Coronavirus (COVID-19): outpatient and primary care consultations - principles

As normal services begin to re-start within the NHS, it is important that risks of transmission of COVID-19 are minimised in all settings. The following guidance outlines some principles for reducing potential transmission within outpatient and primary care settings.

Attendance

Review attendance lists for scheduled appointments and triage patients into those who definitely need to be seen and those who could be reviewed by telephone or remote video consultation. Consults using NHS Near me can be an effective way of remote patient consultation. Exercise discretion in the use of such services – patients do not always betray their concerns when not seen face-to-face. In addition, be aware that digital communications may not be suitable for those with sensory or cognitive impairment, those who are frail, and those who do not have English as their first language. This technology may also not be easily accessed for those with social deprivation.

Direct consultations

For direct consultations, make patients aware that they should not attend if they have symptoms consistent with COVID-19 and should then follow the advice given on NHS Inform. For an added layer of security, it would be advisable for clinic staff directly to ask patients regarding symptoms or to display such advice in a prominent location at the clinic entrance. Patients should also be asked if they have been in contact with anyone diagnosed with COVID-19 or displaying symptoms of the infection and if so to follow the advice provided a from the Test and Protect pathway. In written communications advising of appointments, include this advice and the other restrictions set out below.

Physical distancing

In general, patients should attend on their own. However, if thought essential, one dedicated person can attend with a patient. Examples of situations where this might be important include, but are not restricted to:

• when a person may have difficulty understanding what treatment or course of action a clinician is discussing
• where a person has dementia, a learning disability or autism
• where a person is receiving bad news or information that is potentially life-changing
• where a person is receiving a cancer diagnosis or discussing cancer treatment options
• when a pregnant woman attends an appointment in any setting including an obstetric ultrasound (this would be a birth partner in most instances)
• where a person is distressed or stressed

In addition, consideration should also be given as to whether a family member or supporting person can attend a consultation virtually, for example, via an electronic platform or by phone, if a relative or friend cannot attend in person. There may also be occasions where more than one accompanying person is required e.g. translator, mobility support.

Under all these circumstances, distancing and PPE should be strictly followed as far as is feasible. These restrictions should as far possible be set out in any written communication advising of an appointment.

As far as possible, physical distancing as recommended in both primary and secondary care should be maintained in all outpatient areas. This may require reducing clinic lists or staggering appointment times in a more structured fashion. Provide signage at entry points advising of necessary precautions – include different language versions according to local populations. Consideration should be given to providing a one-way direction of flow through a clinic with appropriate signage. Consider asking those who have mobile phones to call the reception area immediately before arrival to ensure there is not overcrowding.

Patients at increased risk of adverse outcomes

Although shielding is currently paused, there will be some patients who may be judged as being at seriously increased risk of adverse outcome should they contract COVID-19. Consideration should be given where possible in allocating a distinct appointment time and/or waiting room area to such patients.

Teaching

Teaching of medical students and allied health professionals must continue, but again advice on distancing and use of personal protective equipment as required must be followed. This may mean limiting numbers of students who can attend and have direct patient contact.

Face coverings

Staff and visitors should adhere to the guidance over the use of masks and face coverings issued by Scottish Government. Patients and their attendants will need to wear masks and these should be provided if required. Signage showing correct use of masks/face coverings should be displayed. Follow all transmission based precautions as set out in the National Infection Prevention and Control Manual.

Cleaning

Regular cleaning of outpatient areas, especially high touch surfaces, should be undertaken, following guidance from the local Infection Prevention and Control or Health Protection Team. Signage for multi-person public lavatories in outpatient areas should indicate only one person should use at a time. Re-useable patient equipment should be cleaned in between patient consultations in accordance with guidance in the National Infection Prevention and Control Manual.

If possible:

• provide sanitising hand gel at entry and exit points
• ensure there are wipeable chairs in waiting areas
• keep extraneous items to a minimum in waiting and clinical areas to facilitate cleaning
• keep windows open when possible to encourage ventilation
• minimise handling of paperwork

Aerosol Generating Procedures

If aerosol-generating procedures (AGPs) are to be carried out in an outpatient area, appropriate PPE should be worn. AGPs should only be carried out when it is essential and only staff and in appropriate facilities with adequate ventilation. Rooms where such procedures are carried out should be out of use for the period specified by local guidance.

About this guidance

This guidance has been produced by the COVID-19 Clinical Guidance Cell.