Intended for healthcare professionals

Rapid response to:

Practice 10-Minute Consultation

Covid-19: a remote assessment in primary care

BMJ 2020; 368 doi: (Published 25 March 2020) Cite this as: BMJ 2020;368:m1182

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Rapid Response:

Re: Covid-19: a remote assessment in primary care

Dear Editor

Thank you to Prof Greenhalgh and team for much needed advice on handling community covid 19 consultations by telephone or video link. At our surgery, it is estimated we have moved from 10% to at least 90% of all types of consultations being on the telephone. A dramatic change in how we handle patient care, which appears to be reflected nationally.

The three NHS 111 symptom checker questions reported in the article have a positive response bias as they favour agreement with the statement. As the article rightly indicates prefacing these with open statements, such as how is your breathing or how active are you, may reduce this bias.

Having had swab positive covid 19 infection, I am aware of the value of oxygen saturation monitoring and the importance of change from baseline as well as the absolute level. Where appropriate, to support the community care of people with covid 19 infection, it is suggested full or part packs of a thermometer, oxygen saturation monitor and Blood pressure monitor with pulse recording are supplied, cleaned after 2 weeks use and recycled. This will assist remote monitoring by telephone and help detect rapid onset hypoxia that can occur with relatively few symptoms around day 7 after onset of covid 19 infection.

Competing interests: No competing interests

25 March 2020
Mark A Rickenbach
GP and Professor of Healthcare
Park and St Francis surgery, Chandlers Ford, Hampshire, SO534ST