RCGP Chair vlog: 23 March 2020

Professor Martin Marshall, Chair of the Royal College of General Practitioners and Dr Steve Mowle, RCGP Honorary Treasurer, talk about COVID-19 and personal protective equipment.


This transcript is machine-generated and then tidied up by a human. There may be errors. Please do not quote without checking the original video and audio.

Steven Mowle (SM): COVID-19 blog number two. It’s Sunday the 22nd of March, 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 you know I’ve never been more concerned about the safety of my team. I’ve got two GPs, one receptionist currently affected by COVID-19. I felt it was pretty underwhelming, to be honest, when we received our packs of PPE it was barely the size I think of two 9 packs of toilet rolls. There are all sorts of concerns going out there, what kind of things are you hearing as Chair of the College

Martin Marshall (MM): Yeah we’re hearing similar stories to yours Steve from GPs around the country. So 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 you know 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 you can see some of my colleagues working in the hospital who seem to have much more robust protective equipment than we are being given at the moment.

SM: Do you think we will be given enough supplies? Do you think there is a supply chain there from NHS England… what are they saying?

MM: So NHS England are saying that there are adequate supplies at the moment. They were aware that some of those supplies were slower getting through, and it 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 7 day a week service and this is 24 hours a day, so they say that every practice should have adequate supplies now,  if they haven’t we really want to hear that we obviously so we can feed that back.

SM: We asked Professor Trish Greenhalgh at the Center for Evidence-based Medicine at the University of Oxford, very clever and at times outspoken academic. We asked her for her analysis of whether these masks are any good, what do you think the take-home messages are from her analysis?

MM: This an important question because  we know that a lot of GPs are anxious that the standard masks are not adequate for the current condition of patients that we’re seeing and that there is a higher fidelity mask, which is being used by some other people. You know, 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 ITU, people may sometimes be working in casualty departments and dentists as well. No, we asked Trish whether the standard mask was good enough, she conducted a quick systematic review. Interestingly this was… most of the data came from the Chinese Cochrane Collaboration, very prestigious academic collaboration, they’ve done a lot of work on the effectiveness of different masks types, not necessarily for COVID yet because Covid doesn’t been around long enough but for other similar virus types. And 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, total of more than 9,000 patients

SM: We are both in clinic tomorrow… are you gonna be able to be pretty confident with your colleagues and look them straight in the eye and say actually these as far as we know at the moment these masks are fit for purpose.

MM: Yes I think I think we can. Do I mean of course there’s imponderables, there are uncertainties, that’s the world we’re kind of 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 have been telling us for some weeks, that the mask equipment that we’ve got is 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 the question about whether we should have a full-body cover for the aprons… and there’s also questions – the gloves are fine – but there’s 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 equipment, eye protection, and most practices simply don’t have that at the moment. So there still are significant and important questions that we need to address.

SM: 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 you know safety specs which only cost a couple of quid. There’s two issues here for me it’s whether or not you know someone coughs in my face then potentially droplet, if I’m close enough, the droplet could get into my eyes and 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 a 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.

MM: Yeah, it’s a really interesting question about when we should be wearing this equipment because, maybe you know, this is such a fast moving field a couple of weeks ago we were fairly clear when somebody might have COVID. If they have the clinical signs and they have history of travel or contact with someone who travel, then we knew we had to take care… right now we know that it’s circulating in the community and basically any patients 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, you know, very careful with the risk and might well suggest that they should be wearing it, others aren’t… but if we do wear it protective equipment for every single concentration then the chances of supplies running out sooner.

SM: I know you’re on the phone every day to the top powers-that-be in the NHS, Department of Health. What are your sort of top lobbying messages around PPE over the next few days?

MM: We’re saying to them, we want to be absolutely certain the equipment we’ve got, it’s 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 as we need them.

SM: Sounds good to me. I know I meet our staff every day at the beginning of every day, I remind them about the equipment, I remind them about how to wear it, I think really useful videos etc. I think our main messages to everyone out there, is 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.

The British Journal of General Practice and BJGP Open are bringing research to clinical practice. BJGP Life is where we add the debate and opinion to help ensure everyone benefits from that research.

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