This pathway was created for GPs during uncertain times and are currently not evidence based. Always use clinical judgement to supplement the pathway. Clinical judgement over-rides the pathway. Case Definition: Temp >37.8 a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more Patient calls/signposted to GP surgery with Primary concern related to Version 6: 1 October 2020 coughing episodes in 24 hours Covid-19. a loss or change to your sense of smell or taste Primary Care Telephone Clinical Assessment of Covid-19 Related Symptoms in-hours. Triaging out of hours will Symptoms change or be done in OOH. deteriorating. Symptoms of Covid-19

Non-productive cough History significant COVID Severely Ill and for Should be low in number Patients sick with symptoms / deteriorating resuscitation Covid-19 who are very No dyspnoea condition to the extent Covid symptoms +/or are Severe SOB that further face to face Red self-isolating because of frail. No wheeze Blue medical assessment is Can't complete sentences family member . Use of frailty index

Green Mild flu-like symptoms required. Purple Amber Will c/o presenting with (Young patients) Severe chest pains Access anticipatory assessment at covid another pyrexial illness Fever better with centre change your Extreme faintness or Care plan eg suspected paracetamol management? collapse pyelonephritis etc which Signed DNR Symptoms not chest tightness/wheeze ++ Signs of Sepsis needs to be assessed and Palliative Care significantly deteriorating New SOB- 1 flight stairs Cardiac sounding don’t meet threshold for symptoms referral to ED RR < 20 Significant reduction in fluid intake/urine output consultation need a F2F assessment . Other Clinical concern

CCG Referral CCG Referral Stay at home / Self-care advice Ambulance Dispatch Contact GP for other health Assessment at Covid Centre GP arranges ambulance. Refer to Covid Centre with If cannot be managed by Face - Face Assessment issues. Notifies NIAS & ED – potential Clear Request on Referral initial supportive Home Visit PPE Covid-19 case Letter management

Treat temperature: Paracetamol, Fluids ***Pulse Oximetry <94% in a fit individual is a RED FLAG

Possible CAP Bacterial ReferPneumonia: to Covid Centre Intermediate If issue not acute, follow Refer to Covid Centre for Acceptable Assessment Red Flag Assessment Doxycycline 200mg day 1 then Assessment RE up at GP practice. palliative care Initial100 Supportivemg od for total 5 days Or •Sats > 96% •Sats 94-96%*** •Sats < 94%*** Amoxicillin 500mg tds – 5 days •HR 100 - 110 •RR 23-24COns •Severe If known Asthma/COPD do not use •RR 21-22 •Significant breathlessness High Risk Increasing Age nebulisers . Increase SABA or Consider PMH in Baseline Observationstachycardia. Consider 110- 130PMH in Baseline Observations similar use. •No other significant •Sepsis •Deteriorating Dementia Do not routinely offer a red flags. •Other emergency corticosteroid unless the patient symptoms. Diabetes/Hypertension / CVD has other conditions where these •Clinician not signs. •Clinician concerned Cancer/COPD/Multiple Sclerosis are indicated e.g. copd/asthma concerned. •NEWS** = /> 7 •NEWS** =/> 5 Organ transplant / immunosuppressant Safety Netting. Tele/Video review •NEWS** <5 Asthma – high dose ICS in 72 hours (or earlier if unwell Pregnant with Cardiac condition / Other significant issues REFERRAL TO SECONDARY CARE