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GPs go forth

​GPs go forth: Has the Government's strategy put GPs at risk?

Are the Government’s cunning plans putting frontline GPs at risk, asks Jaimie Kaffash

‘It is like walking into no-man’s land with a machine gun blasting at you without any body armour,’ says Dr Zishan Syed, a GP and LMC member in Kent.

Dr Syed is not the only one feeling unsafe. A major survey by Pulse of 675 GPs conducted between 17-21 April reveals that three-quarters fear for their health or lives.

This comes as little surprise. The UK Government had an aim to limit deaths from Covid-19 to 20,000. Sadly, that number has already been surpassed, and that is not including community settings and care homes.

Tragically, a number of healthcare staff are dying, including GPs. GPs and other health workers are, literally, risking their lives in order to do their job.

Central to many of their worries is, of course, PPE. This has been exacerbated by the NHS’s admission that GPs can now expect to see a number of potential Covid-19 patients face to face– potentially in their own surgeries. Antibody testing of healthcare workers would give reassurance to healthcare workers, and even antigen testing may give GPs a boost through allowing more staff to be in practices. But the Government was slow to implement testing processes.

So GPs and their teams are putting themselves at risk to care for their patients. Is this simply an inevitable consequence of a deadly pandemic, or should we be asking to what extent it is due to the Government’s response to the Covid-19 outbreak here? Can GPs have faith in the Government’s cunning plans to protect them in the months to come?

The kids wear better protection for painting

Dr Tracey Turpin

For GPs, the biggest concerns continue to be around PPE. Pulse’s April survey reveals that only a third had received an adequate supply of facemasks and worse still, just 13% and 12% said they had received an adequate supply of gowns/aprons and eye protectors respectively. As a result, more than half of respondents – 52% – said they felt unsafe.

Most worryingly, a quarter of GPs said they had conducted face-to-face consultations with potential Covid-19 patients without PPE. Many of these took place when travel history was – incorrectly in hindsight – treated as the main determinant of risk. But others point out that, since then, they have seen asymptomatic patients who developed symptoms soon after the consultation.

A number of respondents to the Pulse survey said they had been forced to source PPE from unlikely avenues. As Dr Tracey Turpin, a salaried GP in Durham, puts it: ‘We have no gowns, just plastic mini-pinnies. My kids wear better protection for painting. We have eye goggles but only because they were donated by a school.’

For GPs who need PPE, the options are shrinking further. The hotline set up in England advised them to go through their ‘normal channels’ – ie, go back to their suppliers. Then they were told to try resilience forums run by councils – but authorities in Birmingham warned they were running out. The devolved nations have no central hotlines, with much depending on the ability of local health boards to procure protective equipment.

The CCG asked if we would send gowns back to be used in secondary care

Dr Emily Armitage

The problems extended to Covid hubs in secondary care, with health secretary Matt Hancock admitting that gowns were running out and the BMA calling the whole situation ‘shameful’. In response, Public Health England’s highly questionable short-term fix was to change its guidance to advise the re-use of PPE in certain situations.

The Government’s long-term approach is twofold. The first strand is procuring from abroad, with Mr Hancock announcing on 21 April that the Government was working directly with factories in Asia to ensure the UK could obtain PPE without intermediaries, after the delaying of a shipment from Turkey revealed the problems with middlemen. The second part of the plan is ramping up home production; the health secretary said the Government had engaged 159 UK manufacturers to step up production.

But the inescapable issue is the sheer amount of PPE needed. Mr Hancock conceded that the ‘unprecedented scale and complexity’ of the situation called for ‘billions of items per month’. To put that in context, the Government had delivered one billion items in the three months up to mid-April. Mr Hancock said this came down to a ‘global shortage’.

These numbers mean GPs may find themselves down the queue. York GP Dr Emily Armitage said NHS Vale of York CCG had asked whether some of the practice’s gowns could be given to secondary care. She tells Pulse: ‘We sourced some gowns (not many) via a PCN contact and claimed the cost from the CCG. So knowing we had some, the CCG asked if we would send them back to be used in secondary care – which is obviously in great need – which we did.’

Dr Syed points out that the PPE guidance prioritise medics performing aerosol-generating procedures (AGP). He adds: ‘It creates a divide between primary and secondary care, with arguments of AGP being done predominantly in secondary care and not in primary care. This means that hospitals are prioritised for provision of FFP3 masks, etc.’

London GP and chair of grassroots group GP Survival Dr Nick Grundy says Mr Hancock’s calculations are off: ‘A billion items a month would mean 166 million patient contacts, each using two gloves, apron, mask, visor. This equates to 5.5 million a day, which seems unlikely. Anyway, why is the Government only discovering this now when it’s their job to know how many items/month they’d need in a pandemic?

‘Of course primary care is behind secondary care in the queue but the fact that there is a queue is inexcusable, and the health secretary saying ever-larger numbers doesn’t get around that.’

GPs not being prioritised is all the more dangerous when considering changes to guidance on seeing Covid-19 patients. GPs had been reassured at the beginning of the crisis that they could divert any potential cases to NHS 111 or local Covid-19 centres – be they hospitals or ‘hot hubs’. But there was tacit acknowledgement that this was no longer possible when NHS England suggested last month that practices may wish to set up ‘hot zones’ for cases where ‘patients with symptoms of Covid-19 require face-to-face assessment’. The type of patient who may require a face-to-face consultation in a GP surgery were not defined, however. And fears grew even further with the announcement that practices should reserve slots for NHS 111 referrals, potentially overriding the safe triaging practices had been encouraged to set up.

We took a Covid swab but the lab refused to process it as it was “outside the protocols”

Dr Jonathan Heatley

The bigger elephant in the room is that every patient potentially has the virus. As a result, doctors’ leaders are instigating a ‘no PPE, no see’ policy. In a communication to practices, Berkshire, Buckinghamshire and Oxfordshire LMC chief executive Dr Matt Mayer said: ‘There are limits to the risks you can be expected to expose yourself to. You are not under a binding obligation to provide high-risk services where [you are not provided with] appropriate safety and protection.’ The Royal College of Surgeons and the Royal College of Anaesthetists also advised members on a similar policy.

Most GPs – 61% – told our survey they were taking a ‘no PPE, no see’ approach. The BMA is not yet going as far as the RCS and RCA, simply advising: ‘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.’

Yet there is no doubt GPs are in the firing line. One in five GPs say they have had suspected or confirmed Covid-19, with a further one in five saying they are not sure. And the Government has been widely lambasted for its poor response to the World Health’s Organization’s repeated advice to ‘test, test, test’.

This lack of action directly affects the workforce, increasing the risk for GPs. One in four said they have had to self-isolate. Of those, only 24% had both a cough and a fever: a third were only isolating because members of their household were displaying symptoms.

In the case of Sussex GP Dr Jonathan Heatley, this had repercussions for the wider NHS: ‘Three NHS workers (two doctors) in our household had to self-isolate for two weeks due to a daughter-in-law’s cough. We took a Covid swab to try to prove it was nothing so we could all go to work but the lab refused to process it as it was “outside the protocols”.’

There’s no doubt GPs’ fears are justified but their views on the Government’s handling of the crisis are more evenly split than you might think: 36% had a negative view, 39% were neutral, and 25% had a positive view.

How this changes over the coming months will depend on whether the Government finally delivers adequate PPE and testing. For now, however, in the words of Captain Blackadder, it remains a case of ‘good luck, everyone’.

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Readers' comments (22)

  • Wow. A lot of respondents were very forgiving in their rating of government response, considering that we’re on track to be worst in Europe and second only in deaths to Trumps America. Late response, thousands flying in with no screening, no tracking and no effective quarantine. Woeful supply of PPE. Over a hundred dead HCP within a few days of outbreak, PM who manages to contract himself by reckless behaviour. Empty nightingale hospitals due to lack of nurses, while thousands die in care homes (landlocked cruise ships). Economy in nosedive, young people losing education and facing decades of punitive taxation to pay for the inept mistakes of today. Testing centres run by firm of accountants, losing tests and giving incorrect results. Tests with 75% sensitivity. Little access to tests for anyone outside of hospital. Wartime rhetoric browbeating retirees to ‘stand up and serve’. Thousands of unused volunteers. Cancer services paused. All mortality death rates climbing. NHSE spewing diktats, daily emails, unilateral contract changes, spinning propaganda.

    What more will they have to do to get a poor rating? Perhaps it was the Thursday clap that warmed your hearts

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  • I’m getting a green “Care” badge.

    Sorted.

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  • I agree that health and care workers should have adequate PPE, but is there any evidence that fluid resistant masks offer much protection to the wearer. In discussion around the wearing of masks in public, the view seems to be that they afford some protection to others but that they do not give much benefit to the wearer. In that case, are we wearing masks to protect our patients (which is good, obviously)but is it increasing our safety - if so - by how much - is there any research on this?

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  • Extremely scary environment! Recruitment into General Practice will suffer - many “potential” Medical Students will decide to follow alternative careers! Another Government “own goal”!

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  • Incredible that 84% of respondents rated the Government response as anything other than woeful. Almost as incredible are the 1% who 'dont know'. WAKE UP.

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  • Of course the government, but why are you sparing the people REALLY responsible: Public Health England.

    https://www.thesun.co.uk/news/1550250/325-public-health-chiefs-raked-in-over-100000-in-pay-and-perks-last-year/

    https://www.dailymail.co.uk/news/article-8177785/Staggering-incompetence-public-health-fatcats.html

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  • I am a private GP which has been enormously challenging over the years but I am trained in functional medicine. Myself and my staff and family and all my patients are taking at least vitamin C 3g per day (50mg/kg) zinc 25 mg a day, and vitamin D 5000 units a day, and depending upon whether you have autoimmunity or not, there are other means is support. I have tried to post this evidence-based knowledge on to NHS workers social media sites But it has been labelled fake news and taken down. But the whole of our front line staff should be on a combination of these support mechanisms at the very least. If you are not taking this, please google the research and you will see the evidence which has been there for multiple years. Please take care and ensure that you have excellent PPE if at all possible on top of these recommendations. There are also other recommendations you may require if you need if you get symptoms. But with symptoms you will need to engage the medical route too.

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  • wrong target--nhse phe etc

    and bma and colleges and most doctors for tolerating the mess that is the nhs

    but hey carry on with your support for the lefties and this is what you get

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  • GPs are seeing very few patients face to face. Our need for PPE is secondary to that of the care home staff spending all day in contact with COVID-19 positive patients. I'm slightly aghast watching GP colleagues on the news wearing full HAZMAT suits to examine patients. I feel I'm more at risk in Tescos than sitting in surgery phoning patients.

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  • Not only are the Government's plans putting GPs and care staff at risk, they unconstitutionally took a decision to condemn to be sacrificed the lives of 5-10 percent of the nation, in an attempt to make economic gains and save money only; knowing that certain groups would be harder hit - but got it wrong, and the younger generation are suffering too, noty just the old, infirm, and sick.
    Immoral, and negligent advice from PHE and CMOs.

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  • Where's Optimus?

    Mr Dyson... invests 20 million for ventilators.. Gov says we dont need them anymore?

    UK businesses on standby to make vast amounts of PPE.. Gov not ordering.. or says we have enough..??

    NHS gets what the NHS needs....Rubbish
    Staff recruitment as volunteers or basic hourly rate almost half a standard locum rate..
    Despite significant risks..


    Lockdown time Training for a Change of career



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  • Where's Optimus?

    A pair of gloves recorded as two items of PPE ???!!

    Discharge patients COVID/Covid exposed
    Back to care homes
    Thus exposing everyone else..

    The virus needs to be treated like the Australian bush fires..
    You would not put a burning branch back amongst the hay.

    Quarantine care homes needed

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  • Where's Optimus?

    Nightingale Hospitals... Scientists concern that lack of cubicles and nature of ventilation
    likely to spread the virus to all in the hospital... !?

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  • Where's Optimus?

    These are unprecedented times..agreed.. and we have all been patient with all the lies and spin..
    I really can't bear to listen to Hancock anymore
    No clear plan

    No clear strategy to test and quarantine
    Establish safe zones
    Even for small rural areas

    Just an arbitrary 100 000 tests per day..
    And looks like not going to achieve own arbitrary number..

    Spin and false promises are now costing lives and livelihoods

    When will there be accountability?

    More embarrassing interviews with Piers Morgan

    Where no one has any figures and think it's all a joke

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  • Where's Optimus?

    Wheres Jeremy Paxman?
    He needs to sit these shysters down

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  • Please don’t compare the statistics to the rest of Europe as the counting is different in all countries. I agree we should have gone into lockdown a little earlier but this is a new disease and everyone is learning. It’s easy to point our fingers and get angry but lessons will be learnt further down the line. I feel we cannot compare our rates until the pandemic is over as the data is flawed.
    PPE isn’t fool proof at not getting the virus but on the other hand we could just as easily catch this from a door handle later when you take the PPE off. It is a scary disease but Doctors have always been at risk of catching potentially fatal diseases such as bacterial meningitis. Over the entire world the deaths are a small number .
    The best plan is to risk assess all staff and the ones with no risk factors do the face to face work and those with risk factors do the less risky procedures ie results, admin etc
    We are highly trained intelligent and immensely useful members of this Pandemic and if we risk assess ourselves and use PPE wisely then the risks are no higher than for most infectious diseases. Have we ever got this scared each time we see a child with suspected meningitis ?
    Those frontline workers who have succumbed by in large had risk factors and although every death is one too many they would have caught it in the community with the same outcome. It was particularly sad to see people over 70 and those with clear risk factors coming out of retirement and then dying. It’s shocking these people were not risk assessed when they came forward.
    Please let’s not hide from this terrible situation. I spoke to one colleague who was the only one in a large group practice going in to surgery. They had seen just one patient face to face in 2 weeks! This is absolutely horrifying to hear. We should not be hiding while those in hospitals are carrying this alone.
    Please think about what what we said at graduation “ Do no harm “ ... think how many potential cancers and other pathologies we have missed by working from home.
    Would it not be much better to test from our surgery locations in a car with military or other assistance to do the swans. We would be in a much better situation to trace and track than these private companies coming in making mistakes
    I know this post will no doubt be controversial but please let’s help in this. Shop workers are at much greater risk and get paid £7-10 an hour!

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  • GP North West
    I very much appreciate and agree with the sentiments behind your comments.I also feel that this is a very nasty virus and we really aren’t sure about some issues eg can you get it again,what is the definitive animal host (I appreciate pangolins and bats have been mooted),how long can the virus be carried for and how effectively can this RNA virus mutate.,to name a few.I understand my colleagues real concerns re their own and the health of their families
    I was fortunate to have some NBC training in the forces and we trained regularly with surprise NBC exercises
    I would like to see the BMA/PULSE approach Portondown Defence Centre and ask for a definitive opinion on the effectiveness of the various types of PPE in various situations.I would respect their views

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  • behave like supplicants and you get treated like supplicants?

    ps dead doctors=massive saving on pensions

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  • Curious about the thought process behind the idea that we are "hiding from this terrible situation". We telephone triage first. As it happens we are able to solve most problems presented to us remotely, so why increase risk by asking customers to come in for face to face? As it happens, most hospitals have around 30% spare covid or non-covid capacity. Have never seen this in 20 years in NHS. Not sure what it is that we need to be doing to help secondary care with secondary care tasks?
    By the way, now that RCUK stated that they view CPR as aerosol generating procedure, think it needs to be made clear to the public that GP practises do not have appropriate PPE or infection control measures in place to perform this. (Rules on air exchange, decontamination of surfaces, deep clean etc are very specific for this type of procedures, just opening window won't do).

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  • If we look at Australian press the bumbling UK response has been labelled as "Amateur".
    I speak to Australian gp's where they are calm, have good PPE and are all heading out of the pandemic rapidly.
    Yes Australia has geographical advantage, but the biggest difference has been a coordinated clear response.
    Instead health workers and care workers here are being sacrificed into a Covid Volcano.

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  • I now see that the legal advice obtained by BMA seems to be that Covid19 treatment is a part of essential services and we could be in breach of contract if we do not offer face to face consultations for suspected Covid patients. This would force more GPs to see patients without adequate PPE.

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  • The government not only put GPs at risk with lack of PPE but it also put patients at risk allowing doctors and surgeries to become spreading zones. It was only through the rapid and co-ordinated action of GPs that an early switch to remote consulting prevented greater tragedy and almost certainly saved thousands of lives.

    What we've learned from this is that in future, government agencies and their regulators cannot be trusted. From now on we must be left to write our own policies and guidelines.

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