Post Covid Syndrome Service

We have produced an animation that explains Post Covid syndrome and the associated symptoms.

Click on the image below to watch it.

Acute COVID-19 is defined as signs and symptoms of infection for up to the first 4 weeks.
Ongoing symptomatic COVID-19 is defined as signs and symptoms of infection from 4–12 weeks.
Post-COVID-19 syndrome is defined as signs and symptoms of infection consistent with COVID-19 lasting longer than 12 weeks

What to look for
Symptoms include but are not restricted to:

• Generalized symptoms
  • Fatigue
  • Fever
  • Pain
• Respiratory
  • Breathlessness
  • Cough
• Cardiovascular
  • Chest tightness.
  • Chest pain.
  • Palpitations.
• Neurological
  • Cognitive impairment such as loss of concentration and memory issues
  • Headache
  • Sleep disturbance
  • Peripheral neuropathy including paraesthesia and numbness
  • Dizziness
  • Delirium (in older people)
• Gastrointestinal 
  • Abdominal pain
  • Nausea
  • Diarrhoea
  • Anorexia and reduced appetite (in older people)
• Musculoskeletal
  • Joint and muscle pains
• Psychological 
  • Depression and anxiety
• Ear, nose, and throat
  • Tinnitus
  • Ear ache
  • Sore throat
  • Loss of taste and/or smell
• Dermatological
  • Skin rashes

NICE, June 2021

Emerging Findings (July 2021)

• There is growing evidence of the long term effects of COVID 19 in those who were admitted to hospital with COVID 19.
• Studies also suggest that mental health problems may be common.
• Four disease phenotypes have been identified with varying severities of physical, mental and cognitive health impairment.
• Elevated rates of multi organ dysfunction with post discharge adverse events including: diabetes, major cardiovascular events and respiratory disease as well as increased risk of readmissions.
• Risk was greater for those who were less than 70 years old and from ethnic minority groups.
• Long term organ impairment, including impaired lung function at six months after infection, and persistent inflammation in the heart.
• Occurrence in people who were never admitted to hospital and, in some cases, where initial symptoms were relatively mild.
• The prevalence of Post COVID was higher in people aged 35 69, women, those from more deprived groups and amongst people with pre-existing health conditions.
• Health and social care workers had a higher prevalence.
• Some children and young people also appear to be affected with prolonged symptoms such as insomnia, respiratory problems, fatigue, muscle pain, and concentration difficulties, which were also seen in those with asymptomatic acute infection.
• Care should be stratified, and management should be joined up across specialties within primary, community and secondary care and requires a multi professional workforce.

How to refer

The referral form has been updated and embedded in both System One and EMIS. Please access it through these platforms.

Please note: GP/Clinicians are required to manually complete the fields highlighted in green on the form. All other fields will pull the information through from the patient’s records and auto-populate on the form,

The referral pathway

The following diagram illustrates the referral pathway
Download the full referral process document here

Who is suitable for this referral pathway?

The service is for all patients over 18 within NWL ICS believed to have post-Covid syndrome who:

• require further clinical assessment and investigations related to suspected post-Covid syndrome

AND / OR

• who need a programme of physical and/or psychological therapy

Exclusion Criteria

The Triage Team will unfortunately have to reject referrals in the circumstances as listed below:

• Symptoms which are acute or life-threatening
• Symptoms where alternative causes have not been ruled out
• Where a standard face-to-face assessment – set out in this form as per London guidance - has not been completed by the Primary Care referrer
• Patients under 18
• Patients not registered to a GP practice within NWL
• Patients with symptoms less than 4 weeks after Covid infection
• Patients whose primary need is treatment of chronic conditions that existed prior to Covid infection (e.g. patients with a diagnosis of chronic fatigue syndrome/ME or fibromyalgia predating Covid infection) - in this case, please refer to the appropriate specialty
• Patients with a single need requiring investigation or treatment - in this case, please refer to the appropriate specialty
• Patients with symptoms resulting from Covid-19 vaccination

North West London Post-COVID-19 Syndrome Single Point of Access

This is the NWL post-Covid triage service, which will review the referral form, and if accepted will refer the patient on to either:

• their local Post-COVID-19 syndrome assessment clinic (PCAC) if further medical investigations are required, who will assess the patient and refer the patient onwards for treatment
• their local Post-COVID-19 syndrome Multidisciplinary therapy team who will assess the patient and deliver/coordinate a programme of physical and/or psychological therapy

Post-COVID-19 Syndrome Assessment Clinics

These clinics provide specialist assessment for patients with confirmed or suspected Post-COVID-19 syndrome. The clinic model is described below.

Post-COVID-19 Syndrome Community Multi Disciplinary Services

Psychological Support Available for People with Long Covid

Long Covid can have a significant impact on an individual’s emotional and psychological wellbeing. It can impact the way an individual sees themselves and their life, which can lead to low mood and anxiety. Psychologists form part of the Community MDTs and Post Covid Assessment Clinics. Psychologists will consult on referrals made into the pathway, offering triages and assessments to patients if required. Psychologists can also offer consultation to other professionals working with patients with Long Covid. Psychologists may offer support with:

• Anxiety about long covid and it’s symptoms
• Trauma following covid infection/hospital admission
• Adjusting to changes in lifestyle as a result of long covid
• Heightened anxiety about reinfection

Types of Support available:

• One-to-one support (often virtual)
• Group support (virtual)

Should support for an alternative service be more suitable, a Psychologist can make necessary onward referrals. 

For difficulties with anxiety and depression that are unrelated to long covid, patients can be referred to their local IAPT:

Enhanced Service Required Codes

The codes required are based on the requirements for identification and referral within the Enhanced Service 2021/22.

Diagnosis codes: Ongoing symptomatic COVID-19 (4-12 weeks after infection); Post-COVID-19 syndrome (12 weeks plus)

• 1325171000000109 Acute COVID-19 infection
• 840539006 COVID-19 diagnosis (where not previously recorded)
• 1325181000000106 Ongoing symptomatic COVID-19
• 1325161000000102 Post-COVID-19 syndrome

Signposting and referral codes: Signposting to Your COVID Recovery when signposting patients to the publicly available Your COVID Recovery website (phase 1); Referral to post-COVID assessment clinic

• 1325041000000104 Referral to Your COVID Recovery/ Living With Covid rehabilitation platforms
• 1325021000000106 Signposting to Your COVID Recovery
• 1325031000000108 Referral to post-COVID assessment clinic

Resolution code: Post-COVID-19 syndrome resolved: to be used at the patient and clinician discretion when all symptoms are fully resolved and there is no evidence of persisting organ impairment or if an alternative diagnosis has been made to account for all symptoms (code not available at time of publishing)

Coding of key clinical information in letters from post-COVID assessment clinics or other specialist services is also required

Assessment (optional)

• 1325061000000103 Assessment using Newcastle post-COVID syndrome Follow-up Screening Questionnaire
• 1325081000000107 Assessment using C19-YRS (COVID-19 Yorkshire Rehabilitation Screening) tool Primary Care Minimum Data Set (as at April 2021)

For ongoing symptomatic COVID-19 or post-COVID-19 syndrome in primary care