All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Although most people will recover following a COVID infection with time, a sizeable minority will continue to have symptoms lasting over 12 weeks.
The likelihood of Long-COVID developing is not thought to be associated with the severity of the acute COVID-19 or if hospitalisation was required or not.
Long-COVID can be a multisystem disease presenting with a variety of symptoms that can have a significant impact on a person’s quality of life. As such, Long-COVID investigation and management requires a multisystem holistic approach.
Because of the huge variety of presenting symptoms, an examination and numerous investigations are essential before referring to the Post (Long) COVID service.
It is important to think of Long-COVID as a diagnosis of exclusion and to investigate symptoms as you normally would.
The Post (Long) COVID service aims to provide a holistic assessment of the patients around a virtual MDT and referral on for diagnostics and to specialist services as required.
WITH
AND
AND
AND
must be attached to the referral to aid appropriate triage.
Please note that patients whose symptoms predate the pandemic and have not changed as a result of COVID infection are NOT appropriate for this service
Referrals submitted not on the mandated proforma +/- do not meet the referral criteria will be returned.
Aim of assessment should be to determine the nature and severity of current symptoms and exclude alternative diagnoses.
It is important that the patient is assessed holistically including:
It is important to recognise that:
Important to take a comprehensive history including:
Prior to onward referral a face-to-face appointment is essential.
Examination should be tailored to presenting symptoms. However, some specific routine examination findings are mandated on the referral proforma.
Examinations that must be included:
Examination to consider, include:
All referrals require a minimum of:
AND
Even if the patient is not reporting fatigue symptoms
These results must be attached to the referral to aid appropriate triage.
Other investigations should be ordered for specific clinical indications after careful clinical history and examination.
If a patient has any of the symptoms below, then the results of the investigations listed for that specific symptom must be attached along with the ‘Long-COVID’ blood results and examination findings.
E.g.
The specific investigations which must be attached for each symptom are:
CXR
Be aware that a plain CXR may not be sufficient to rule out lung disease.
3. Tachycardia/palpitations:
People who have had suspected COVID or confirmed acute COVID-19 should be given advice and written information on:
Providing/signposting to written information is especially important as the Post-COVID symptoms can have an impact on retaining information.
2. Assessment
For people who are concerned about new or ongoing symptoms 4 weeks or more after acute COVID should be offered an initial consultation in primary care by telephone or video consultation or face to face if deemed appropriate and available.
See ‘Assessment’ section.
3. Ongoing care options
After the holistic assessment use shared decision making to discuss and agree with the person what support and onward care they need and how this will be provided. This may include:
Post (Long) COVID Service
The Post (Long) COVID service will involve initial virtual clinical triage at locality level by a designated clinician who will hold the caseload for that locality.
A screening questionnaire based on the Newcastle Screening Tool will be shared with individuals accepted onto the service. They will complete this prior to assessment, to support them in thinking about previous and current symptoms to aid the assessment process.
Following initial triage patients may be directed to:
Decisions made at MDT will be actioned by the locality case holder. As Long COVID is a multisystem disease it is envisaged that a person may require several discussions at the MDT and review by multiple specialities and the aim will be to complete a full assessment before discharge back to primary care therefore avoiding the need for multiple referrals.
People aged 16 and over
AND
AND
AND
AND
must be attached to the referral to aid appropriate triage.
Please note that patients whose symptoms predate the pandemic and have not changed as a result of COVID infection are NOT appropriate for this service
Referrals submitted not on the mandated proforma +/- do not meet the referral criteria will be returned.
e-Referral Service Selection:
Specialty: Respiratory
Clinic Type: Not Otherwise Specified
Service: DRSS-Northern-Long Covid Referral-Devon ICB-15N
DRSS Long COVID referral template
MyHealth Devon website - Long COVID
BMJ article: Management of post-acute COVID-19 in primary care
NHSE National Guidance for Post COVID syndrome assessment
NICE guidance NG188: COVID-19 rapid guideline: Managing the long term effects of COVID-19
This guideline has been signed off on behalf of the NHS Devon.
Publication date: January 2021
Updated: January 2022
This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group
Publication date: January 2021
Updated: January 2022