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
essential infusion services
blood tests for drug monitoring that cannot safely be delayed.
4.3 Defer all non-essential monitoring, surveillance and interventional procedures. For emergency or essential procedures, limit the number of staff present.
4.4 Only use endoscopy or liver biopsy when needed to make urgent management decisions.
4.5 Provide advice and guidance to GPs, to avoid unnecessary emergency department attendances and admissions.
4.6 Think about pooling resources with other specialities and NHS trusts to provide services such as drug monitoring and telephone and email advice.
4.7 Put plans in place to manage potential disruptions to the supply of medicines during the COVID‑19 pandemic.
4.8 Do not prescribe larger than usual quantities of medicines, because this puts the supply chain at risk.