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GPs should not routinely use FFP2 as surgical mask gives ‘very good protection’

GPs should not routinely use FFP2 as surgical mask gives ‘very good protection’

NHS England has said GPs and practice staff should not routinely use FFP2 respirators because surgical face masks give ‘very good protection’.

GPs were told in an NHS England webinar that they should only wear FFP2s if they have been risk assessed as needing a higher-grade FFP3 but this is unavailable.

This is in contrast to BMA advice issued last month, which advised GPs to wear FFP2 face masks ‘as default’ when consulting patients face to face to protect against the highly-infectious Omicron Covid variant.

The BMA has since published further advice around how to risk assess which type of face mask is needed, including both FFP2s and FFP3s.

Speaking at the webinar, held last Thursday, NHS England national infection prevention and control team member Jackie McIntyre said that GPs should use FFP3 face masks if a risk assessment deems there to be an ‘unacceptable risk’ of transmission.

She said: ‘The recommendation for PPE for Covid-19 requires the majority of healthcare workers to wear a Type II surgical face mask for all patient contact. 

‘The exceptions to that would be those that are undertaking aerosol-generating procedures such as dentists or once you’ve done a hierarchy of controls risk assessment, you feel that there is an unacceptable risk of transmission, then you should consider wearing respiratory protective equipment (RPE).’

Infection prevention and control guidance on face masks

Current Government infection prevention and control (IPC) guidance still recommends ‘face coverings or surgical masks (Type II or IIR) to prevent the transmission of SARS-CoV-2 and other respiratory infectious agents in health and care settings’ for ‘all staff, patients and visitors’.

However, it also advises:

 ‘Where an unacceptable risk of transmission remains following the application of the hierarchy of controls risk assessment, it may be necessary to consider the extended use of RPE for patient care in specific situations.

‘Where a risk assessment indicates it, RPE should be available to all relevant staff. The risk assessment should include evaluation of the ventilation in the area, operational capacity, and prevalence of infection/new SARS-CoV-2 variants of concern in the local area. The hierarchy of controls can be used to inform the risk assessment.’

Source: UKHSA

Ms McIntyre added: ‘If you can’t follow the hierarchy of controls, you’ve got lots of patients coming in, you can’t screen, you can’t triage, your staff perhaps aren’t vaccinated – and obviously there are different risks with individuals – then you may wish to wear RPE routinely.’

RPE must be either a fit-tested FFP3 respirator or something with ‘the same filtration criteria as FFP3 and not an FFP2 because that’s less filtration quality’, she said.

She added that wearing RPE such as FFP3 masks routinely is not ‘something you want to do in primary care’ and is ‘not necessarily required’. This is because it has lots of disadvantages, such as difficulty getting a fit test and communicating with patients, she said.

However, she added that the UK Health and Safety Executive recommends healthcare professionals ‘should not use’ FFP2 masks and that ‘the only requirement to use them’ would be ‘if you couldn’t get FFP3’. 

Also speaking at the webinar, NHS England primary care medical director Dr Nikki Kanani said that NHS England will ‘make sure’ practices use FFP3 and FFP2 masks where needed, and will be writing to GPs ‘shortly’ to set this out.

Ms McIntyre added: ‘Surgical face masks give you very much good protection, there’s some good evidence. 

‘We’ve got some really good evidence that the precautions that we have put in place across the country and that are supported by the World Health Organisation are key and have been useful throughout the pandemic. So hopefully, that’s reassured you about that.’

Meanwhile, the BMA has published new guidance advising GPs and practice staff to wear FFP3 masks if they are risk assessed as being ‘very high risk’ and FFP2s if they are ‘high risk’.

The latest GP Committee bulletin said that the BMA occupational medicine committee is drafting further guidance on risk assessments and mitigations to be published ‘shortly’.

It added: ‘We continue to call for GPs to either have access to or reimbursement of associated costs of appropriate RPE and have urged NHSE/I to provide FFP2 masks as a default for all practices and for availability for FFP3 and fit testing where appropriate.’

It comes as the BMA informed GPs last month that they can now order FFP3 masks free of charge in special circumstances and on condition they have been fit tested.

The Department of Health and Social Care (DHSC) has agreed to ‘arrange access to FFP3s’, so long as it has been informed of a local risk assessment through which GP staff have ‘been assessed as needing FFP3’, the BMA said.

The BMA had written to the Government to demand higher-grade PPE to protect GPs and their staff against Omicron, with Pulse reporting that GPs were forced to buy their own higher-grade PPE to protect staff.

In November, the Government said PPE was the least effective in their hierarchy of measures in an update to IPC guidance.

Meanwhile, the Government last week announced that it will extend its free PPE provision scheme for GPs for a further 12 months, until March 2023.


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Please note, only GPs are permitted to add comments to articles

Mr Marvellous 19 January, 2022 8:59 am

NHS England can do one.

I spent 10 minutes with an unexpectedly Covid positive family yesterday (family had failed to disclose their symptoms fully, PCR returned after the consultation) but fortunately I was wearing FFP3 because it’s practice policy for ALL clinical staff to consult in nothing less than this.

Unlike other local surgeries we’ve not had a single case of Covid acquired through work.

Michael Mullineux 19 January, 2022 9:38 am

With Mr Marvellous above. Absolute and utter garbage as usual from NHSE Ivory Towers. Infection control lead spouting nonsense that is politically and cost driven as usual. What is their explanation for so many medical staff in the NHS having tested positive in the last few weeks and having to isolate? All whilst wearing standard surgical masks.

Sonia Chester 19 January, 2022 10:22 am

I’ve worn my own FFP2 throughout & despite seeing lots of Covid patients face to face have never got infected. Majority of my colleagues in surgical masks infected including ICU admissions. We are being gaslighted by NHSE. Surgical masks do not offer adequate respiratory protection & I hope there will be consequences for failure to protect UK HCW.

Fay Wilson 19 January, 2022 10:26 am

Has this adviser told us what would be an acceptable risk of transmission for GPs? This is just like the original GP skinny pinny advice that led to so many workplace infections in GP practices. We continue to buy our own FFP2s even for red site working.

Don’t these folk realise how giving untrue advice undermines their credibility of ALL advice they give?
Or could it be the case that “Nobody told me”?

Karen Potterton 19 January, 2022 10:47 am

As usual NHSEs advice is tailored to cost and availability of PPE rather than evidence or any concern for the wellbeing and safety of their workforce. How can an FFP2 be less effective than a type 2 fluid resist? Even without a fit test it will outperform it easily. And they are just ignoring the research that shows Omicron is airborne and that coughing is an extremely effective AGP even if it wasn’t. We are all using FFP2 for every contact and FFP3 for higher risk. No work acquired infections at my surgery either.

David Church 19 January, 2022 10:56 am

I feel the headline is misleading.
Please consider changing it to something like BMA recommends better protection, but NHSE advice is faulty and may lead to more infections and deaths of GP’s and their staff, as well as disruption to services.
There is plenty of evidence that FRSM are nothing like as good, and government has plenty of money – as shown by lucrative contracts handed out willy-nilly.
And risk rises as uncaring government encourages further spread of infection by allowing infected people out of isolation, and misleads them that ‘endemic’ means ‘mild’, which is just NOT TRUE.

Subhash Chandra Bhatt 19 January, 2022 11:40 am

There is no such term as acceptable risk. Take risk or don’t.
FFP2 for me every where work or shop or aeroplane.

Dermot Ryan 19 January, 2022 11:50 am

You really cannot believe anything NHSE say. There is a paucity of evidence about the effectiveness of surgical face masks: I am sure there is a lot of publication bias concerning them as no-one wants to take the risk of publishing negative studies.
The study in schoolchildren which appeared last week is probably the closest to the truth> It demonstrated that face masks were associated with a 0.6% reduction in transmission, a figure which means no significant difference. Surgical face masks create psychological problems and pollution but otherwise probably make little difference, although I would wear one on a busy train or tube.
Meaning mask wearing means FP2 masks which by law you have to wear in public in certain situations e.g. public transport, in other European countries.
But don’t ever expect anything meaningful from NHSE.

Michael Mullineux 19 January, 2022 11:56 am

What exactly is the point of an infection prevention and control team member who spouts such meaningless garbage and gives advice that encourages viral dissemination?

Julian Spinks 19 January, 2022 12:28 pm

From the FDA in the states.: “While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, it does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face.”

Patrufini Duffy 19 January, 2022 2:51 pm

I think all surgeries should invest in more capable paper shredders, and ways to recycle “procedures” safely, effectively and caringly.

Samir Shah 19 January, 2022 8:06 pm

‘Has this adviser told us what would be an acceptable risk of transmission for GPs?’ – GPs are expendable according to the powers that be.
Actions speak louder than words.
But they say ‘Thank you for your continued hard work’.

Simon Jones 20 January, 2022 10:18 am

The next thing to happen following yesterday’s statement in Parliament is that the general public will now want to walk in to our surgeries without any masks because “it is their right”. There needs to be some immediate communications released to state that all healthcare settings still require mask wearing. This is something that was not done last summer until belated advice was released and practices were fielding a torrent of abuse. You watch as the GP bashing starts soon: the same people who rolled up their sleeves and did everything possible to deliver a rapid booster vaccination programme last month.

Patrick Pearson 20 January, 2022 10:40 pm

I shall continue to wear my mask and insist that my patents do the same. I am in an at risk group and live with a grand-child who is extremely vulnerable. No mask- no f2f consult. I am not cannon fodder.