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GPs advised to avoid ‘over-reliance’ on PPE and to focus on hand hygiene

GPs should focus on hand hygiene and other basic infection prevention, with NHS England suggesting there was an ‘over-reliance’ on personal protective equipment in the face of Covid-19.

In a live webinar last Thursday evening, GPs had expressed concern for their safety in light of recent NHS England advice that they should return to delivering ‘as much routine and preventative work as can be provided safely’, including screening.

Gaynor Evans, NHS England’s senior infection prevention and control advisor, told GPs: ‘The really important issue is around hand hygiene and this over-reliance on PPE as the protector. 

‘While we do need [PPE], it does not work on its own and you’ve still got to have the very basic infection prevention and control practices in place.’

She added that, as practices resume routine work while the UK remains in the ‘sustained transmission’ phase of the pandemic, the current PPE guidance ‘still stands’.

She said: ‘I don’t think we’re going to change that because at the moment we are still able to consolidate the guidance along with the research.’

NHS England further clarified in the webinar that any PPE purchased by practices which goes above and beyond that which is recommended for general practice by Public Health England will not be financially reimbursed.

NHS England director for primary care strategy and contracts Ed Waller said: ‘The reimbursement system is going to be set up on the basis of the guidance that has been given to the system. 

‘In the case of PPE, the expectation is that we will reimburse PPE expenses in line with what PHE has recommended.’

The PHE guidance has come under fire from GPs for recommending lower levels of protection than the World Health Organisation for what some have suggested are political reasons.

In a recent letter to commissioners, one LMC recommended that practices should be able to provide full WHO-level PPE for their staff.

Berkshire, Buckinghamshire and Oxfordshire LMCs said: ‘The LMC position on PPE follows the WHO, which is the international authority on the issue. Their guidance has no political interference.’

It added: ‘We recognise that there is a PPE shortage [but] our professional advice cannot and should not be changed for issues of supply or convenience.

‘In the context of a shortage, it is rational and reasonable to first provide WHO-standard PPE for those who are in contact with patients with Covid symptoms.

‘In the community, this would include clinicians supporting hot hubs, hot visiting services, hot palliative care work, and staff in care homes supporting residents with Covid symptoms.’

In April, PHE published guidance on when to reuse PPE during shortages, which it has updated this month to include the substitution of Type IIR surgical face masks with FFP2 respirators in times of ‘severe shortage’, without requiring fit testing.

The BMA has said GPs can refuse to treat patients if their PPE is ‘inadequate’, while many GPs have already been implementing a ‘no PPE, no see’ policy, which a medical defence organisation has said should not result in GPs being punished.

Meanwhile, the BMA said last week that GP practice PPE supply remains a ‘postcode lottery’.