The whole team at the Green Practice are dedicated to helping our patients and relatives during this terrible pandemic. We would like to thank our patients and relatives for their patience and the great efforts they are making to allow your practice to concentrate on the most crucial things we do, when we too are under increased workload and are affected with staff off due to self isolation or illness. These pages, along with the very excellent and up to date information at www.nhsinform.scot are here to help you answer your question so we can keep the limited phonelines clear for more urgent matters.
There is also a very good website and helpline opened called coronavirusadvice.scot, run by the charity Advice Direct Scotland, offers practical advice and information on issues including employment, housing and personal finance, as well as cancellations and consumer rights. It can be contacted on 0808 800 9060 between 9am and 5pm on Mondays to Friday, and via live webchat or email at www.coronavirusadvice.scot.
The government has issued advice about taking Vitamin D. The full advice is available at this link https://www.gov.scot/publications/vitamin-d-advice-for-all-age-groups/ but in summary it says:
Everyone (including children) should consider taking a daily supplement containing 10 micrograms of vitamin D, particularly during the winter months (October – March). It is specifically recommended that groups at higher risk of vitamin D deficiency take a daily supplement all year round. These groups include:
-all pregnant and breastfeeding women
-infants and children under 5 years old
-people who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, are housebound, confined indoors for long periods or live in an institution such as a care home
-people from minority ethnic groups with dark skin such as those of African, African-Caribbean and South Asian origin, who require more sun exposure to make as much vitamin D
You can buy vitamin D supplements or vitamin drops containing vitamin D (for under 5s) at most pharmacies and supermarkets. Please don’t buy more than you need.
If you are in doubt on what to buy please ask your local pharmacist.
Covid Symptoms and Children
Medical Exemptions from mandatory face coverings
Please do not contact the practice about this as they are not required and it will keep our phonelines free to deal with medical problems.
The official wording from the official website is :-
"You must wear a face covering when using public transport in order to prevent the transmission of the virus. For children under 5 years of age or those with particular health conditions who cannot put on, wear or remove a face covering because of any physical or mental illness or impairment or disability or without severe distress an exemption applies. There is no requirement to obtain evidence in the form of a letter from a doctor or government that you are exempt. If you have a condition which means you cannot wear a face covering you need only advise if asked that you cannot wear a face covering because you are exempt for one of the reasons listed above."
Coronavirus (COVID-19) infection – what you can do to protect yourself against infection and how you can reduce the chance of spreading it at home.
This advice sheet summarises the various (and varying) situations in which you may find yourself in the coming weeks in your home and everyday lives, whether you are infected, self isolated, belong to a vulnerable group, or are trying to carry on with working in the community. For each group it gives general advice on how to comply with “social distancing” whilst also fulfilling family and work responsibilities and guidance on the hygiene measures which will best protect you from getting infected, and those who become infected from spreading their infection to other people.
Coronavirus Hygiene advice
Coronavirus Sick Notes/Fit notes. Please do not contact the practice if you require a fit note for self isolation. These are obtained via nhs111 here
If you have been sent one of the Very High Risk letter from the Government telling you to self isolate for at least 12 weeks,and your employer is requiring a fit note. Please do not contact the practice or NHS111. Instead that letter will suffice as a fit note.
Shielding - self isolation letters for the high risk and extremely high risk patient
We have had a number of queries from patients and relatives asking where their letter was. It is confusing but here are some questions and answers.
Am I in the high risk or very high risk category? Will I get a letter?
The Government has defined two categories of patients. Those that are a high risk if they caught Covid-19 and those at very high risk. The Government is currently making lists from disease databases and when complete they (not the GP Practice) will send letters directly to households.
High risk patients are essentially those aged 70 or over and those that get invited for a flu jag because of a medical condition not just because they are over 65. The government list is:
- aged 70 or older (regardless of medical conditions)
- under 70 with an underlying health condition listed below (i.e. anyone instructed to get a flu jab as an adult each year on medical grounds):
- chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
- chronic heart disease, such as heart failure
- chronic kidney disease
- chronic liver disease, such as hepatitis
- chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
- problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
- a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
- being seriously overweight (a BMI of 40 or above)
- those who are pregnant
The Very High Risk Patients
The up to date list is kept here at NHSinform
Group 1 - Solid organ transplant recipients
This group includes people who have had a transplant of heart, lung, stomach or other part of intestine, liver, kidney and need to take medication to prevent organ rejection.
Group 2 - People with specific cancers
This is made up of five sub-groups. They are:
- 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; and
- People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.
Group 3 - People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD and people on long term home oxygen for their lung condition. On 20th April it was modified to include current and severe forms of the following lung conditions sarcoidosis, pulmonary hypertension (this is not the usual high blood pressure type hypertension), bronchiectasis, some pneumoconioses and interstitial lung disease.
Severe Asthma has been defined as:
- Patients who have been prescribed a medicine for asthma for at least 4 of the last 6 months AND have also been prescribed Prednisolone for at least 4 of the 6 months or are on long term steroid tablets e.g. prednisolone or regular injections for asthma.
- patients who have been prescribed a regular medicine for asthma (eg inhaled steroid, montelukast, LABA like formoterol or atimos, theophylline) AND are on regular Prednisolone tablets over the previous 6 months at an average daily dose of 5mg (revised to 10mg on 23.4.20) or more.
And additional categories of severe asthma have been added from 20/4/20
- Patients with asthma who are taking biological therapies from the hospital for their asthma (injections or tablets that end with the letters ...imab).
- Patients who are being prescribed antibiotics every week long term as a preventer such as azithromycin 3 times weekly.
- and added on 23/4/20
- patients on steroid sparing medicine for asthma like methotrexate, azathioprine or MMF.
- patients taking long term steroids at 10mg or more daily for more than 4 weeks
Severe COPD was defined as:
Patients who are being prescribed Roflumilast in the previous 6 months
OR who have been prescribed a combination of 3 inhaled medicines including
1. an inhaled corticosteroid (ICS) like beclomethasone, clenil, kelhale, Qvar, soprobec, budesonide,Budelin, pulmicort, ciclesonide, alvesco, or fluticasone , flixotide, mometasone, amanex
2. Long Acting Beta Agonist (LABA) – like formoterol, atimos, bambec, Onbrez Breezhaler, Striverdi Respimat Easihaler, Foradil, Oxis Turbo
3. Long Acting Muscarinic Agonist (LAMA) like Braltus, Incruse Elipta, Eklira Genuiar, Seebri Breezhaler, atrovent, spiriva as either 3 separate medicines
combinations of single and dual inhalers like
1&2 combined Steroid and LABA inhaler like Fostair, Trimbow, Durosep Spiromax, Fobumix Easyhaler, Symbicort, AirFluSal, Sereflo. plus one from group 3 above
1&3 combined Steroid and LAMA Like Trelegy Ellipta or Relvar Ellipta plus one from group 2 above.
2&3 combined LABA and LAMA like Duaklir, Ultibro, Spiolto, Anoro Ellipta plus one from group 1 the steroid inhalers
combination triple inhaler LABA LAMA and steroid alone like Trimbow or Trelegy Ellipta
An additional category was added to include those with COPD who are prescribed antibiotics every week as a preventer usually azithromycin 3 times weekly but also added 23.4.20 daily doxycicline, co-trimoxazole or penicillin
and added 23.4.20
patients on the active lung transplant list
patients on long term non-invasive ventilation for tpe 2 respiratory failure
Group 4 - People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease) and added 23.4.20 patiente receiving ventilatory support for conditions like MND.
Group 5 - People on immunosuppression therapies sufficient to significantly increase risk of infection
This category was changed to a new flowchart on 20th April 2020 and is in 4 groups
5.1 Patients on corticosteroids equivalent greater than or equal to prednisolone 20mg per day for 4 weeks or more
5.2 Single agent (medication) of high risk - Cyclophosphamide, Rituximab, Infliximab, Cladribine, Alemtuzumab (neuro)
5.3 Multifactorial 1 - Corticosteroid tablets greater than or equal to 5mg prednisolone equivalent per day AND one other immunosuppressive medication/DMARD/ biologics from the list below.
5.4 Multifactorial 2 - Two immunosupressants DMARD/ Biologics AND Comorbidity – see below
Medications: (see the 5.3 and 5.4 above on how to work it out)
Immunosuppressants – include : methotrexate, azathioprine, mycophenolate (mycophenolate motefil or mycophenolic acid), ciclosporin, fumaric acid esters (or dimethyl fumarate), hydroxycarbamide, 6-mercaptopurine, leflunomide, cyclophosphamide, tacrolimus, sirolimus. It DOES NOT INCLUDE hydroxychloroquine, dapsone, acitretin, altretinoin or sulphasalazine either alone or in combination withe each other.
Biologics – include: all anti-TNF drugs (etanercept, adalimumab, infliximab, golimumab, cetolizumab pegol and biosimilar variants of all of these, where applicable); IL 17/IL17Ra agents (secukinumab, ikekizumab, brodalumab); P40/P19 (ustekumab,guselkumab, tildrakizumab, risankizumab) and anti B cell (rituximab in last 12 months, belimumab); IL6 agents (sarilumab, tocilzumab); abatacept; IL1 (canakinumab, anakinra); dupilumab (possibly lower infection risk than other drugs); omalizumab (possibly lower infection risk than others)
Co-Morbidities Age>70, Diabetes mellitus, Lung Disease, Renal Impairment, Ischaemic Heart Disease/ Hypertension.
Patients on a single disease modifying drug(DMARDS) or Biologic such as methotrexate, azathioprine, ciclosporin, leflunomide plus others would not be considered automatically on the highest risk group if they are otherwise healthy.
Group 6 – People who are pregnant with significant heart disease, congenital or acquired and are usually being followed up by s specialist heart clinic during your pregnancy.
What advice or help will I get?
The High Risk patients will receive a letter sent by the government advising them to be particularly stringent social distancing and hand washing. The advice is here.
The Very High Risk patients will receive a different letter sent by the government. A copy of it is here Very High Risk Letter.
- it advises very high risk patients to stay at home at all times and avoid all face to face contact for at least 12 weeks
different advice if they get symptoms of persisting new cough and temperature over 37.8 to call right away to NHS24 on 111. Do not call your GP or hospital.
- The letter is evidence for their employer that they cannot work outside the home. They do not need a sick line just that letter.
- It gives advice how to stay safe
- It asks for a mobile phone number to stay in contact
- It says the GP practice will be in touch at some point to get more information including contacts of carers and next of kin and backup carers.
- There is likely to follow help where needed from other organisations for delivery of medicines and basic food items.
What if I think I have been missed out?
If in the meantime whist you are waiting for a letter and you think you are in the High or very high risk categories you can still be following the advice.
After the government has made the lists and sent out letters the government has asked us to double check that no-one has been missed off the Very High Risk list only, and notify the health board and get a letter sent out. If after mid April you still feel you are in the Very High Risk group and haven't had a letter the contact the practice and advise reception that you have not had a letter and which condition in the very high risk group you have and we will investigate for you.
I don't have a mobile phone to text the number on the letter or it doesn't seem to be working
Here are the key numbers for West Dunbartonshire for shielding and vulnerable patients.
For Shielding Patients
Text Number for Shielding Service - 07860 064525 (on shielding letter) Make sure you text your 10 digit CHI number at the top of your shielding letter from the government for the system to recognise you as a designated shielding person.
Those without a mobile phone, call West Dunbartonshire Council - 01389 738282 (press option 5)
Or you can email firstname.lastname@example.org
West Dunbartonshire Council Support for other Vulnerable Residents - 01389 738282 (press option 5)
WDC can help people if they have no support network. This will include those who are:
- Self isolating
- Over the age of 70
- In receipt of a letter from the NHS advising you are high risk
- Medically vulnerable according to the government criteria
- Single parents
Support includes help with practical tasks including collecting and delivering essential groceries or medicines; walking pets or being a friendly and reassuring voice at the end of the telephone.
Emergency Dental Care
If you are registered with dentist please contact them and they will provide emergency dental care triage by phone including antibiotics if required. if you are not registered with a dentist then call the EDTC emergency dental treatment line on 0141 232 6323.