Changes to prepare for and manage COVID surge (March/April 2020 – archive material)

All material and documents below were prepared in March/April 2020 during the earliest stage of the COVID-19 pandemic and have been retained for their ongoing relevance.

Regarding trauma surgery and fracture services

The BOA has worked with NHS England to prepare guidance which is available here. This guidance discusses the handling of trauma patients during the period when there is increased pressure on the NHS from treating coronavirus patients. It includes a ‘T&O Escalation Policy’ (p.5), which our members have been telling us is useful, and it is clear some areas of the UK are already progressing up the escalation stages. We encourage all members to read this at the earliest opportunity. The BOA intends to work with other relevant bodies to share ideas and good practices about ways of working during this time.

The BOA has published guidance on 24th March, entitled ‘Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic’, which is designed as a series of ‘COVID BOASTs’ and includes sections on management of inpatient, outpatient, paediatric and hand trauma. This is available here.

Regarding elective surgery

All parts of the UK have issued guidance permitting suspension of non-urgent elective surgery (NHS England letter here, Scottish government statement here,  Wales announcement here). As at the end of March, the BOA understands that most, if not all, non-urgent elective operating has now stopped. In England, the advice read that that this suspension would last at least three months but the full duration will depend on various factors as the pandemic progresses.

Additional delays to their planned surgery, at a time when waiting times have already increased significantly in recent years, will have a huge impact on patients, and the waiting list will undoubtedly grow significantly over the coming weeks and months.

  • We have published some ‘Frequently asked questions’ for patients, which we will keep updated as the coronavirus situation unfolds.
  • We are liaising with the NHS England National Clinical Director for MSK to discuss the handling of elective patients over the coming weeks and months, particularly in terms of interim arrangements for those with worsening or ‘red flag’ symptoms and ensuring there are pathways for urgent elective patients.
  • We are highlighting to NHS England that a ‘recovery plan’ will be needed once elective surgery resumes to handle the extended waiting lists.

For GP, diagnostic and outpatient appointments, providers have been asked to roll out remote consultations ‘as a priority’. ‘Face-to-face appointments should only take place when absolutely necessary.’ One of the early articles for the ‘Transient JTO & the Coronavirus’ covers this topic and can be read here.

Two other useful resources are:

If you have found other helpful resources, do let us know and we can add them.

What’s happening with community and rehab services related to musculoskeletal conditions

NHS England guidance has been published regarding community and rehab services, listing which services should continue and those that should stop or change. It covers both children and young people services and adult and older people services and is available here.

What’s happening regarding referrals from primary and community care

This is a situation that may differ in different parts of the country. We highlight to our members that we have supported guidance on ensuring that emergency and urgent referrals for T&O are prioritised. That guidance relating to adults is available online here, and further guidance for paediatric orthopaedics is underway.

NB We have a separate webpage available which lists all the guidance documents available regarding coronavirus in the T&O specialty and subspecialties here.