Matt Hancock announced at the daily briefing on 5 June 2020 that face covering will become mandatory in all NHS hospital settings from 15 June 2020. Hospital staff will have to wear Type 1 or Type 2 surgical masks (or more stringent protection when advised) in all areas except those which have been designated “COVID-secure”.
NHS England confirmed in a letter to clinicians on 9 June 2020 that the rule for staff to wear surgical masks will also apply to all other NHS and primary care settings, including GP practices. All GPs and their staff will therefore have to be expected to wear surgical facemasks at all times when at their place of work, unless working in an area which has been specifically designated COVID-secure. Further guidance on this is expected imminently.
Patients and visitors to NHS hospitals will also be required to wear face protection though there have been reassurances that the NHS will not turn away patients or restrict access to care if someone does not. Plus there will be exemptions for very young children, those with certain disabilities and those who have breathing difficulties. Face protection worn by patients and visitors will not need to meet the same surgical “types” required of workers and provided they cover the mouth and nose, any face covering can be used including scarves, bandannas or homemade fabric masks.
The British Medical Association (“BMA”) has been pushing for the wearing of face coverings also to be mandatory for all patients and visitors in the GP setting although it is not yet clear that the guidance will recommend this. Either way, GPs are likely to want to strongly encourage patients and visitors to use them for the protection of themselves and their own staff, even if they do not formally make them a condition of entering the surgery or accessing treatment.
The ability to comply with the new requirements presupposes that GP surgeries currently have sufficient stocks of face masks and will have easy access to increased supplies of them going forward, at a reasonable cost. Whilst the government continues to reassure the public that there are sufficient stocks of PPE available, and that more supply options are being sourced. Despite this, we have continued to see reports of services struggling to get hold of PPE, or being able to source adequate stocks only at significantly increased cost.
The BMA reported recently, for example, that “A significant proportion of doctors still report struggling to access basics: masks, gowns, and protective glasses”. Further, there have been numerous reports of suppliers imposing unfair or excessive pricing to PPE supplies, or restricting supply without warning. Whilst the Competition and Markets Authority are looking into a number of complaints over pricing and supply chains of PPE, the fact remains that demand for PPE is – and will likely remain high for the foreseeable future – and prices are therefore likely to stay significantly higher than they were pre-Covid-19.
The new portal coordinated by the Department of Health and Social Care should, in theory, help GPs to access PPE stock and request critical items from DHSC. However, given that there have been reports of ongoing supply chain difficulties since the portal was set up, it would appear that it has not fully resolved the problem. At the very least, it looks unlikely that PPE supply issues will have been fully resolved by 15 June 2020 when the new guidance will come into force and by which time GPs have been asked by NHS England to ensure that they have made “any necessary changes to implement the advice”.
GP surgeries are likely to need to have higher PPE supplies to meet their own staff demands, and also ensure that there are sufficient stocks of surgical masks (or other suitable face coverings) for patients and visitors. GPs should therefore be considering their current and future PPE supply needs now and the likely costs of increased PPE requirements going forwards, to ensure that they can meet the expected new guidance by next week and going forwards. They may also want to consider informing staff and patients about expectations on face coverings and updating any relevant risk assessments, if they have not already done so.