What are members telling us about PPE?

22 March 2020

PPE guidance, concerns about supply, and effectiveness of standard masks are among questions from members discussed by Professor Martin Marshall and Dr Steve Mowle of the RCGP.

Vlog transcript

Dr Steve Mowle: My name is Steve Mowle and I'm here again with Martin Marshall. RCGP Chair. Today's topic is personal protective equipment. 

Martin, I've been a partner for twenty years and I've never been more concerned about the safety of my team. I've got two GPs, and one receptionist, currently affected by COVID-19.  I felt it was pretty underwhelming, to be honest, when we received our packs of PPE. They were barely the size of two packs of nine toilet rolls. There are all sorts of concerns out there. What kind of things are you hearing as Chair of the College?

Professor Martin Marshall: We're hearing similar stories to yours Steve, from GPs around the country. Some GPs are saying, ‘We just don't understand what the guidance is. The guidance isn't clear enough.’

Quite a few GPs are saying, ‘We don't know whether we've got enough supplies, particularly over the next few weeks, as this crisis deepens,’ and then some people are saying, ‘Have we got the right sort of protective equipment, because we can see some of our colleagues working in the hospital who seem to have much more robust protective equipment than we’re being given at the moment’.

Dr Steve Mowle: Do you think there will be enough supply? Do you think there is a supply chain from NHS England? What are they saying?

Professor Martin Marshall: NHS England is saying that there are adequate supplies, at the moment. They were aware that some of those supplies were slow at getting through, and that this was patchy in different parts of the country. Over the last few days, they say they've increased the supply chain. There's now a seven-day-a-week service, 24-hours a day. They say that every practice should have adequate supplies now. If they haven't, we really want to hear that.

Dr Steve Mowle: We asked Professor Trish Greenhalgh at the Centre for Evidence-Based Medicine at the University of Oxford - a very clever and at times outspoken academic - for her analysis of whether these masks are any good. What do you think the take-home messages are from her analysis?

Professor Martin Marshall: This is this an important question because we know that a lot of GPs are anxious that the standard masks are not adequate for the current conditions, and patients who we’re seeing, and that there is a higher fidelity mask which is being used by some other people. 

Those high fidelity masks, at the moment, there is a shortage of supply, and they are being used by priority groups, and that's any group that's working with aerosols. So, in particular people who work in ICUs. People sometimes, who are working in casualty departments, and dentists as well. 

We asked Trish whether the standard mask was good enough? She conducted a quick, systematic review. Interestingly, most of the data came from the Chinese Cochrane Collaboration, a very prestigious academic collaboration. They've done a lot of work on the effectiveness of different mask types, not necessarily for COVID yet because, of course, COVID hasn’t been around long enough, but for other similar virus types. What the evidence suggests is that the standard mask is more than good enough for the vast majority of people. So, that's reassuring. It's based on six large randomised control trials with a total of 9,000 patients.

Dr Steve Mowle: We’re both in clinic tomorrow. Are you going to be pretty confident with your colleagues, and look them straight in the eye, and say, ‘Actually, as far as we know at the moment, these masks are fit for purpose’.

Professor Martin Marshall: Yes, I think we can do. I mean, of course, there are imponderables, there are uncertainties. That's the kind of world we're living in at the moment. But as far as the evidence is concerned, at the moment it does seem to confirm what Public Health England has been telling us for some weeks that the masks that we've got are adequate.

Now I think there are questions about the aprons, particularly given that the aprons that we're getting in general practice have no sleeves, and there is a question about whether we should have a full-body cover for the aprons. 

I think the gloves are fine, but there are also questions about eye protection, because if we're in any territory where there might be splashes, then the WHO advice is that we should be using eye protection and most practices simply don't have that at the moment. 

So, there are still some significantly important questions that we need to address. 

Dr Steve Mowle: Well, I must say, from my point of view, we've simply bought simple eyewear, which I think offers good protection. I'll be wearing just simple safety specs. I think there are two issues here for me. It's whether or not someone coughs in my face. Then potentially, if I’m close enough, droplets could get into my eyes. I'm always worried about what I'm doing with my hands as well. I think if I've actually got specs on, and I've got gloves on, I think the chance of me actually rubbing my eye with my gloved hand is pretty low, but wearing specs on top of that just gives me that extra level of protection. 

Professor Martin Marshall: I think it’s a really interesting question about when we should be wearing this equipment, because this is such a fast moving field, and a couple of weeks ago we were fairly clear when somebody might have COVID - if they had the clinical signs and a history of travel, or contact with someone who had travelled, then we knew we had to take care. Right now, we know that it's circulating in the community, and basically any patient that we see could have COVID. 

We all know that the number of face-to-face consultations is going down dramatically, and I think that's a really big question, and we simply don't know the answer to that at the moment. Some practices want to be very careful with the risk and might well suggest that they should be wearing it. Others aren't. But if we do wear protective equipment for every single consultation then the chances of supplies running out sooner are that much greater. 

Dr Steve Mowle: Now, I I know you're on the phone every day to the top powers-that-be in the NHS, and the Department of Health. What are your top lobbying messages around PPE over the next few days?

Professor Martin Marshall: We're saying to them, we want to be absolutely certain that the equipment we’ve got is good enough. We don't want the equipment to be sector specific. It's no good saying, ‘You just don't need high-risk equipment in general practice,’ when actually, increasingly, we're going to be seeing high-risk patients in the same way as they are in hospital sectors. So, we're making that point very clear as well, and we want to be reassured about the supply chain, that there will be adequate supplies.

Steve Mowle: Sounds good to me. I know I meet with our staff at the beginning of every day. I remind them about the equipment. I remind them about how to wear it. I think there are really useful videos. I think our main messages to everyone out there are to be careful and be safe and we're very much thinking about them, and doing everything we can to raise this really important issue.

So, thank you so much Martin, and we'll be back with another vlog very soon.

Professor Martin Marshall, Chair of the RCGP

Professor Martin Marshall is a GP in Newham in east London and Professor of Healthcare Improvement at UCL, Programme Director for Primary Care at UCLP Partners. He leads Improvement Science London, an initiative to promote and embed the science of improvement across the health service and academic sectors. 

Previously, he was director of research and development at the Health Foundation, Deputy Chief Medical Officer for England, and Director General in the Department of Health, a clinical academic at the University of Manchester and a Harkness Fellow in Healthcare Policy.

He has been a GP for 28 years. He is a fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012.

He has over 200 publications in the field of quality of care and in 2005 he was awarded a CBE in the Queen's Birthday Honours for Services to Health Care.

Dr Steve Mowle, Honorary Treasurer of the RCGP

As Honorary Treasurer, Dr Mowle has responsibility for all matters relating to the College finances. He was Vice Chair of the RCGP from 2011-13 and was the lead officer for Commissioning, GP Nursing, the RCGP Annual National Conference, Patient and Carer Partnership Group and GPC liaison. He has also previously chaired South London Faculty Board and RCGP London.

He trained in Wales and has been a GP Partner at the Hetherington Group Practice in South London since 2000. Dr Mowle has held a number of different educational roles including GP Trainer, Programme Director and most recently Associate Dean for HEE, with lead roles around recruitment and supporting trainees in need of support. He currently works as an RCGP International Tutor in South Africa.



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