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.’
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.