PPE is still one of the top issues for GPs

The RCGP's Professor Martin Marshall and Dr Jonathan Leach talk about how we lobbied for PPE in face-to-face consultations, influenced guidance, and the evidence review commissioned by the College.

Vlog post transcript

Dr Jonathan Leach: Hello, I’m Dr Jonathan Leach. I'm a GP here in Worcestershire and I'm joint Honorary Secretary of the Royal College of General Practitioners.

I'm joined by Professor Martin Marshall, Chair of the Royal College of General Practitioners, and we're going to be particularly looking at the issues around personal protective equipment on this vlog. Martin, what are you hearing?

Professor Martin Marshall: Jonathan, good to speak to you. It's good to have another opportunity to talk about PPE, which remains one of the top issues for GPs. We're hearing a lot about it, both on our COVID-19 email, but also through the members' forum as well.

We're hearing probably less about the availability of PPE than we did a week ago, when we posted a blog on this subject, and we're hearing more about both the need for clearer guidance about what PPE people should be using, and also about when to use it, as well.

Dr Jonathan Leach: How much has College responded to these concerns Martin?

Professor Martin Marshall: Well, we're feeing those concerns directly into our contacts in all the four nations, into ministers, into our Civil Service contacts, and also in my case, into NHS England. They're hearing loud and clear – we’re persistent and vocal on behalf of general practitioners - about how important this is, not just for GPs actually, but for staff groups across the NHS, in community and in hospital settings, ambulances, and care homes, for example. These are very relevant to us.

We sent a letter to the Secretary of State in Westminster last week. He's responded very positively to that, and there's been an awful lot of media coverage. You and I and other officers have done a fair amount of media work over the last few days to make sure that the message is heard loud and clear.

We've made a very strong case, which we know needs to be guided by evidence. Of course, that's what we're here for, as a College. We've also made a strong case that we need to understand the concerns and the anxieties that are being expressed by frontline staff, and that the perceptions of being safe are just as important as the evidence in this area.

Dr Jonathan Leach: I would agree with that. And what has been the response from those who we've been talking to?

Professor Martin Marshall: Well, the response has been very positive in terms of sorting out the logistics. NHS England now tell us that all practices across England have got PPE in place and we're hearing similar things in Wales, Scotland and Northern Ireland. Of course, that might not be true, and if it isn’t true, it's really important that practices let us know through our COVID-19 email so that we can follow up, if that's necessary.

As a result of the intervention that we made, NHS England has agreed to update their guidance for PPE in community settings. That's going on right now, and we have been inputting into that process, and the advice is now very much in line with what we've been asking for, that standard PPE should be used for just about all face-to-face consultations that take place in general practice. That's on the assumption that we do not know who might test positive for COVID-19.

Of course, there has to be some space for professional judgement. If you're seeing a young child who's frightened by seeing you in a mask, you might decide to take it off. Professional judgement is important.  We're hoping that this guidance will give reassurance that clinicians are able to deliver the kind of care that they want to deliver at minimal personal risk to themselves and to their staff.

Dr Jonathan Leach: Yes, and of course that's very important for all of us who are seeing patients. So, what do you mean by standard PPE?

Professor Martin Marshall: Well standard PPE in our setting, in a relatively low risk setting, is about a standard mask, an apron and gloves. Those are the standard three pieces of equipment. In addition, eye cover, eye protection. Some people are getting it from a local DIY shop or just using their glasses, if they think somebody might be coughing and spluttering. So, that's the standard equipment.

There is, of course, an upgrade to equipment, which is available for people working in high-risk settings, particularly people who are exposed to aerosol, like dentists. Equipment is in limited supply, of course, and we think it's right that it's prioritised for those who are at greatest risk. There is a question about what we mean by aerosol of course. So, something like a nebuliser, is that an aerosol? We think it probably is. We’re seeking guidance on that. I know [inaudible] have said you shouldn't be nebulising in general practice because it is a risk. We're seeking your guidance on that in order to understand what is required. But overall that standard level of PPE seems to be adequate.

We commissioned Professor Trish Greenhalgh from University of Oxford to undertake a review of the evidence. That evidence is available on our website and linked to the Oxford Centre and that seems to uphold the position that we've taken at the moment.

Dr Jonathan Leach: Yes, and that's a very good review isn't it. It's an independent review of the work done by Public Health England, and other devolved nation public health departments, and I think having that will probably give a lot of assurance to people about things. As you say there are lots of questions and again, we've been asking those. One of the things that we have posed to us is around reception staff. Obviously, these are key members of our colleagues and obviously sometimes our employees. So, what about reception staff?

Professor Martin Marshall: So, the guidance, which is about to come out, says reception staff by and large, particularly as long as they can and maintain the acceptable safe distance of two meters from patients, don't need to have any protection. I do know that some practices are supplying their staff with face masks. I think if they’re able to do that, that's probably fine. It probably isn't absolutely necessary.

Dr Jonathan Leach: Do you think this overall level of protection is sufficient? Obviously, because receptionists can be there at a desk, if you've got somebody coming in. Although clearly, we're advising practices very much to do remote and video consultations first.

Professor Martin Marshall: That's right. I think all practices will recognise that the number of face-to-face consultations has dropped dramatically. I don't know what the actual percentage is. I'd be surprised if it's much more than 10 per cent of patients, probably less than that, who are being seen face-to-face now. Whether this level of protection will reassure people, whether I'll be able to talk to my team in my own practice in east London, and say, ‘We're confident this is okay,’ that's a big question. I think we can say with some confidence, ‘It looks to be fine now’. We know that the evidence is changing all the time. We want to collect data along the way. When things change, we will let people to know about it.

Dr Jonathan Leach: Yes, I think that's very fair, and, of course, as we said at the beginning, we at the Royal College have been looking at the evidence ourselves, and of course we have been lobbying behind the scenes, and in public, regarding this. We absolutely appreciate that this is a concern for us as individuals, because we're clinical doctors ourselves, and also obviously on behalf of the College. Are there any other final points that you want to cover, Martin?

Professor Martin Marshall: I think we really want feedback. So, please do keep on feeding back through email or join the members' forum. It’s run by Amanda Howe, our President. There are over two and a half thousand participants in the forum at the moment, posting their concerns, sharing good practice, sharing their problems. That seems to be going really well. So, please keep on feeding back to us and we will do future blogs, maybe even another one about this subject area, but certainly about other subject areas that are coming up. I think there's likely to be one on access to technology fairly soon, because that seems to be a big issue to allow GPs and their staff to do remote consultations.

Dr Jonathan Leach: So, thank you very much Martin. I hope everybody finds this helpful. Thank you very much.

About the contributors

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 Jonathan Leach is a GP in Bromsgrove Worcestershire. Jonathan originally pursued a military career for 25 years and worked around the world in the army, being promoted to the rank of Colonel in 2002. Posts included clinical, managerial and academic roles including Professor of General Practice and Director of GP Education, as well as providing medical support for UK operations overseas. Since returning to the NHS in 2008, he has had senior executive positions including medical director and director of primary care for Worcestershire and associate medical director for NHS England.

In addition to clinical work in Bromsgrove, Jonathan is now the chair of the NHS England Armed Forces and their Families Clinical Reference group which advises the NHS in England on the care of service personnel, their families and veterans. He is also a clinical lead with responsibilities for primary care and a governing body GP for the Worcestershire Clinical Commissioning Groups.

Jonathan has published regularly, most recently on workforce issues within the NHS and general practice specifically and separately on urgent and emergency care. He was previously a member of the NHS England task force considering the options for urgent and emergency care nationally. Jonathan is a non-executive director for Primary Care Commissioning.