PPE in Primary Care

In recent weeks, newspapers, clinical journals and social media sites have documented ongoing concerns about health and social care staff not getting the PPE required to deliver safe patient care. In response to growing concerns about the risks faced by clinical staff, medical and nursing professional bodies have released guidance on the right to refuse to deliver care if PPE is inadequate. Such a refusal would be the last resort, and very likely one of the most difficult choices a clinician could face.

What is the latest advice?

This poster can be found on the Public Health England website:

T2_poster_Recommended_PPE_for_primary__outpatient__community_and_social_care_by_setting

You can also access this ‘COVID-19: visual guide to safe PPE’:

PHE_COVID-19_visual_guide_poster_PPE

How to safely use PPE:

In this short video, Dr Riordan, a GP in Leeds demonstrates the use of PPE

https://www.youtube.com/watch?v=Zpg64grevO0

What to do if you don’t have access to the correct PPE?

These are the key points from the RCN guidance ‘Refusal to treat’:

• If the PPE provided is right for your work setting, then you should continue to work
• If you believe (having read government guidelines) that the PPE provided is inadequate, escalate according to RCN guidance document ‘Personal Protective Equipment (PPE) – Are you safe?’
• If PPE is still not provided you must consider your own safety
• Under the NMC Code, the safety of nursing staff remains a key consideration alongside patient and public safety
• If you become unwell, you might spread infection including to high-risk patients. You will not be available to provide care to others. You might put your own family at risk including more vulnerable relatives
• You must take part in identifying changes to the way that you work that reduce the risk to you short of refusing to provide treatment at all
• If you have exhausted all other measures to reduce the risk and you have not been given appropriate PPE, you are entitled to refuse to work. This will be a last resort
• You must be able to justify your decision as reasonable, so keep a written record of the safety concerns that led you to withdraw treatment using local incident reporting procedures
• If you decide not to treat due to a lack of adequate PPE, and your action is subsequently criticised, there are potential legal consequences, as follows: dismissal, NMC investigation, being sued for clinical negligence, inquests, criminal charges

The RCN will provide you with legal representation and other support in any proceedings without judgement.

Hopefully other professional bodies and unions will follow suit, but I hope that the very existence of these guidelines is sufficient pressure to ensure that no staff are working without adequate PPE.

Rebecca Owen

References

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

https://www.rcn.org.uk/professional-development/publications/rcn-refusal-to-treat-covid-19-uk-pub-009231

https://www.bma.org.uk/advice-and-support/covid-19/your-health-and-wellbeing/covid-19-refusal-of-treatment-where-ppe-is-inadequate

We’d love to hear about your experiences. You can email us on admin@pctc.co.uk, or just post on our Facebook page.