• Patients should be assessed to ensure they can be managed safely in the community.
  • COVID-19 rapid guideline: managing COVID-19

• If safe to be managed in the community:

1) Initial assessment for consideration of a COVID-19 treatment

The patient should meet ALL of the following to be considered for treatment:

*If there is any uncertainty, CMDU Advice & Guidance should be considered.

**There are no routine treatment options for children under 12 years or weighing less than 40kg. GPs should contact the child’s specialist team directly.

Please Note: patients should be made aware that not all patients within “high risk” groups will need treatment e.g., neurological conditions, if mild and not on immunosuppressive treatment.

2) Other referral pathways should be utilised in parallel as appropriate.

Other Essential Information:

• COVID-19 vaccination status
• a complete and accurate list of the patient’s current medication

This information is essential for safe prescribing of COVID-19 antiviral medication.

Patients who require hospitalisation for COVID-19 should be referred to an acute trust. See:

COVID-19 rapid guideline: managing COVID-19

SARS-CoV-2 polymerase chain reaction (PCR) or lateral flow testing within the last 5 days

• Eligible patients can now collect lateral flow tests from local pharmacies. This has replaced the online and telephone ordering service for free lateral flow tests. The pharmacy may ask the patient for their medical history to confirm their eligibility.

• Eligible patients have been advised to keep tests at home. However, tests can also be purchased from a pharmacy or shop if required.

Advice on when to test

The advice from NHS England states:

‘If you have Covid symptoms you should take a test immediately, even if your symptoms are mild.

If your test is negative but you continue to have symptoms, you should take another test on each of the next two days (three tests in total over three days).

You should report your test result where possible at https://www.gov.uk/report-covid19-result or by calling 119, using your NHS number and postcode (at the top of this letter). This will ensure your test result is visible to the NHS, to support referral and assessment.

You will not be able to report the result of a test purchased from a pharmacy or shop, but this will not affect your access to an assessment for treatment.’

• Patients should be assessed to ensure they can be managed safely in the community (including giving appropriate safety netting advice). See:

COVID-19 rapid guideline: managing COVID-19

If safe to be managed in the community:

• Assess Patient Eligibility (see Assessment section)

If eligible:

• Assess the patient for suitability for Paxlovid. Refer to Formulary guidance COVID-19 treatments for patients who do not require hospitalisation: N&E Devon / S&W Devon
  

Oral antivirals can now be prescribed in primary care. Medication stocks are now available for eligible patients via community pharmacies as well as through CMDUs.

Please refer to the Devon Formulary guidance to aid appropriate and safe prescribing in the community – including checking for drug interactions, contraindications and dose change requirements e.g. for impaired renal function.

Do not prescribe Paxlovid without carefully considering whether it is appropriate for the patient.

So, GPs may either assess and:

• Refer to the local CMDU:
  • complete the referral template and refer to a CMDU by searching for the CMDU services on e-RS (see Referral section).
  • As treatment is time sensitive, referrers are requested to complete referrals at their earliest opportunity (ideally on the day of assessment).
  • Advice and Guidance (A&G) is the preferred e-RS referral method to the CMDUs. This allows the CMDUs an efficient way to communicate with the referrer (e.g., when the patient isn’t eligible, or the referral template is not completed). The CMDUs will convert those referrals that cannot be managed in the community (for any reason).
  • Referrals made on day 5 will still be triaged and actioned by CMDUs, even if these are seen after day 5 (e.g., referral on Friday evening). Clinical judgement will be used.

OR

• Prescribe Paxlovid (nirmatrelvir/ritonavir) directly
  
  • Do not prescribe Paxlovid without carefully considering whether it is appropriate for the patient. For more information, refer to Formulary guidance COVID-19 treatments for patients who do not require hospitalisation: N&E Devon / S&W Devon)
  • Please note that community pharmacies are unlikely to have Paxlovid in stock and will have to order it (which may be up to 24 hours). As long as the patient meets all the eligibility and exclusion criteria, this time delay is acceptable.
  • Once prescribed in primary care, the patient or their representative should contact the pharmacy to confirm whether the medication will be available within the 5 day treatment ‘window’, and to let the GP know if this will not be the case. If the time delay will push the patient outside the 5 day treatment ‘window’, then a referral is appropriate.

Please see the Devon Formulary guidance for prescribing advice:

• Formulary guidance COVID-19 treatments for patients who do not require hospitalisation: N&E Devon / S&W Devon

• Formulary section 5.3.6. Nmabs and other antivirals: N&E Devon / S&W Devon

There is also prescribing training available the NHS Learning Hub here.

A list of those eligible for these treatments can be found on the referral form and on the national website here – under ‘Recommendations update: Box 1 and Box 2’. This list does change, so it is important to check when assessing a patient with a positive COVID-19 test.

• Consider other referral pathways should be utilised in parallel as appropriate.

• See ‘Referral’ section for details on the referral process for Out of Hours (OOH) or NHS 111.
  

PANORAMIC study
Oral antivirals will be made available to a wider cohort of at-risk patients through a national study known as the PANORAMIC study. Further information is available here: PANORAMIC trial. Patients eligible for nMABs or oral antivirals under this guidance should be offered treatment in the community and not be referred to this study.

Referral Instructions:

a) In Hours Referral (access to e-RS):

If a patient meets the eligibility criteria, patients should be referred using the referral template to a CMDU by searching for the CMDU services on eRS:

e-Referral Service Selection

Specialty: Infectious Diseases

Clinic Type: A&G

Service: There will be an option for a service that includes ‘CMDU’ in the name

If an A&G option is not available on e-RS for your local CMDU, please use the direct referral option below. If appropriate, and asked for, advice may still be provided via the below option.
e-Referral Service Selection

Specialty: Infectious Diseases

Clinic Type: Not Otherwise Specified

Service: There will be an option for a service that includes ‘CMDU’ in the name

b) Out of Hours (OOH) / NHS111 (no access to e-RS)

If a patient meets the eligibility criteria, patients should be referred using the referral template to a CMDU and emailed to the appropriate CMDU:

• Royal Devon University Healthcare Trust – Eastern rduh.cmdu@nhs.net

• Royal Devon University Healthcare Trust – Northern rduh.cmdu@nhs.net

• University Hospitals Plymouth plh-tr.cmdu@nhs.net

• Torbay and South Devon NHS Foundation Trust tsdft.covidantiviraldeliveryunit@nhs.net

Referral Form

Referral form nMAB community access - no merge fields

Referral form nMAB community access - EMIS

Referral form nMAB community access - S1

Patient Information

Treatments for coronavirus (COVID-19) - NHS

Easy read and other language versions of this information are available from: Treatments for COVID-19 – Easy Read - NHS

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: January 2022

Updated: January 2024