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Referral
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COVID-19: Community Access to Neutralising Monoclonal Antibodies (nMAB) and Oral Antivirals for Covid-19 Treatment
Key Messages
Oral antivirals can now be prescribed in general practice (if confident of appropriateness and safety – see Devon Formulary guidance). Medication stocks are now available for eligible patients via community pharmacies as well as through CMDUs.
NICE TA878 update (March 2024): NICE has recommended a phased implementation of new recommendations for Paxlovid to expand its use. Further patient groups have been added (see referral form). There will be a further expansion of the patient groups eligible for Paxlovid during the course of 2024.
Eligible patients can now collect lateral flow tests from community pharmacies.
GPs may either assess and:
a) Refer to their local CMDU (via A&G or direct referral)
OR
b) Prescribe Paxlovid (nirmatrelvir/ritonavir)
(if confident of appropriateness and safety – see Devon Formulary guidance)
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.
- Formulary guidance COVID-19 treatments for patients who do not require hospitalisation: N&E Devon / S&W Devon
There is also prescribing training available the NHS Learning Hub here
A referral form has been developed and agreed for use by GPs. The referral form has been made available by Ardens for SystmOne and EMIS practices.
- Patients should be assessed to ensure they can be managed safely in the community.
If safe to be managed in the community:
- Initial assessment for consideration of a COVID-19 treatment
The patient should meet ALL of the following to be considered for treatment:
| COVID-19 test | Positive SARS-CoV-2 infection lateral flow test or Polymerase chain reaction (PCR) testing |
| Date of onset of COVID-19 Symptoms | Onset of symptoms of COVID-19 within the last 5 days |
| Severity of COVID-19 infection | Does not require hospitalisation or supplemental oxygen for COVID-19 |
| Age and Weight | NOT under 12 years or weighing less than 40kg** |
| Clinical history | Any of the following patient groups: 1) At increased risk of progression to severe COVID-19 (patient groups defined in section 5 NICE TA878)** 1a) Adults: Risk factors for progression to severe COVID-19 1b) Young people aged 12 to 17 years: Risk factors for progression to severe COVID-19 2) aged 85 years and over
For hospital acquired CV-19: see full guidelines here |
*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.
**If there is any uncertainty, CMDU Advice & Guidance is available here. North & East Devon / South & West Devon>
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. If uncertain, please refer for A&G.
Patients who require hospitalisation for COVID-19 should be referred to an acute trust. See:
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.
A. 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:
B. Assess Patient Eligibility for a COVID-19 treatment (see Assessment section)
If eligible:
C. GPs may either assess and:
a) Refer to their local CMDU (via A&G or direct referral)
- Referrers are requested to complete referrals at their earliest opportunity.
- 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 and organise action together. (e.g., when the patient isn’t eligible). The CMDUs will convert those referrals that cannot be managed in the community (for any reason).
OR
b) Prescribe Paxlovid (nirmatrelvir/ritonavir)
(if confident of appropriateness and safety – see Devon Formulary guidance)
- Prescribing may be undertaken in general practice with the use of the Devon Formulary guidance and the Liverpool COVID-19 Drug Interaction Checker to support prescribing decisions.
- Please note, there are potential serious risks of patient harm if prescribing advice is not followed. If the requestor is willing to prescribe Paxlovid, but needs clinical advice prior to this, then please refer on e-RS asking for A&G.
- 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.
• There is also prescribing training available at the NHS Learning Hub here.
• Please note that community pharmacies may not 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 and will receive the treatment within the 5 days of symptom onset, 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.
D. Consider other referral pathways should be utilised in parallel as appropriate.
Referral Instructions:
a) In Hours Referral A&G Referral (access to e-RS):
If the requestor is willing to prescribe Paxlovid (if appropriate), but needs clinical advice prior to this, then please refer on e-RS A&G using the Referral Template.
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, but you are willing to prescribe with appropriate advice, please use the Direct Referral option below, using the shortened A&G Referral Template.
b) In Hours Direct Referral (access to e-RS):
If the requestor is NOT willing to prescribe Paxlovid, then please refer on e-RS using the Referral Template:
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
c) Out of Hours (OOH) / NHS111 (clinicians with no access to e-RS ONLY)
If a patient is assessed by OOH/NHS 111 and meets the eligibility criteria, patients should be referred by completing the Direct Referral Template and emailing it to the appropriate CMDU:
- University Hospitals Plymouth plh-tr.cmdu@nhs.net
- Torbay and South Devon NHS Foundation Trust tsdft.covidantiviraldeliveryunit@nhs.net
- Royal Devon University Healthcare Trust – Eastern rduh.cmdu@nhs.net
- Royal Devon University Healthcare Trust – Northern rduh.cmdu@nhs.net
A referral form has been developed and agreed for use by GPs. The referral form has been made available by Ardens for SystmOne and EMIS practices.
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: July 2024
