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‘Not yet safe’ for GP practices to allow walk-in patients, says BMA


GP appointments


Many GP practices are ‘not yet safe’ for walk-in patients due to unsuitable reception areas, the BMA has said.

The BMA has said in its latest GP Committee bulletin that is still unsafe for walk-in patients who have not been triaged and that they ‘should only receive a face-to-face appointment if they need one’.

It comes as updated Public Health England (PHE) infection prevention and control (IPC) guidance makes no changes to PPE recommendations despite concerns over Covid transmission amid new face-to-face guidance.

Last month, new NHS England guidance said GP patients must now be offered face-to-face appointments if that is their preference and receptions must be open for walk-ins.

GPs have warned that many Covid-symptomatic patients are now attending face-to-face appointments having only had a negative rapid lateral flow test (LFT), putting GPs and staff at risk.

The BMA’s bulletin added: ‘With social distancing and infection protection and control measures still necessary, patients should only receive a face-to-face appointment if they need one, not simply because they demand one. 

‘Many surgeries have restricted and unventilated reception areas and are not yet safe for patients to walk in without an assessment.’

In a letter to the health secretary last month, the BMA called on the Government to provide funding for premises development to ‘improve ventilation and space in waiting areas’.

The BMA bulletin added that practices are ‘already working well beyond their safe limits’ and that it is ‘not possible for practices to continue to deliver all that is expected of them’.

The BMA will produce guidance defining ‘unacceptable and dangerous’ workload in practices ‘over the next few weeks’, as well as resources to help practices deal with patient abuse and ‘push back’ against unacceptable demands, it said.

It will also ‘work collaboratively at an ICS level to introduce an “OPEL alert” system for use by practices supported by their LMC’, it added.

It follows renewed calls for a GP ‘black alert’ operational pressures escalation level (OPEL) system to flag unsafe workload, after the one developed by the BMA in 2018  was never recognised by NHS England.

Meanwhile, PHE yesterday updated its IPC guidance for all healthcare settings across the UK – although it made no changes to PPE recommendations.

It said: ‘Following a clinical and scientific review, no changes to the recommendations, including PPE, have been made in response to the new variant strains at this stage, however this position will remain under constant review.’

The guidance said that primary care services ‘should utilise virtual consultation’ where ‘possible and appropriate’.

However, it also listed GP practices among settings considered ‘high risk’ – defined as those where ‘untriaged individuals present for assessment or treatment’ with ‘unknown’ symptoms – thanks to new walk-in guidance.

And it might be ‘necessary’ for organisations across all settings to consider the ‘extended use’ of respiratory protective equipment (RPE) such as FFP3 masks, it said.

Organisations should undertake risk assessments including an ‘evaluation of the ventilation in the area and [local] prevalence of infection/new variants of concern’, the guidance said.

It added: ‘If an unacceptable risk of transmission remains following this risk assessment, it may be necessary to consider the extended use of RPE for patient care in specific situations.’

Previous PHE PPE guidance for general practice stated that FFP3 masks are only required for ‘aerosol generating procedures’, and advised a fluid-resistant surgical mask (FRSM )for other direct patient care, including in Covid assessment centres.

The BMA and researchers have called for the guidance to be updated to require FFP3 face masks in Covid hot hubs, while healthcare bodies have called for PPE guidance to be strengthened overall.

Pulse reported in February that GPs were turning down shifts at a Covid-19 assessment centre after the local health board ‘banned’ them from wearing higher-grade PPE in the form of FFP3 face masks.

READERS' COMMENTS [3]

Patrufini Duffy 2 June, 2021 1:21 pm

The day the British public and politicians respect GPs categorically – is the day they may walk back-in. Naughty school children who want to bicker, complain and have a selfish go is getting quite narcissistic, sour and tedious – monotonous and dull to be honest. It is not science – it is irresponsible trivia, self-ordained privilege and whining. They don’t whine about the priest or the footballer. They never whine about the coffee shop barista or pub owner who just asked them to pay £28 pounds for a round of 4 diuretics. So, until then, it will be hard to eradicate the traumatic memory of dead colleagues and bus drivers of this momentous time:

https://www.independent.co.uk/news/health/coronavirus-nhs-deaths-healthcare-workers-covid-care-doctors-nurses-a9665386.html

Permitting any member of public to freely walk-in and demand to use the GP surgery toilets used to be such a UK comedy – then you got nailed for a safeguarding incident or have to clean up the urine on the floor and worry about why they spent 20 minutes in infectious diarrhoea on your site and the risks to all. The baby changing facilities and the patient who wants to leave the nappies on your desk and their headphones in their ears while you consult. The other patients may come off a bus or out of Ladbrokes or Heathrow Airport via the safest and most clean Piccadilly Line in Europe (or not). They want to sit in your waiting area again, watching Teletubbies and Loose Women while leaving the Evening Standard on the floor and crumbles of Wotsits for your reception to clean up after them whilst they conjure up the odd cough for amoxicillin or tears in that “corridor of disease” prior to entering your room with mask perched near their jugular. And you must make it all “covid-safe” because everywhere else isn’t.
This country should stop talking about GPs – it’s getting a bit weird and perverse now. I don’t know of any walk-in centre or dentists that are freely walk-in. When they are – let us know. And when you have less than 50 cases in the UK per day – currently 3,304 of a mostly new Indian variant which the Government permitted, openly.

John Graham Munro 2 June, 2021 4:08 pm

Got a migraine now

Turn out The Lights 2 June, 2021 8:02 pm

Safe is when the WHO declare the pandemic over not a two bit Tory rags like the one declaring it over today.