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The waiting game

GPs advised to avoid 'over-reliance' on PPE and to focus on hand hygiene

GPs should focus on hand hygiene and other basic infection prevention, with NHS England suggesting there was an 'over-reliance' on personal protective equipment in the face of Covid-19.

In a live webinar last Thursday evening, GPs had expressed concern for their safety in light of recent NHS England advice that they should return to delivering 'as much routine and preventative work as can be provided safely', including screening.

Gaynor Evans, NHS England’s senior infection prevention and control advisor, told GPs: ‘The really important issue is around hand hygiene and this over-reliance on PPE as the protector. 

‘While we do need [PPE], it does not work on its own and you’ve still got to have the very basic infection prevention and control practices in place.’

She added that, as practices resume routine work while the UK remains in the ‘sustained transmission’ phase of the pandemic, the current PPE guidance ‘still stands'.

She said: ‘I don’t think we’re going to change that because at the moment we are still able to consolidate the guidance along with the research.’

NHS England further clarified in the webinar that any PPE purchased by practices which goes above and beyond that which is recommended for general practice by Public Health England will not be financially reimbursed.

NHS England director for primary care strategy and contracts Ed Waller said: ‘The reimbursement system is going to be set up on the basis of the guidance that has been given to the system. 

‘In the case of PPE, the expectation is that we will reimburse PPE expenses in line with what PHE has recommended.’

The PHE guidance has come under fire from GPs for recommending lower levels of protection than the World Health Organisation for what some have suggested are political reasons.

In a recent letter to commissioners, one LMC recommended that practices should be able to provide full WHO-level PPE for their staff.

Berkshire, Buckinghamshire and Oxfordshire LMCs said: 'The LMC position on PPE follows the WHO, which is the international authority on the issue. Their guidance has no political interference.’

It added: 'We recognise that there is a PPE shortage [but] our professional advice cannot and should not be changed for issues of supply or convenience.

'In the context of a shortage, it is rational and reasonable to first provide WHO-standard PPE for those who are in contact with patients with Covid symptoms.

'In the community, this would include clinicians supporting hot hubs, hot visiting services, hot palliative care work, and staff in care homes supporting residents with Covid symptoms.’

In April, PHE published guidance on when to reuse PPE during shortages, which it has updated this month to include the substitution of Type IIR surgical face masks with FFP2 respirators in times of ‘severe shortage’, without requiring fit testing.

The BMA has said GPs can refuse to treat patients if their PPE is ‘inadequate’, while many GPs have already been implementing a ‘no PPE, no see’ policy, which a medical defence organisation has said should not result in GPs being punished.

Meanwhile, the BMA said last week that GP practice PPE supply remains a ‘postcode lottery’.

Readers' comments (24)

  • Bollox.

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  • I've stopped listening. All faecal overload. I watch Japan and S.Korea now. Hygiene masters laughing at your mediocrity.

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  • Vinci Ho

    You see
    That is exacting where the arrogance and bigotry lie as far as these NHS England ‘experts’ sitting up the summit of the ivory tower are concerned .
    First of all , nobody said the hand hygiene , cleansing the surfaces as well as social distancing are to be ignored by GPs . The PPE is on top of all these . Yes , it could be seen as pedantic but in a pandemic with full knowledge understanding the contagion , this is exactly why we need this mentality .
    The full PPE recommended by WHO( no matter how controversial their positioning along China was) is for the sake of confidently protecting both the health professionals and patients .
    The reality is the track record now set up by UK government as far as number of testings , total number of deaths ,the plight of elderly living in care homes etc , is evidently appalling . There is no need to compare with other countries , in my opinion .
    So has any of you guys up there honestly admitted making mistake and misjudgment with some humility ?The answer to that is a resounding NO .
    Confucius said an authority can never stand in the absence of trust from people , no matter how much this authority thought they had said and done the ‘right’ thing . Listen to people and forget that you are an elite of science because the more advanced knowledge you think you have , the further and further distance you have positioned away from people .........
    Please get off from your high horse and restore the connection with those fighting at the frontlines.............

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  • When Gaynor Evans does a video of her seeing patients face to face, with no PPE, and only hand washing to protect her.

    Then we will take her views
    seriously.

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  • doctordog.

    Didn’t think Covid-19 could penetrate the skin?!?

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  • No PPE no see. If removed from post happy to sell the house and emigrate if needed. Lots of jobs in Canada at the moment. The middle East are recruiting as well. 9 GP's have passed away now in the uk.
    Would love to see international comparison of death amongst healthcare workers and what the factors were.
    Would also be great to see what Trisha greenhalgh has to say on this as well. Could pulse request her for comment.
    - anonymous salaried!

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  • Vinci Ho

    Apology and correction

    .....Yes , it could be seen as pedantic but in a pandemic without full knowledge of understanding the contagion , this is exactly why we need this mentality .

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  • Many think that there is a link between early lockdown and the reduced spread of the virus. But that is often confounding with the supply of PPE for healthcare prodessionals. That might just be the most important step, because in a country where most people are staying at home, transmission via the health workforce is really significant.

    Germany South Korea and other low transmission countries had a good system of PPE.
    USA UK Italy and Spain had major shortages of PPE.

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  • A lot of whinging here.

    If we are independent contractors we have to take this on the chin and provide our staff with what we see fit. The guidance is just that.

    If you think practices should be able to provide full WHO-level PPE for their staff then buy it for them.

    TBH I'm very grateful for the loads of PPE that just appears to turn up at our door.

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  • The health and safety exec will be very busy investigating the employers who fail to provide safe workplaces.

    One key aspect of a safe workplace is adequate protective equipment. Failure to provide this is a reason for significant fines and closure of workplaces.

    Responsibility for ensuring compliance with HaSaW legislation is the responsibility of employers and employees.

    The HaSaW notice should be on display in all workplaces with the number to call if you need advice from the the health and safety executive.

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