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GPs can refuse to treat patients with 'inadequate' PPE, says BMA

GPs can refuse to treat patients if their personal protective equipment (PPE) is ‘inadequate’, the BMA has said.

BMA guidance updated today advised GPs that they are ‘under no obligation’ to treat patients without appropriate protection and pledged to ‘robustly defend’ GPs who refuse on these grounds.

It comes as a BMA survey this week revealed that over a third of GPs still lack eye protection and ‘feel unprotected’ at work.  

The new guidance said: ‘There are limits to the risks you can be expected to expose yourself to. You are under no obligation to provide high-risk services without appropriate safety and protection. 

‘You can refuse to treat patients if your PPE is inadequate, you are at high risk of infection and there is no other way of delivering the care.

GPs can also decline to treat patients if personal circumstances such as health conditions or disability mean the PPE provided is not adequate for them, the BMA added.

The guidance said GPs should not face ‘a disciplinary process or detriment’ if confronted with ‘serious and imminent danger’ in the workplace but that the BMA ‘will robustly defend your employment rights to ensure your protection’.

The BMA recommended that GPs:

  • Identify what PPE they need according to the latest guidance
  • Raise any concerns ‘urgently’ with their practice manager or partner
  • ‘Escalate’ the issue with their CCG and ask it to contact the emergency PPE hotline 
  • ‘Risk assess’ using their professional judgement

It said: ‘Depending on the circumstances, it may be appropriate to ask [your CCG] to urgently contact the National Supply Disruption Line to obtain the identified PPE. 

‘They can do this where there is a clinical emergency. This is defined as where care has to stop or change due to supply of PPE.’

The guidance said GPs should take into consideration certain factors when deciding ‘whether to proceed with the PPE offered or refuse to treat’.

These include: 

  • ‘whether the treatment can be delayed or provided differently, such as remotely
  • ‘whether additional steps can be taken to minimise the risk of transmission
  • ‘whether you are at higher risk from infection than others (for example, if you have a health condition or other vulnerability that puts you more at risk)
  • ‘what course of action will give rise to the least harm in the circumstances.’

The guidance added that ‘wherever time permits’ GPs should get in touch with the BMA before deciding what action to take and alert their defence organisation.

They should also keep a record of any decisions, the ‘reasons behind them’ and how they ‘sought to manage safety concerns’, it said.

It comes as updated Public Health England (PHE) guidance published last week recommended wide-ranging re-use of PPE amid shortages. 

The BMA called the situation ‘dire’ and said it was raising ‘serious concerns’ with the Government over the new guidance.

In Birmingham, political leaders warned that the city is due to run out of PPE, with the news coming as GP practices have been added to the list of settings the council should supply. 

Related images

  • facemask PPE coronavirus - getty RF

Readers' comments (7)

  • I totally hate this guidance about choosing individually. It is a total sell out for those less knowledgable skilled and confident. I think I could calculate my own position easily, at what stage would I be willing to say no.

    But can we expect others to do the same. What about a junior nurse? What about a porter or cleaner? Are they really going to be in a position to judge risk themselves they need someone to take the decision for them.

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  • A step in the right direction. Especially for older colleagues, those with medical conditions, carers and BAME. Risk assess everything, you are NOT invincible to this. And do not concede to your 'all-giving' autopilot, HABITS must be broken. Many private hospitals already state clearly they 'will not see cough or flu symptoms'...black lines drawn. PUT ASIDE THE BRAINWASHING of NHSE AND YOUR 'DUTY' and do not let up in the fight for your life, your family and how you practice the career you invested so much in. Do NOT become their statistic.

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  • CQC is very good at setting a “Gold Standard”

    Unions now need to set a “PPE Gold Standard” based on WHO.

    Then they need to support all NHS workers to down tools if PPE Gold standard is not adhered to.

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  • you cant tell me to do all this training in HPE and infection control, with strict guidelines and not work where its not safe to do so and then ignore workplace protection and safety measures because its an emergency. The rules are there for a reason regardless of whether its an emergency or not. This outbreak has demonstrated that the NHS was unprepared for this previously predicted event, there was no adequate stockpile of equipment, guidelines have been broken by management at every level and people have died as a consequence. I hope ebola never goes airbourne, because if it did, most of us would be dead. This has been a mass panic response, with panic planning and ill thought out responses. You wont maintain lockdown for 18 months - already failing in the US. You need a fully constructed plan to allow people back to work asap, even if as a phased timetable, so people have some certainty. already seeing more people out on the roads. Get a timetable out there now. and the media better not moan if we refuse to see people without adequate PPE. we are not soldiers, we did not sign up to die at work. its not in our contracts.

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  • thank god i'm a locum and have some comtrol. as i have copd i consider myself perfectly fit to work - but as i am vulnerable, and very likely to be exposed to covid, i have decided not to work until this is either all over, or PPE is sorted out. ok, money is a bit tight, but my wellbeing is paramount. sorry guys - if the politicians can sort this mess out, i'll willingly come and help - otherwise no can do.

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  • d in vadar.
    We are EXACTLY like soldiers: deployed with inadequate kit on the whim of political REMFs (*).
    Remember Iraq 2003.
    Same shit, different bucket.

    * Rear Echeleon Medical Facilitators.

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  • Good. Thanks BMA. A step in the right direction. 2 doctors are now suing the government. Time to apply Gross Negligence Manslaughter charges like Dr BG and Corporate manslaughter charges.

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