Sections on this page:
- COVID-19 prioritisation for community child health
- Resuming services
- Are your ‘at risk’ patients shielding?
- Contractual Advice from the BMA
- Retirees wanting to return to practice
- Working remotely by phone/video
- Ethical guidance/Advanced Care Planning for children & young people with disability
- Child death notifications
- Support for families
(including letter template to support parents with food or continence requirements/mask wearing exemption)
- Examples of impact and/or innovation from CCH departments (for information)
- Safeguarding medicals
- Looked After Children Initial Health Assessments (may be modified or just provide initial advice by phone if appropriate)
- Other essential clinical work (likely remotely) including emotional and behavioural support for families e.g.
- HVs/school nurses may benefit from access to telephone advice on new patients who cannot be seen*
- Some families will undoubtedly keep their children – even those with SEND – at home to avoid infection. We know that being off school causes stress in families of children with SEND, resulting in behavioural crises presenting to primary care and A&E. Access to telephone advice may help to avert escalation*
- New SEND guidance on assessing the risk of pupils attending school vs staying at home
(Unfortunately this doesn’t include any health guidance.)
- Writing prescriptions*
- Answering the phone/call back for non-COVID clinical questions*
- Statutory advice e.g. safeguarding advice, LAC advice, advice to schools that remain open on managing COVID or other medical issues (EHCPs are not mentioned):
(This page was first created on 25.03.20 and was last amended on 14.09.20. It is no longer being regularly amended and neither is the linked service resumption page.)
COVID-19 prioritisation for community child health
COVID-19 national policies and advice
Please see RCPCH website for advice on clinical management of COVID-19, PPE and other COVID-19 advice.
There is now a section on COVID research evidence called ‘Epidemiology’. RCPCH advice will not be duplicated here.
At this time of national emergency, community paediatricians will want to ‘do their bit’ to support the national effort. For some with appropriate skills, this may involve increasing or returning to acute hospital work. However, others will be unable to do so for a variety of reasons including current skill set, caring responsibilities or personal health. NHSE has also directed that some CCH work must continue during the emergency.
NHSE advice on prioritisation in CCH services in England is available (NOTE this has now been superseded by advice from 3.6.20 available on service resumption page):NHS advice on prioritisation in CCH services in England (PDF)
Scottish National Clinical Guidance for Nursing & AHP Community Health Staff
(Note: it doesn’t have any specific advice for community paediatricians)
We are not aware of similar advice for the other nations.
This document states the following services will continue, offering opportunities for retirees to help clinically if appropriate, releasing other staff e.g. trainees with more up to date skills, for COVID work (* indicates roles with reduced exposure to infection):
RCPCH guidance on Child protection, LAC & vulnerable children (RCPCH safeguarding medicals advice updated on 27.04.20)
CoramBAAF guidance on Adoption, Fostering & LAC
Government guidance on introductory meetings for children with new adopted parents (updated on 06.05.20)
- New support for vulnerable CYP announced by Government on 24 April:Multi-million support for vulnerable children during COVID-19
- Where a decision is made to continue Serious Case Reviews and/or Child Death Overview Panels, provide support for these
- Childhood immunisations e.g.
- Clinical advice and/or programme support, releasing public health staff for COVID work*
- If a vaccine becomes available, we could be a valuable asset
- CHIS support and advice, especially call/recall systems for imms and blood spot screening (as above)
- Mentoring/supporting colleagues e.g. those working outside normal skill set, juniors acting up (locally e.g. your own previous department/employer or perhaps via BMA or other support services)*
- Doing baby checks on the postnatal ward
- Admission avoidance and supported discharge from hospitals – setting up systems/planning to support early paediatric discharge to release bed space.
- Helping to plan services including admission avoidance/early discharge for adults (care of the elderly has many similarities with CCH and we could perhaps support our community geriatrician colleagues with this)
- Supporting discussions on critical care/end of life decisions with patients and families alongside hospital colleagues
- Writing new guidelines/pathways e.g. COVID-related or re-designing pathways that need to be re-thought during the crisis*
- Action research/QA activities to refine the COVID response*
Other areas for which we have transferable skills (perhaps with some re-training). Not everyone will feel these are appropriate for their particular circumstances
Lastly, when the emergency has ended, there is likely to be a large backlog of clinical work that will need extra support to get services back on track.
The NHS issued a letter on 29 April 2020 indicating some service resumption can begin (linked below). Understandably, these focus on urgent acute treatments including cancer investigations and surgery and other urgent cases. However, where capacity allows, other services may decide locally to re-start provided appropriate infection control/PPE can be maintained. Where possible and appropriate, remote consultations are preferred but patients or professionals may decide a face-to-face appointment is preferable in the specific circumstances of the case.
Are your ‘at risk’ patients shielding?(See updated advice from 03.06.20 service resumption page.)
- People at risk of severe illness due to COVID-19, including children and young people (CYP) have been advised to shield.
- Automatic re-licensing and re-registration has been extended to all those who left the register after March 2014 or had registration but didn’t have a licence to practise. Doctors can opt out if they wish.
- If you did not pay your exit fee, apparently you may not and may have to take steps yourself
- Advice on return including roles available here (based on the country you live in)
- Roles available include
- Face to Face
- All departments report trainees already re-deployed to acute paediatrics
- Some CCH consultants with recent experience also re-deployed
- Very few services considering redeployment of career grade community paediatrician without recent experience
- 25 - 50% sickness/self-isolation absence
- Remote (telephone) consultation is the norm except safeguarding medicals. For safeguarding medicals, collect all info possible before the face-to-face consultation to minimise contact. Use appropriate PPE
- Changing safeguarding rota to just one day on call instead of week to avoid having to provide emergency cover for whole weeks in the event of sickness/self-isolation
- MDT hub based in/linked to a special school to provide advice for parents
- New referrals not being seen but making telephone contact on receipt of referral
- Panels and peer review meeting held virtually
- Taking on hospital safeguarding
- Supporting epilepsy clinics
- Doctors were requested to review their complex needs caseloads and identify the 2 main groups which apply to us:
- CYP with neurodisability with respiratory complications - these include CYP with tracheostomy, non-invasive ventilation, overnight 02, and those on prophylactic antibiotics for recurrent LRTIs in line with advice from our tertiary centre. This does not include CYP with Down syndrome who are well, but on respiratory support for obstructive sleep apnoea
- CYP with rare diseases and inborn errors of metabolism who have significant risk of infection.
- Our community nursing team have highlighted the ‘at risk’ CYP (as above) in their caseloads - special schools (confirmed by the doctors), continuing care etc.
- The doctors will undertake a telephone review for the ‘at risk’ CYP from the complex needs caseloads and arrange a letter if appropriate.
- The nurses will call the families of CYP who are not on doctors’ caseloads and send the shielding letter to the vulnerable group identified.
PHE Guidance on shielding & protecting the vulnerable from COVID-19
(note the section at the very bottom of the list of topics to the left of the webpage!):
NHS Scotland Coronavirus (COVID-19): Shielding
The RCPCH has updated its advice and list of conditions on 10.06.20:RCPCH Guidance for children at increased risk of COVID-19
The list of conditions includes respiratory compromise due to neurodisability. Inborn errors of metabolism with immune issues e.g. SCID and homozygous sickle cell disease are also mentioned in the NHS guidance.
The list of conditions still includes respiratory compromise, particularly reduced ability to cough, due to neurodisability. The risk of severe COVID disease and/or death in CYP is extremely small.
What should you do?
In England NHS Digital and NHSE has conducted a search of electronic patient records to identify those at risk.
These patients have already received texts and/or letters advising them of their risk and recommending shielding. In addition, NHSE has issued a letter to Trusts, Royal Colleges etc to help to identify other patients who may be at risk. This letter includes instructions on how to ADD and SUBTRACT patients from the shielding list. Any patient identified who have not had a letter, should have one sent to them.
While many of these CYP are likely to be known to specialist teams e.g. respiratory teams, they are also likely to be known to community paediatrics. Therefore we suggest that services might wish to contact this small number of CYP to ensure they have received a shielding letter and understand the advice. The Clinician guidance advises what to do if they have not had one. It may be wise to liaise with the treating team before sending a letter to ensure advice is consistent and avoid duplication.
One community paediatric team has tweaked it for CYP:
Example template for CYP (Word)
See the ‘Examples’ section at the bottom of this page for details of how one team has put this into practice.
Patient FAQs on shielding is available and many parent support groups have guidance for their specific conditions:
Caring for those at highest clinical risk: Background & FAQs for patients (PDF)
There is practical information for families of CYP with life-limiting illness here:Together for Short Lives: Coronavirus Q&A
Information for other countries are available on the RCPCH ‘shielding’ webpage linked above.
Contractual Advice from the BMA
Retirees wanting to return to practice
There is state indemnity but Medical Defence Organisations are offering individual indemnity to former members (arrangements vary – see links to MDOs below)
Working remotely by phone/video
Ethical guidance/Advanced Care Planning for children and young people with disability
RCPCH ethical framework
NHS guidance supporting individualised decision-making:NHS guidance supporting individualised decision-making (PDF)
General guidance on ethical decision-making:
BMA/ CPA/ CQC/ RCGP Joint statement on advance care planning
General guidance on supporting CYP with LD/autism during COVID:NHS England Clinical guide staff to support & patients with LD/autism during the coronavirus pandemic
Child death notifications
The National Child Mortality Database wants to be notified within 48 hours if you receive notification of any death where the cause is confirmed or suspected to be COVID-19.
Support for families
Advice on supporting children & young people:
Advice on face covering exemptions:
(From Monday 27 July face coverings will be mandatory on all public transport in Wales.)
Examples of impact and/or innovation from CCH departments (for information)
How one Trust has implemented shielding advice (with thanks for allowing us to use it!)