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PHE says GPs can use higher-grade face masks without being fit tested

Type IIR surgical face masks, recommended for general practice during the Covid-19 pandemic, can be replaced by higher-grade FFP2 respirators without being fit tested in non-surgical settings, PHE has said in new guidance.

It said this was a ‘pragmatic approach’ for times of ‘severe shortage’ of respiratory protective equipment.

But the BMA has warned the change in guidance will not solve PPE shortages during the Covid-19 pandemic as GPs will still struggle to get hold of the higher-grade respirator.

FFP2 respirators filter out droplets and ordinarily require the wearer to have a face fit test.

They are recommended for use in the UK when an aerosol generating procedure is being carried out on a patient with possible or confirmed Covid-19 – but only if an FFP3 respirator is not available, according to a review by the Government’s Health and Safety Executive (HSE).

However, PHE’s latest guidance, updated on 3 May, said: ‘The HSE has examined the use of FFP2 respirators as an alternative to Type IIR surgical face masks in non-surgical settings

‘In circumstances where a lower level of user protection is required, such as that provided by a surgical mask, an FFP2 worn without a face fit test will offer protection similar to the levels from a surgical face mask.’

It added: ‘This is a pragmatic approach for times of severe shortage of respiratory protective equipment, FFP2 respirators being used in this way will not be carrying out the function they were designed to perform

‘All healthcare settings are reminded that where their risk assessment has identified the requirement for a tight-fitting respirator users must pass a face fit test for that respirator model before it can be used.’

But Dr Richard Vautrey, the BMA’s GP Committee chair, said: ‘Most staff working in primary care are currently using fluid repellent masks where necessary, but there are concerns about ongoing supplies as we continue to respond to the Covid-19 pandemic.

‘While this new guidance lays out that FFP2 masks can offer protection similar to the levels from a surgical face mask, the same issue remains – that we will not have access to large enough stocks of these to use as an alternative.’

He added: ‘The UK is now seven weeks into lockdown and it is unacceptable that we should still be worrying about availability of these essential items that protect both healthcare workers and their patients.

‘It’s therefore, vital that any changes to official guidance can be bolstered by Government supplies and that PPE availability becomes an issue of the past, not one healthcare professionals across the country continue to find themselves living with every day.’

A Pulse survey of 675 GPs at the end of April revealed that one in four have seen Covid-19 patients face-to-face without PPE, while more than half felt unsafe as a result of the lack of PPE.

Only 33% of GPs said they had received an adequate supply of facemasks, according to the survey.

During April PHE published guidance on when to reuse PPE during shortages, which it has now updated to include the substitution of Type IIR surgical face masks with FFP2 respirators.

The BMA later 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.

Pulse’s sister title Management in Practice has revealed some GPs are being left with no option but to buy PPE from suppliers at inflated prices. It found one online PPE company selling two FFP3 face masks for £35.99, despite listing them for only £4.79 last June – a 650% markup.

The Department of Health and Social Care was approached for comment.