GP COVID-19 information :: Hampshire Hospitals

Dear Primary Care Colleagues,

Endoscopy is an aerosol generating procedure, and a significant number of patients attending the unit are over 70. This means that both staff and patients are at risk of Covid 19 infection during the procedure itself, and whilst waiting and recovering in the endoscopy unit/DTC.

With current pressure rising on the secondary care service, and in line with guidance from the BSG/JAG, we are stopping all non-emergency endoscopy after Friday- with only a few urgent and TWR patients under 70 on the lists for the next 3 days. Bowel Cancer Screening and Bowel Scope flexible sigmoidoscopy has paused with immediate effect. These measures will reduce the risk of infection to both patients and staff, and will release staff for front line activity and redeployment.

In order to try and manage on-going demand, we have decided to suspend GP direct access requesting via ICE, so that all requests for out-patient endoscopy must come through the ERS as a single point of triage by consultants.

We have cancelled all procedures which had already been scheduled for the next 6 weeks, and informed patients by telephone if short notice cancellation.

All patients who have been cancelled, are on the waiting list to be booked, and who are currently joining the waiting list will be sent a letter explaining the circumstances. They are being asked to call a helpline number if they feel that their symptoms are too severe to wait – and they are asked to keep the number to hand in case their symptoms deteriorate to an unmanageable level before they are listed for a procedure. It is clear that it may be several months before we can resume normal service. The helpline will be manned by a clerical team who will either direct the patient back to their primary or secondary care team for advice, or escalate the query to a member of the endoscopy clinical team. This clinical team will be supported by a consultant. There will inevitably be a few patients who need their procedure doing –and there will be capacity for a small number of procedures in those it is safe to bring up to the unit. We aim to identify and manage those via patient initiated contact to this helpline number but are hoping that the helpline will not be overwhelmed with anxious patients.

We will still be offering emergency endoscopy for in-patients, and those out-patients requiring intervention for acute presentation of IBD, oesophageal and colonic stents, oesophageal dilatation, feeding tubes and ERCP – especially if it will help to keep them out of hospital.

We are grateful for your help during this time to manage expectation and try and limit referrals where possible. We would like to suggest that when referring a patient to join the waiting list – you do consider starting treatment, as there will be long delays. We would support you in starting iron in those who are deficient, PPI/Acid suppression in those with dyspepsia/dysphagia/suspicion of peptic ulceration, and a gluten free diet in patients with positive coeliac serology. Dietitians can take direct referral and do telephone appointments to support potential new coeliac disease patients, and we can always do a gluten challenge later to confirm the diagnosis.

Please feel free to contact us via Advice and Guidance if you need clinical support at this difficult time, and thank you again for your support.

With best wishes

Dr Corinne Brooks
Consultant Gastroentoerologist
Clinical Lead for Gastroenterology
Basingstoke and North Hampshire Hospital
Hampshire Hospitals NHS Foundation Trust
Aldermaston Road
Basingstoke
RG24 9NA
Tel: 01256 314859

Please note that emergency ENT cases continue to be referred to University Hospitals Southampton (UHS) during Covid-19. If an emergency ENT patient presents, please contact the emergency ENT team at UHS to assist you. This diversion of emergency ENT care will continue to be in place until Covid-19 resolves and emergency work is repatriated back to Royal Hampshire County Hospital.

Advice and Guidance is still available, and we would encourage you and your colleagues to use this service and our team will be happy to help you with any queries. ENT also continues to have telephone appointments available for patients, as well as establishing video consultations. The first ENT face-to-face consultations during the recovery phase will be restricted to suspected cancer and high risk patients. Patients on a two-week wait pathway will initially be invited to a telephone consultation, with only selected high risk patients being brought into clinic for procedures.

Our team remain committed to assisting and advising on ENT patient care. Please do not hesitate to contact the ENT team if you have any concerns or issues you need advice on. Surgical intervention will remain very limited at the present time, and long waiting times for routine patients should be expected.

Mr Ashok Rokade
Clinical Lead, ENT, Royal Hampshire County Hospital and Andover War Memorial Hospital

Dr Lara Alloway, Intro HHFT Covid