Latest Guidance Updates
June 2022: updates to both algorithms, wording changes (notably, lateral flow test [LFT] replacing polymerase chain reaction [PCR] test), updates to the sections on COVID-19 Oximetry @home monitoring and COVID-19 medicines delivery units.
This updated Guidelines summary provides key information for primary care on the assessment, monitoring, and treatment of patients who present to general practice with symptomatic COVID-19.
Reflecting on Your Learnings
Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.
Adult Primary Care COVID-19 Assessment Pathway
Algorithm 1: Adult Primary Care COVID-19 Assessment Pathway
COVID-19 Oximetry @home Monitoring
- As per Algorithm 1 in the section, Adult Primary Care COVID-19 Assessment Pathway, patients who are at higher risk and are well enough to be managed at home should be considered for COVID Oximetry @home (CO@h)
- The CO@h pathway should be available to people who are:
- diagnosed with COVID-19: either clinically or positive test result and
- symptomatic and either
- aged 65 years or older or
- under 65 years of age and at higher risk from COVID-19, or where clinical judgement applies considering individual risk factors such as pregnancy, vaccination status, learning disability, caring responsibilities, and/or deprivation
- Pregnant women being referred to a CO@h service should also be asked to contact their maternity team for specific advice around pregnancy and COVID-19
- CO@h is a self-monitored and self-escalated pathway, with optional check-in calls for some patients. Patients are provided with a pulse oximeter, a supporting pack including instructions on self-monitoring, and clear guidance on safety netting and escalation
- For those patients in whom a self-monitored pathway is not clinically deemed to be sufficient, a referral to local CO@h services providing proactive telephone calls to support patient monitoring should be considered
- All patients who are eligible for COVID-19therapies should also be considered for CO@h monitoring, as they are in high-risk groups.
- As per Algorithm 1 in the section, Adult Primary Care COVID-19 Assessment Pathway, the highest risk patients with mild-to-moderate symptoms should be considered for treatment with new antibody and antiviral treatments if they are within 5 days of symptom onset
- Two types of COVID-19 treatments are available:
- neutralising monoclonal antibodies usually given by infusion or injection in a local hospital or health centre
- oral antiviral treatment—currently molnupiravir (Lagevrio) in capsule form that can be taken at home
- Patients who are eligible for these treatments should be referred to COVID-19 medicines delivery units (CMDUs)
- Patients who are not eligible for COVID-19 treatments could be eligible for the PANORAMIC trial.
COVID-19 Medicines Delivery Units
- GP practice teams can still refer potentially eligible patients if they have tested positive for COVID-19. COVID-19 treatments must be delivered quickly following symptom onset. Practices and 111 should use the clinical policy document to help identify if a symptomatic patient is potentially eligible. GP teams should check the patient meets the criteria for referral. The CMDU will confirm eligibility and discuss treatment options
- Therefore, if you are assessing a patient who is at highest risk (for the full list of eligible patient criteria, see Table 1), has not been contacted by a CMDU, and meets the following referral criteria, you should refer to a CMDU. If your area is using e-Referral Service (eRS) to refer patients to CMDUs, the NHS has asked commissioners that their CMDU services are listed in the infectious diseases specialty, under a nonspecific ('not otherwise specified') clinic type, but to include in the service name, the words ‘COVID-19 medicine delivery unit (CMDU)’. Some services may have been established with the service name ‘COVID MABS delivery unit (CMDU)’.
- Referral criteria for CMDU:
- positive test for COVID-19 and
- symptomatic with COVID-19 and showing no signs of clinical recovery and
- onset of COVID-19 symptoms within the last 5 days and
- patient is a member of the highest-risk cohort
- NOT requiring hospitalisation or oxygen for COVID-19
- NOT under 12 years old
- NOT a child weighing less than 40 kg
- NOT been contacted by the CMDU directly within 24 hours of their test result
- The main message for everyone is that vaccination is key and is still the mainstay of protecting people against COVID-19.
Table 1: Eligibility for COVID-19 Medicines Delivery Unit Referral
|Sickle cell disease|
|Patients with a solid cancer|
|Patients with a haematologic malignancy|
|Patients with renal disease|
|Patients with liver disease|
|Patients with IMIDs|
|Primary immune deficiencies|
|Solid organ transplant recipients|
|Rare neurological conditions|
|Abbreviations: AIDS=acquired immunodeficiency syndrome; APECED=autoimmune polyendocrinopathy candidiasis ectodermal dystrophy; ATG=anti-thymocyte globulin; CAR=chimaeric antigen receptor CD=cluster of differentiation; CKD=chronic kidney disease; CML=chronic myeloid leukaemia; CVID=common variable immunodeficiency; eGFR=estimated glomerular filtration rate; GVHD=graft versus host disease; HSCT=haematopoietic stem cell transplant; HIV=human immunodeficiency virus; IMID=immune-mediated inflammatory disorder; Ig=immunoglobulin; IgM=immunoglobulin M; MDS=myelodysplastic syndrome; MGUS=monoclonal gammapathy of unknown significance; nMABs=neutralising monoclonal antibodies; SACT=systemic anti-cancer treatment; SCID=severe combined immunodeficiency; TKI=tyrosine kinase inhibitor|
|© NHS England, 2022. Contains public sector information licensed under the Open Government Licence v3.0.|
For information on eligibility for the PANORAMIC study, refer to the full guideline.
For further information on CMDUs, refer to the full guideline.
COVID-19 Treatment Pathway—Overview for GPs
Algorithm 2: COVID-19 Treatment Pathway—Overview for GPs/111
For information on the PANORAMIC study and additional resources, refer to the full guideline.