COVID Medicine Delivery Unit (CMDU)

Overview

Treatments are available for those the NHS considers at highest risk of developing severe COVID-19. 

Information for patients can be found here www.nhs.uk/CoronavirusTreatments 

Supporting information on risk factors for progression to severe COVID‑19 | Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19 | Guidance | NICE

Eligibility

Eligibility criteria

Non-hospitalised patients are eligible if they meet all of the following:

Patients eligible for treatment are also eligible for free COVID-19 lateral flow tests, which can be collected from a community pharmacy. They can also use tests purchased from a pharmacy or shop. 

Process within BNSSG

A Covid Medicines Delivery Unit (CMDU) Service has been set up in two GP practices within BNSSG (Mendip Vale Medical Practice and Concord Medical Centre). A clinical assessment team within these GP practices will screen and review patients for their suitability for specialist COVID treatments and prescribe medication. These two practices also have an Infusion Unit where they can administer the antiviral or nMAB via an intravenous infusion for the treatment of COVID-19 if most appropriate choice for the patient.

Referral

Eligible patients should contact their GP practice or out of hours NHS 111. Alternatively, they may contact their specialist hospital clinician. You can refer to the Covid Medicines Delivery Unit (CMDU) via the route below.

Please ensure that patients are aware that referral does not guarantee treatment and CMDU will assess eligibility and benefit.

The CMDU service referral form is available on EMIS. Please send via email address below. A Word version of the referral form is also available.

For the minority of clinicians unable to refer patients via the EMIS referral form e.g. specialist hospital clinicians please use the Word version and email as detailed below.

EMAIL ADDRESS:  bnssg.cmdu@nhs.net 

Subject: Referral for BNSSG Covid-19 CMDU 

Include the patient’s:

• Full name
• NHS number
• Date of Birth
• Address including postcode
• GP practice
• Date of most recent positive Lateral Flow test 
• Include medical condition making patient eligible for CMDU
• List of all patient medications/allergies
• Date of symptoms start (if known)
• Make sure patient contact details are included (a telephone number is essential)
• Hospital and ward if in Mental Health hospital

Children

The referral process is the same for children. The CMDU will liaise with the UHBW Paediatric Clinical Assessment Team. Children will receive infusions at the Bristol Children’s Hospital.

Weekend Referrals

NHS111, Out of Hours and colleagues working within BNSSG

Over the weekend period the CMDU service within Primary Care is available on a Saturday morning only. The service is then reinstated on a Monday morning with additional workforce. Therefore, patients referred on a Saturday afternoon, Sunday morning or afternoon are all screened on a Monday morning. Please can you advise patients that may present over the weekend to expect a phone call from a clinician on the Monday and to contact their regular GP if they haven’t heard from a clinician by the Monday afternoon. 

Mental Capacity

A pool of clinicians across BNSSG support the service by checking those referred are eligible and discussing treatment options with the patient. 

In rare cases where patients lack capacity it may be necessary for the service to seek help from the patient’s GP. The time critical nature of the treatment means decisions need to be made on the day or within 24 hours for the majority of cases. The CMDU clinician will contact the practice – initially by phone and then by sending details to the email address the practice provides – with details of the eligibility criteria and treatments available. They will ask the GP whether the patient meets the criteria and if so – on balance – whether treatment is likely to be in the patients bests interest. For example, would traveling to GP site for infusion be unduly distressing, would they accept an IV cannula.

Screeners will make every effort to make this decision independently and the patient’s GPs will be asked to support only in exceptional circumstances.

Additional information

Treatments available from CMDU

Antiviral

Antiviral medications inhibit viral replication and prevent progression of infection.

Neutralising Monoclonal Antibodies (nMABs)

nMABS are synthetic monoclonal antibodies that bind to the spike protein of the Covid virus, which prevents entry into the host cell and replication.

• Paxlovid (nirmatrelvir + ritonavir) = 1^st line option (Antiviral – oral medication)
• Sotrovimab = 2^nd line option (only if paxlovid is contraindicated or unsuitable) nMAB – IV infusion)
• Molnupiravir 3^rd line option (Antiviral – oral medication)

Interactions

• Further detail on interactions for nMABs or antivirals with other medication(s) can be found in the individual SPC.
• Further information can also be found on the University of Liverpool COVID-19 drug interaction checker  https://www.covid19-druginteractions.org/checker

e-Learning

• COVID- 19 Antiviral Treatments e-learning module can be found here

Side effects 

For a list of side effects please refer to individual summary of product characteristics below

Summaries of Product Characteristics:

1. SPC/Paxlovid  Patient information leaflet Paxlovid
2. SPC/Xevudy (Sotrovimab)
3. SPC/Lagevrio (Molnupirivir)

Learning events

It is important that any near miss or incident is reported on Datix

As these medications are MHRA black triangle drugs, all adverse reactions occurring in individuals of any age after administration should be reported to the MHRA using the specific Coronavirus Yellow Card Scheme. https://coronavirus-yellowcard.mhra.gov.uk/

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.