Public Health England is working on updating its guidance on the use of personal protective equipment (PPE) and is expecting to publish the results later this week, Pulse has learned.
The latest guidance says GPs should wear PPE within one metre of patients with possible or confirmed coronavirus (Covid-19) – but this only applies to patients who are symptomatic, meaning GPs are not advised to wear PPE for patients who are asymptomatic.
The BMA has sought clarification from the Government on what risk doctors are expected to take when caring for patients without adequate PPE, saying they are still receiving widespread reports from doctors around the country who have not received PPE, or who do not feel the PPE they have received offers sufficient protection.
One LMC has told members to implement a ‘no PPE, no see’ policy for all patients.
The recommended PPE is a fluid repellent facemask, apron, gloves and eye protection ‘if there is a risk of splashing or exposure to respiratory droplets’, NHS England, Public Health England (PHE) and the Academy of Medical Royal Colleges said in a letter sent to practices, PCNs and trusts at the weekend.
The letter added that although there had been ‘some issues’ with the supply of PPE, NHS England, PHE and the Academy of Medical Royal Colleges are ‘confident’ that those who need PPE will be supplied with ‘adequate’ stock ‘in good time’.
But, quoting communities secretary Robert Jenrick, who said on Sunday that ‘we cannot and should not ask healthcare workers to be on the frontline without appropriate protective equipment’, the BMA has urgently sought clarification on the current guidance.
BMA consultants committee chair Dr Rob Harwood, said: ‘We need clarity from the Government on what it is that healthcare staff should do and, particularly, what risks they should not have to take if they do not have adequate PPE, if they should find themselves in this situation.
‘This is about the safety of patients and doctors first and foremost. Doctors are placing themselves at significant risk by treating patients on the frontline and there are concerns that sometimes this is without adequate PPE.’
Dr Yvonne Doyle, medical director at PHE, said: ‘In response to NHS staff feedback about their personal protective equipment, the Department of Health and Social Care; PHE and NHS England and NHS Improvement have looked again at the guidance.
‘Now that Covid-19 is much more widespread, we will carry out a rapid piece of work ensuring the guidance is clearer on which PPE should be worn in different NHS settings.’
‘The Academy of Medical Royal Colleges will support this urgent work.’
A PHE spokesperson told Pulse new guidance was expected later this week.
In the meantime, some GP leaders have taken matters into their own hands and recommended their colleagues to avoid seeing any patients without PPE.
Berkshire, Buckinghamshire and Oxfordshire LMCs said in a communication to practices: ‘We continue to press centrally for appropriate PPE for all practices. In the meantime, in the absence of appropriate PPE, we support practices in adopting a NO PPE, NO SEE policy and not conducting any face to face consultations without appropriate PPE.’
LMCs chief executive Dr Matt Mayer continued: ‘We draw constituents’ attention to recently published BMA Ethics guidance on PPE8 which makes it clear GPs are under no obligation to risk their own safety and says:
‘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 your employer does not provide appropriate safety and protection.’
And more than 20,000 people in three days have signed a petition launched by doctors’ wellbeing lobby group EveryDoctor, urging the Prime Minister that ‘every NHS worker, from surgeons to nurses, GPs to paramedics’ needs adequate protection.
Dr Julia Patterson, who leads EveryDoctor, said: ‘We are not satisfied with the PPE guidelines set out by NHS England and NHS Improvement, Public Health England and the Academy of Medical Royal Colleges on 28.03.2020.
‘The guidance being issued by these bodies does not meet WHO recommendations.’
The Government has been criticised for failing to act fast enought to secure PPE for the NHS frontline battling the coronavirus pandemic.
Global demand for PPE and a ban on export of the products in China is causing constraints on securing additional UK supplies, the Department of Health and Social Care has said.
Yesterday, the Government released a service specification for manufacturers who believe they can provide PPE.
The technical specifications differentiate between guidance for examination gloves; gowns; surgical face masks; respirator masks and eye protection.
They come as companies including Mercedes, JCB and Dyson have joined the work to try to meet the UK’s impending demand for ventilators and CPAP breathing aids for hospitalised Covid-19 patients.
Current PPE recommendations
Recommended PPE to be used by healthcare workers within one metre of a patient with possible or confirmed COVID-19, including staff working in hospitals, primary care, ambulance trusts, community care settings, care homes:
• fluid repellent facemask
• eye protection if there is a risk of splashing or exposure to respiratory droplets.
Source: NHS England’s 28 March letter to practices
This is the entire delivery of #PPE for a surgery with 4 GPs, ACP, PN and HCA. Weeks of lies and waiting, then this. How can safe care be delivered with this insulting token?@NHSEngland @Channel4News @CNagpaul @jkaffash @bbchealth @TheBMA @Tess1959 @alwaysthedutydr @nhsfatcat pic.twitter.com/L7i7b3T9Ze
— Dr John G Hughes (@johnghughes3) March 31, 2020