4 Modifications to usual care

4 Modifications to usual care

4.1 Think about how to modify usual care to reduce patient exposure to COVID‑19 and make best use of resources (workforce, facilities, equipment).

4.2 If it becomes impossible to provide usual services, prioritise core services. These include:

  • services for urgent inpatient and outpatient review (both new and follow-up)

  • essential face-to-face reviews to manage disease flares and complications of therapy

  • advice lines

  • essential infusion services

  • blood tests for drug monitoring that cannot safely be delayed.

4.3 For recommendations on delivering planned care, including interventional or diagnostic procedures, see the NICE COVID-19 rapid guideline on arranging planned care in hospitals and diagnostic services. For specific advice on resuming endoscopy services, refer to the British Society of Gastroenterology guidance on restarting gastrointestinal endoscopy in the deceleration and early recovery phases of the COVID-19 pandemic. [amended 21 August 2020]

4.4 Provide advice and guidance to GPs, to avoid unnecessary emergency department attendances and admissions.

4.5 Think about pooling resources with other specialities and NHS trusts to provide services such as drug monitoring and telephone and email advice.

Supplying medicines

4.6 Put plans in place to manage potential disruptions to the supply of medicines during the COVID‑19 pandemic.

4.7 Do not prescribe larger than usual quantities of medicines, because this puts the supply chain at risk.