Primary care bulletin - 15 May 2024
Bulletin:
Measles; death registrations; the role of NW London ICB; fraud alert reminder; webinars and more

Welcome to this week's primary care bulletin


Key points this week include:
  • Measles 
  • Death registration process
  • The role of NW London ICB
  • Fraud alert - reminder
  • Training and webinars including:
    • NW London respiratory webinar
    • Lifestyle medicine webinar
    • Reducing health inequalities in pharmacy - showcasing written medicine's technology
    • Reducing admissions and improving quality of life for patients with COPD

Measles


Measles is highly infectious & can be severe in immunosuppressed patients and young infants. Measles in pregnancy increases the risk of miscarriage, stillbirth, or preterm delivery.

The incubation period is typically around 10 to 12 days but can vary from 7 to 21 days. Patients are infectious four days before & after the onset of rash. R rate for measles is 15-20 (15 to 20 individuals infected from a single case in a totally susceptible population).

All staff working in primary care should have two documented MMR vaccinations or be IgG positive for measles. Staff who do not have immunity/ pregnant/ immunocompromised should not be involved in the assessment or management of patients with suspected measles.

All children presenting to primary care with fever and coryzal symptoms should be triaged before being seen f2f. They should not be waiting in reception areas. Please do have hot and cold pathways if practically feasible within your surgeries. If this is not possible, children should be triaged and seen with minimal waiting times within the surgery. Think about seeing the patient at the end of a session in a designated room where fallow time and cleaning can be undertaken.

Ask about, and look for symptoms of measles:
  • Fever of 39ºC or more without taking paracetamol or ibuprofen, a rash which goes away with pressure and at least one of the following: cough, runny nose, and conjunctivitis.
  • A measles-like rash - red spots non-itchy, sometimes raised and joined together to form blotchy patches. The rash starts three to four days after the initial symptoms behind the ears, then the face, trunk of body and limbs.
  • Small white spots inside the cheeks and on the inner part of the lips – Koplik spots.
Think about differential diagnosis - Scarlet fever/streptococcal infection, Kawasaki disease, early meningococcal disease, parvovirus B19, rubella, infectious mononucleosis (glandular fever), herpes virus type 6 (roseola infantum) and safety net the patients appropriately.

Wear appropriate personal protective equipment (PPE). FFP3 is recommended by NHSE. FFP3 Fit testing has been arranged through mutual aid at various acute providers in NWL. Please see below for further details.

Seek immediate advice from secondary care services if the patient has a measles-like rash and is in one of the following high-risk groups:
  • Younger than one year of age
  • Immunocompromised (regardless of immunisation status)
  • Pregnant
Immediately notify the local Health Protection Team (HPT): They will advise on public health measures including contact tracing and surveillance testing.

The HPT will also advise on post-exposure prophylaxis. Healthy immunised patients deemed as low risk will need warn and inform letter from the surgery or A&E.

Post exposure prophylaxis is recommended for immunocompromised, younger than one year of age and pregnant patients.

For immunocompromised patients, HPT will arrange administration of intravenous immunoglobulin through secondary care. 

For pregnant women and infants under nine months of age, HNIG (Human Normal Immunoglobulin) is recommended. HPT will liaise obstetric team for pregnant patients & local paediatric team for infants under nine months. Infants between 6-9 months of age who did not have a household exposure and infants over nine months, will need MMR (to be done at the surgery).

Patients with measles need to exclude themselves from nursery/educational settings and work until four days after the onset of rash. Please do safety net patients regarding complications – Pneumonia, otitis media, diarrhoea, encephalitis (rare), subacute sclerosing panencephalitis and other secondary bacterial infections.

Unimmunised household contacts might be advised to exclude themselves from school/work settings up to 20 days’ post exposure. Local public health teams and HPT will advise the patients themselves. 

Please continue to invite unvaccinated children and adults for their MMR vaccination.

Additional information and links:

1. Timeline of the symptoms 

2. National measles guidelines 

3. Measles guidance for primary, community care, emergency departments and hospital 

4. PPE: Refer to the National infection prevention and control manual (NIPCM) sections 1.4, 2.4 and appendices 5b and 6 for further information of the use of PPE. NHS England’s Infection Prevention and Control guidance on PPE is available online.

5. Please note details of the trusts who are able to help with FFP3 fit testing across NWL. Some are able to offer train the trainer sessions:

London North West University Hospitals
Ryan Bautista
Call 0208 869 3745, the line is manned from 8:30 to 12:00,13:00 to 16:00

Imperial College Healthcare
Niina Bell - niina.bell@nhs.net
Alice O’Brien - alice.obrien1@nhs.net

Chelsea and Westminster links to book fit testing
Chelsea Site Fit Test Bookings 2024
West Middlesex Site Fit Test Bookings 2024

Hillingdon Hospital
James Brind - james.brind@nhs.net

Death registration process


Emailed Referral to the Medical Examiner Service will be rejected

When the new legislation comes into force on 9 September for changes to  the death certification process and use of the medical examiner service. Make sure several members of your practice know how to use the new referral system.

You must use the new Systmone/EMIS referral forms and process to send the medical certificate of cause of death to the medical examiner’s service.

Please make sure several members of staff within your practice are trained to refer to the medical examiners service using Systmone or EMIS.

For practices who currently have one or two trained staff, please ensure training on the system is cascaded through the practice.

All deaths will have to go through this referral route from 9 September and delays will occur if the new process is not followed.

Guides for SystmOne and EMIS can be found below – along with FAQs, staff and public information on the ME service.
NEW: Medical examiner process :: North West London ICS (nwlondonicb.nhs.uk)

The NW London IT team can support practices with the set-up please contact: tsmith8@nhs.net 

The role of NW London ICB


The communications team have recently published an article on the ICB website which explains the role of the ICB. The article covers the three key roles the ICB has and who it is accountable to.

Read the full article here. 

Fraud alert

Our counter fraud provider has alerted us to fraudulent payment requests targeting GP practices. Fraudsters are contacting practices, pretending to be doctors, requesting an urgent payment is made. Examples of the email addresses used to send the demands include:

gp30029388@gmail.com
manager.app4093546@gmail.com

GP practices should review any requests thoroughly to ensure the goods or services were ordered and provided, prior to making payment. Any false payment requests received should be referred to your ICB’s LCFS.

Education and training

NW London respiratory webinar


Wednesday 22 May, 1pm 

This webinar is for GPs and primary care teams 

The webinar will be hosted by NWL Respiratory Clinical lead Dr Eleanor Worthington and Dr Kuldhir Johal.

It will cover:
  • The focus of the enhanced specification
  • The training requirements
  • The role of the PCN respiratory champion and the support offer
  • An opportunity to ask questions on the spec
  • An Introduction to the NWL respiratory template
Click here to register for the webinar. 

If you have any queries before then, please get in touch with Eleanor.phelan@nhs.net

Lifestyle medicine webinar


Thursday 23 May, 1pm 

This webinar is for GPs and primary care teams 

The webinar will be hosted by Dr Tony Willis, GP and Clinical Lead for Personalised Care, Clinical Effectiveness and Diabetes for NWL.

It will cover:
  • Learning about four lifestyle factors to reduce risk of chronic disease by 78%
  • Key principles of lifestyle medicine
  • The powerful evidence base for lifestyle medicine
  • Practical tips to support patients in making sustainable changes
Click here to register for the webinar.

If you have any queries before then, please get in touch with Eleanor.phelan@nhs.net

Reducing health inequalities in pharmacy – showcasing written medicine’s technology


Tuesday 28 May, 12:30 – 13:30

The webinar will showcase Written Medicine’s technology for the translation of pharmacy labels and discharge papers, and the benefit that this could have on reducing health inequalities, inaccurate use of medication and adverse events.  

Click here to register. 

Reducing admissions and improving quality of life for patients with COPD


Thursday 6 June, 12:00 – 13:30

This webinar will focus on Lenus’ technology for the remote monitoring of patients with COPD. HIYH has recently supported an evaluation of the technology at Hull University Teaching Hospitals Trust. The webinar will cover these results with talks from the clinical team and from York Health Economics Consortium.  

Click here to register for the webinar.