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Clinical Guidance

To see information about PHE- Immunisation training of healthcare support workers national minimum standards and core curriculum, please click on the link below:



To see Practical and clinical guidance for vaccine administration, please click on the link below:

Restoration of Cervical Screening Invitations for full document please click HERE

North West London Paediatric Telephone Advice and Guidance for GPs and Primary Care during Covid-19

ACTION: Print the document available here and reference as needed

Local Paediatrician advice lines are provided below; these lines are designed to enable clinical discussion between all primary care professionals and a local on-call Paediatrician. These advice lines will enable quality out-of-hospital care through sharing of specialist knowledge where clinically safe children can be cared for within the community.

Recovery of the NHS Cervical Screening Programme in London

Following the launch of The NHS is Open for Business campaign last week, we are revising the advice of 31 March 2020, for taking cervical samples.

To view the full document please click HERE

Second phase of NHS response to COVID-19: Letter from Sir Simon Stevens and Amanda Pritchard

Please click HERE for more information

To view document please click HERE

For more information click HERE

ACTION: Ensure you have read the cancer communications in full


It is important that during the response to the Covid-19 pandemic, appropriate clinical priority is given to the diagnosis and treatment of cancer, with service provision needing to flex as part of infection control. The following update details key changes, any actions required by Primary Care and Provider Trusts and information useful to you and your patients as the recovery period starts. This cover note provides the key points for general practice to refer to in all of the attached documentation.  


  1. Cancer Two Week Wait Pathways


Important Action – New Referral Forms: As guidance is updated and pathway changes are authorised referrals forms will be updated to reflect new temporary processes. These changes are being managed centrally by TCST. For FIT, Practices using DXS will have their LGI referral form automatically updated.


Practices not on DXS can download the latest version forms from either IT system, EMIS, Vision, Systm One, and upload to their practice systems via:  


It is important to check this link and update as soon as available.



  • Please visit for all forms.
  • LGI referral form live and distributed to all IT leads in London, is available on the HLP website.
  • Breast and Lung forms updated and distributed to all IT leads in London (this includes C the signs), also available on the HLP website.
  • Pan London patient information leaflet, LGI patient information leaflet and LGI FAQ available on the HLP website.  


General: 2WW Appointments Reminder: During the current Covid-19 crisis, a first outpatient appointment in secondary care may be via telephone triage.


If after triage, the clinician feels;


  1. i) They are able to reassure the patient they don’t have cancer, or their symptoms would not justify a diagnostic at this stage (irrespective of Covid-19) then they can discharge the patient


  1. ii) The patient will be offered a diagnostic at a later date and will be held on the Trusts PTL until an appointment becomes available/or it is safe to carry out the specified diagnostic.


Trusts may contact GP practices via email to discuss individual referrals so please ensure you check your practice inbox on a daily basis as a minimum GP practices must continue to check their worklists for patients referred on a 2WW and safety net as necessary. The guidance that 2ww referrals cannot be downgraded without prior discussion with the referring GP remains unchanged.


  1. Patient Safety Netting


Primary Care


Safety Netting templates have been created for both EMIS and S1 (see attached guidance). As a minimum, practices are encouraged to commence coding of patients who have a referral deferred (due to patient choice, isolation etc.) even if they choose not to utilize the templates. Codes as below:

Suspected malignancy (162572001)

Suspected breast cancer (134405005)

Suspected gynaecological cancer (397682005)

Suspected gynaecological cancer (397682005)

Suspected cervical cancer (315266007)

Suspected endometrial cancer (315267003)

Suspected haematological malignancy (315275009)

Suspected leukaemia (315262009)

Suspected lymphoma (315264005)

Suspected head and neck cancer (315277001)

Suspected neuroblastoma (315265006)

Suspected kidney cancer (315270004)

Suspected lower gastrointestinal cancer (315274008)

Suspected lung cancer (162573006)

Suspected malignant mesothelioma (518611000000107)

Suspected pancreatic cancer (247591000000101)

Suspected prostate cancer (315268008)

Suspected sarcoma (315261002)

Suspected skin cancer (315276005)

Suspected testicular cancer (315272007)

Suspected upper gastrointestinal cancer (315273002)

Suspected urothelial cancer (315271000)

Suspected bladder cancer (315269000)


Patient information


Patient information: Patients must also continue to be provided with up to date information about what to expect during this time, including any likely delays due to reduced diagnostic capacity and having telephone, rather than face to face appointments in secondary care. The latest pan-London patient information leaflets are now available:


COVID-19 Suspected Cancer Patient Information Leaflet

COVID-19 Urgent Suspected Bowel Cancer Patient Information


Following the release of new guidance (by speciality), practices should not hand out any other versions or previous copies of patient leaflets to avoid confusion.


Please read these documents in full for further details on specific cancers.

To view website click HERE

To view more information please click HERE

As a result of the Covid-19 (coronavirus) pandemic, the Royal Free London NHS Foundation Trust will only be accepting urgent paediatric referrals.


GPs to submit a clinical advice and guidance (CAG) request via e-RS before sending a referral. One of our paediatricians will review the request and confirm if the patient requires an urgent appointment. If there is no visible CAG request in the patient’s UBRN history, the referral will be sent back. We aim to respond to all CAG requests within the nationally agreed two working days.

GPs can also refer urgent patients by calling the on-call paediatrician on 07983 637 686 Monday to Sunday (including bank holidays), between 8:30am and 5pm. If advised to by the on-call paediatrician, referrals can be emailed to Any referral that is emailed will not be accepted unless discussed with the on-call paediatrician first.

In order to manage additional demand for end of life medicines, and ensure safe, equitable and compassionate care for patients, the Association of Palliative Medicine, Royal College of GPs, Hospice UK and the Association of Supportive and Palliative Care Pharmacy, working with NHS England and NHS Improvement, have published:



This clinical guidance for essential end of life medicines, which sets out the first and second choices for these medicines, will enable the NHS to conserve supplies, switch to alternatives drugs when required and minimise waste. This is also being used to guide the purchasing of medicines for the UK.


The clinical guidance aims to support healthcare professionals working in palliative and end of life care across hospital, community, social care and hospice settings to work together in managing additional demand on end of life medicines due to Covid-19.


During the Covid-19 pandemic, across many clinical specialties, there is a need to adapt clinical practice to respond to the situation and ensure patient care guidelines are

consistent, equitable, safe and appropriate.

CCGs have already been asked to work with providers to establish local hubs to ensure rapid access to priority end of life medicines for patients. These hubs can be in community pharmacy, GP practice, community hospital, acute or other settings where palliative medicines (including controlled drugs) can be safely and legally stored and rapidly released when needed.


A standard operating procedure for Running a medicines re-use scheme in a care home or hospice setting was published by the Department for Health and Social Care on 28 April 2020.

For more information click HERE

To view full information click HERE

Please see below new useful information related to Diabetes:

Sick day rules for patients  - download here 

Emergency department discharge, clinical strategy and outpatient prioritisation - download here

TO view the full document please click HERE

To view the full document click HERE

To view the full document please click HERE

To view the full document please click HERE

To view the full document please click HERE

Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resource-preservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnoea severity in terms of hypoxia. Hypothesis: The Roth score has correlation with dyspnoea severity. Methods: This is a prospective, controlled-cohort study. Roth score index is measured by having the patient count from 1 to 30 in their native language, in a single breath, as rapidly as possible. The primary result of the Roth score is the duration of time and the highest number reached. Results: There was a strongly positive correlation between pulse oximetry and both maximal count achieved in 1 breath (r = 0.67; P < 0.001) and counting time (r = 0.59; P < 0.001). For oxygen saturation <95%, the maximal count number area under the curve is 0.828 and counting time area under the curve is 0.764. Counting time >8 seconds had a sensitivity of 78% and specificity of 73% for pulse oximetry <95%. Conclusions: The Roth score has strong correlation with dyspnoea severity as determined by hypoxia. This tool is reproducible, low resource-utilization, and amenable to telemedicine. It is not intended to replace full clinical workup and diagnosis of respiratory distress, but it is useful in risk-stratifying severity of dyspnoea that warrants further clinical evaluation.

To see more information on the ROTH Telemedicine score, please click HERE