVID-19) outbreak - Public Health England
• Newsround: Your coronavirus questions answered - BBC
• Helping children cope with stress during the Coronavirus outbreak - World Health Organization

In line with NHS England and Public Health England advice, we have made big changes to how we serve our patients. This has not been an easy decision but unfortunately is needed at the moment to protect our patients due to Coronavirus and the risk of this being passed to patients whilst in the Practice.

For many, coronavirus will be a mild illness and the NHS is focusing its efforts on those most unwell and affected by the condition.

Thank you for your understanding and please be assured that our aim is to protect you and your families. We will also continue to update this page with further details.

Please remember we are still here for you and happy to be contacted.

The NHS is open, general practice is open and here to support you. #HelpUsHelpYou

Stay at home if you have coronavirus symptoms – these are either:

• A high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
• A new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
• Loss of, or change to, your sense of smell or taste

To protect others, do not go to places like a GP surgery, pharmacy or hospital. Stay at home.

Use the NHS 111 online coronavirus service if:

• You feel you cannot cope with your symptoms at home
• Your condition gets worse

Use the 111 coronavirus service by clicking here

Only call 111 if you cannot get help online.

Get an isolation note to give to your employer by clicking here

For the following queries, please see here

How long to stay at home

• If you have symptoms
• If you live with someone who has symptoms
• If you have symptoms and live with a vulnerable person

Testing for Coronavirus:

At Tunstall Primary Care, like other GP surgeries, we cannot test for coronavirus.

If you have symptoms of coronavirus (COVID-19), you can ask for a test to check if you have the virus. This is called an antigen test. You can request this by clicking here

There is another type of test (antibody test) that checks if you've already had the virus. This test is not widely available yet. You can find out about antibody testing on GOV.UK.

For general information on the Coronavirus infection please review the information on the NHS website by clicking here

Appointments at Tunstall Primary Care

All on the day requests to see a clinician will be a telephone triage consultation first with the clinician deciding if the patient then needs to be seen, which may be by video consultation or we may ask you to send a photo if it helps decision making.

This is to ensure that patients with infectious symptoms do not inadvertently pass these infections to our patient population. There is great difficulty as some patients may not have symptoms but still be carrying the virus.

People entering the building

• We are taking steps to minimise the number of people entering the site to ensure that this is limited to people that enter our practice site to protect our patient community.
• We ask that you only enter the building if you have been invited to attend by a clinician and have had a telephone triage in the first instance.
• Our Packmoor Medical Centre Site currently remains closed to patients.
• All consultations will now be by telephone unless you have specifically been told otherwise.
• If any clinician wishes to see a patient face-to-face, this will need to be discussed and agreed first with a clinician first to ensure that this is only done in exceptional circumstances.
• For those few patients given a face-to-face appointment (following their telephone consultation) :
• Please arrive on time for your appointment
• Please observe social distancing in our waiting room on the rare occasion there may be more than one patient there.
• Please attend you appointment on your own, or if you are bringing a child please limit the carers with that child to 1 person.
• Please wear a face covering at all times.
• Please use the hand gel available when entering and leaving the building

Thank you for your co-operation.

Home Visits

Home visit requests are to be put on the system as normal but patient/carer/care home will be advised that the doctor will call first to telephone triage and decide if a visit is needed/appropriate. You can imagine our service is under tremendous pressure at the moment so please do not be disappointed if we give you advice over the phone or sign-post you to the 111 service.

Repeat Prescriptions

The NHS has asked us not to organise more than 1 months’ worth of prescriptions at a time for routine medications as this will cause supply problems for the NHS and mean that patients may miss out.

Repeat Prescription requests can now also be made over the phone until further notice. Please ring 0300 123 0978.

You can also order your medications via your pharmacy and by emailing us: tunstall.primarycare@nhs.net

On-line services

Please use the Online Consult service available on our home page (no in person registration required - this can be done via the internet) if possible to reduce the load on our phone system as it is the safest and most structured way of seeking online help.

You can request medical certificates, get self-care advice and also seek information on medical problems. Please click here for the direct link.

Results

We aim to discuss results with patients over the phone rather than a face to face appointment where possible. Even if referrals are needed, these will be further discussed with patients over the phone where possible.

Letters from specialists / other providers

On a daily basis we receive several hundred letters from the hospital and other services that help our patients. Normally we would call you in to discuss letters or you would come to see us to discuss a letter. We will now try to call you to discuss letters where needed or may send you an SMS message regarding this.

Referrals

We will continue to refer patients for further care as we would normally do however due to the pressure on the NHS in the current circumstances, you may wait longer than normal for your appointment. We ask that you continue to bear with us at this time.

Procedures

Postnatal medicals – these will be booked in to coincide with your baby’s 8 week injections. Our practice nurse will normally ring you to arrange the appointment, this will enable you to minimise the time spent in the surgery.

Contraceptive appointment requests

• Oral Contraception – A telephone consultation to be made with a GP or nurse. We may ask you to monitor your blood pressure and phone us with the readings if you have the ability to do this at home.
• Non Oral Contraception – A telephone consultation to be made with a GP or nurse and you will be triaged before a face to face appointment is made.

Paid medicals

We normally complete medicals for the DVLA and for patient’s employers. The DVLA have suspended their usual checks due to the coronavirus. We will try to help our patients with employment matters but please remember that our priority will be your health rather than your employment.

Minor operation assessments and actual procedures

Any already booked will be cancelled and no new appointments will be made until advised otherwise

Continuing/New Fit Notes

These can be arranged over the telephone with a clinician and will be sent to you electronically.

“Fit Note”: We have had employers asking patients to come to the practice for a “fit note”. A fit note does not exist. Please advise your employer of this. Each employer has their own responsibility to ensure that you are ready to return to work and they should follow their own procedures for this. We also cannot provide proof that you have not had Coronavirus.

Blood tests

All walk-in services for blood tests have been suspended at this time. All blood tests are by appointment only and can be booked by calling 01782 674242, these telephones are exceptionally busy and we do not have access to the booking system. Patients will have to arrange these appointments personally.

Long term condition clinics

We are finding alternative ways to get information to allow us to continue to monitor and help you with your long-term conditions. We are currently contacting suitable patients to carry out their reviews remotely, either by telephone or video call.

Extended Access Sessions

All appointments will be prioritised for ring backs or video consultations, these will be utilised to support our patient’s needs.

PROCEDURES

NHS England has asked that we review and postpone many procedures during this COVID season.

Ongoing Care:

Implant and coil insertion – the expiry dates have been reviewed and extended by one year as per national specialist advice.

Nibedo (Testosterone) and antipsychotic depots– These to be carried on as normal

Stitches removal - To be continued as normal but with planned surgery reduced we expect less consultations for this.

Wound care – This will be continued but we may need to assess whether the patient or a carer could take over the dressings at home to minimise the risk to patients.

Childhood Immunisations – To Continue as normal.

Reduced Care:

Dopplers - These are tests on circulation. Only Urgent Doppler’s will be performed.

ECG’s – Only Urgent recordings will be requested by the GPs. Any pre-booked will be assessed to see if they can be cancelled.

Cancelled procedures: if you are very concerned by your cancellation, please call for a telephone consultation and explanation.

Smears

Any patients who need 6 monthly or yearly smears as they had a previous abnormal smear will continue. Any new symptoms such as bleeding would need to be investigated in a different way and therefore a phone consultation may be needed.

Vitamin B12 Injections

Patients who receive vitamin B12 injections will all be reviewed by our Practice Pharmacist reviewing their records. Where possible we will be trialing an oral tablet form of B12 and recheck of levels where appropriate.

Travel Vaccines

These will be assessed on an individual basis, please book a telephone appointment with the Practice Nurse to discuss this.

We wanted to clear up a few of the frequently asked questions our reception team are dealing with.

Who needs to isolate/sheild for 12 weeks?

All ‘extremely vulnerable’ patients are advised to isolate/sheild for 12 weeks. There has been some confusion as to who falls into this category. Generally speaking, if you are eligible for an NHS flu vaccination for any reason, this puts you in the ‘at risk’ category but not necessarily ‘high risk’.

Every patient is different and if you feel your medical history makes you vulnerable or high risk, the decision to isolate for 12 weeks is one you need to make yourself. Our advice to patients would be to read the online information from reliable websites (111/NHS/GOV UK). Don’t rely on receiving a letter to tell you to isolate, as these are only being sent to a specific group of people (detailed below)

What is meant by ‘shielding’?

Shielding is a measure to protect extremely vulnerable people by minimising interaction with others. This means that those who are extremely vulnerable should not leave their homes, and within their homes should minimise all non-essential contact with other members of their household.

I haven’t got a letter, will I be receiving one?

The letters do not come from general practice, they are sent by NHS England. The groups defined as “extremely vulnerable” who should have received the letter are:

- Solid organ transplant recipients.

- People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer.

- People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment.

- People having immunotherapy or other continuing antibody treatments for cancer.

- People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or Parp inhibitors.

- People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.

- People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.

- People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID and homozygous sickle cell).

- People on immunosuppression therapies sufficient to significantly increase risk of infection.

- Women who are pregnant with significant heart disease, congenital or acquired.

Can I have a sick note for my isolation period?

No, we are not issuing sick notes for any isolation reason. 111 website can issue sick notes for those isolating due to symptoms of COVID-19 or a household member having symptoms of COVID-19. Sick notes for other reasons continue being issued as normal.

Can I rebook my cancelled appointment for a couple of months’ time?

At the moment, all routine checks are suspended and we do not know when this will change. We therefore cannot book anything at this time but all patients whose annual reviews have been cancelled, will be contacted if they are suitable to be carried out over the telephone.

I have symptoms of COVID-19, what do I do?

Visiting the 111 website remains the first thing to do in this situation. There are a series of questions to answer and it will advise you of the path to take. If 111 advise you to contact us, then please do so. You will be put on the list for a phone call with the GP and they will assess you over the phone.

Am I allowed to contact the surgery about routine problems?

Yes! Please still contact the surgery as you would for all routine health problems. It is important for us to be keeping patients well in the community.

How do I request a prescription?

Online access or email to tunstall.primarycare@nhs.net is the preferred option for prescriptions requests.

I need to collect my sick note/blood form/referral/prescription etc, can I come to the surgery?

All documents will be sent electronically where possible or posted to you to prevent gathering outside the practice doors.