Table 8 Core recommendations

• Patients must be encouraged to seek medical advice when they have symptoms that they would normally seek advice for, and not delay because of the Pandemic or advice to “Stay at Home”.

• More targeted face to face assessments may reduce future risk.

• Stay at home advice must be given in the context of the patient’s medical and social vulnerabilities.

• Patients at high risk of complications should be contacted early in their illness when medical services become aware of a positive test.

• Patients with a positive COVID-19 test and symptoms need active reviews to detect early desaturation to facilitate early admission to hospital.

• A low threshold should be set for planned follow up calls after any telephone contact.

• Care homes may need access to specialist palliative care at short notice.

• Pre-emptive telephone welfare checks for vulnerable relatives of positive cases should be considered as they are at high risk of infection.

• A joined-up approach to follow up between primary care, secondary care, ambulance services, and NHS 111 is necessary after first contact.

• Pre-emptive discussions about ceiling of care and preferred place of death should be held with care home residents, and families where appropriate.

• As evidence of survivability emerges, decisions to not ventilate must be fully evidence based.

• Decision making should be patient focussed, not service focussed.

• Telephone consultations should not be made with second or third party carers unless unavoidable.