Calderdale Clinical Commissioning Group says that no Calderdale GP practices have reported a shortage of Personal Protective Equipment.
Responding to questions we asked the NHS commissioners’ Governing Body meeting last week, Neil Smurthwaite, Chief Finance Officer/Deputy Chief Officer, writes:
“Calderdale CCG has made funding available to all member GP practices for Personal Protective Equipment (PPE). All five of Calderdale’s Primary Care Networks currently have an adequate supply of PPE. Should an immediate need for PPE arise, the CCG’s contingency plan is to escalate the issue to the West Yorkshire Local Authority Local Resilience Forum and to our NHS England Local Area Team.
… None of our member practices have reported a shortage of personal protective equipment.””
What’s this then?
Covid-19 GP Hubs
When Calderdale GPs closed their practices to face-to-face appointments at the end of March, Calderdale Clinical Commissioning Group set up 5 Covid 19 hot hubs, also known as red/amber hubs. This is where patients with confirmed or suspected/possible Covid19, who need face to face appointments, are directed to attend.
Obviously GPs and other staff at these hubs need Personal Protective Equipment of a standard that will prevent infection when in close physical proximity with patients.
How come GP Practices have turned to volunteers for PPE, rather than to their own membership commissioning group?
In saying that no Calderdale GP Practices have reported PPE shortages, Neil Smurthwaite sidestepped the question we asked: Did the NHS commissioners know that the shortage of Personal Protective Equipment for GPs and community health staff has led Calderdale GPs to turn to a crowdfunded group of sewers, Calderdale GPs Need Scrubs, for scrubs. And to the co-operative, not for profit hackerspace Bridge Rectifier for 3D printed and laser cut face visors.
That is certainly what Calderdale GPs have done.
Bridge Rectifier has confirmed that,
Our first small batch was directed by a local locum GP and covered all Calderdale NHS Covid-19 hot hub front line staff present on any given shift. Until that point as far as I understand they were working in masks only, and hadn’t been provided with visors at all.
The local locum GP who’s been helping to distribute the visors confirmed,
The visors went to the central hot hub from where they were distributed to all 5. They have also gone to GPs who are staffing the so-called step-down wards, where recovering covid-19 patients who are not yet fit to go home will be convalescing.
Bridge Rectifier are applying for CE approval, which should be given since their visors use the same model as 3D Crowd, which is CE-approved.
The local locum GP added,
I have seen the standards for the visors and confirmed with the manufacturers that they do meet those, apart from having a CE number stamped on them.”
Bridge Rectifier added,
“As well as distributing visors to GPs, the local locum GP has grabbed batches here and there for local NHS staff as opportunities arise and has been trying to work out a way we can supply all Calderdale NHS community staff who need visors.”
Calderdale Clinical Commissioning Group are responsible only for GP practices’ PPE
Calderdale Clinical Commissioning Group explained to me that the provision of Personal Protection Equipment for community health staff is not their kettle of fish. They do not commission these staff – but,
“Through our partnership working the CCG is assured our partners are doing as much as possible to secure and provide PPE to all organisations.”
Local supply of Personal Protection Equipment is not a straightforward matter, in the currently fragmented out-of-hospital NHS and social care services. Calderdale Clinical Commissioning Group went on,
“While the CCG works closely with care homes, it does not have a responsibility for provision of PPE to care and residential homes. We have therefore not been made formally aware of a shortage of PPE in this area.
This issue would be better raised with Calderdale Council. The Government has announced a range of support packages to organisations, including financial support for such additional costs. We are working with the Local Authority to support our health and social care market on all aspects.”
Calderdale GPs thank sewing ladies for scrubs
The Calderdale GPs Need Scrubs group has been very busy since it was set up on the 1st April, with an appeal on facebook:
I’m in contact with the PPE/finance coordinator for GP PRACTICES OF CALDERDALE they are in DESPERATE need of medical scrubs, they are in need of 50 of each size! They are not bothered about colour just need them AS SOON AS POSSIBLE.
Today (1st May), on behalf of GP practices in Calderdale, a representative thanked all the sewing ladies in the Calderdale GPs Need Scrubs group.
The “thank you” message drew attention to the large amount of scrubs the sewing ladies have made, and which GP practices they’ve been sent to:
“We have received three large deliveries of a range of scrubs in many different sizes, colours and patterns from your local co-ordinator. There are blue scrubs, green scrubs, scrubs made from lovely patterns and rainbows. All of them have been made with love and care by the cohort of makers out there, some have even been embroidered with lovely messages.
“So far, the donations have been distributed to the North Halifax Primary Care Network, one of 5 in Calderdale who make up all the practices in Halifax and the surrounding areas. The networks include groups of GPs, Nurses, Healthcare Assistants, Paramedics, Advanced Practitioners and support staff are seeing patients face to face.
“So far, clinicians who all normally work at Beechwood Medical Centre, Caritas Group Practice, Keighley Road Surgery, Lister Lane Surgery and Plane Trees Group Practice have received scrubs.”
The Calderdale GP representative added,
“There are many more to distribute and early next week, deliveries will be made to Calder and Ryburn, Central, Lower and Upper Calder Valley Primary Care Networks.
“This means that all primary care clinicians in Calderdale will have the opportunity to wear one of the scrubs sets made by For the Love of Scrubs makers.
The huge kindness of these makers is a great way of letting NHS staff know that we are all behind them and thinking of them at this uncertain time for us all. Thank you so much for your time, effort, fabrics, love and patience in creating them for us whilst you are staying at home, protecting the NHS and saving lives.
Kind regards On behalf of GP practices in Calderdale”
As the sewing ladies set to work in early April, the Calderdale GPs Need Scrubs coordinator created a careful collection and delivery process based on infection control measures.
The sewers deliver completed scrubs (and laundry bags) to the Coordinator’s house. Wearing her own PPE, she stores them in a polytunnel for the length of time needed to make sure that any Covid19 virus on the fabric will have died. She then dispatches the scrubs to a central distribution point for Calderdale GPs.
Here’s the Calderdale GPs Need Scrubs Just Giving website. Funds raised are used to purchase the fabric and supplies and distribute it in a kit to the people that are willing to help. The group need to cover the cost of the materials and the cost of postage and packaging.
GP Preparedness update from NHS England shows why Calderdale GPs had to turn to volunteers for PPE
As to why Calderdale GP Practices have turned to volunteers for Personal Protection Equipment, rather than to their own membership commissioning group, the reason is probably to be found in a 27th March update from NHS England about GP preparedness.
It reveals that only Type IIR facemasks, aprons and gloves were available – and in short supply, at that.
Addressed to “Dear GPs and their Commissioners”, the letter says,
“We know that one of the issues we’re hearing most from you is about PPE distribution. For immediate short-term issues National Supply Disruption Response (NSDR) are able to issue ‘pre-packed kits’ with a minimum of 100 Type IIR facemasks,100 aprons and 100 pairs of gloves within 72 hours. Primary care providers who raise requests for kits through NSDR must to be able to make arrangements to receive emergency delivery of these pre-packed kits outside business hours. NSDR 24/7 telephone helpline:0800 915 9964. We are focused on providing swift responses, for example,to meet gaps until scheduled deliveries arrive and until orders with wholesalers through BAU are back up and running.”
The GPs must simply have been desperate for whatever PPE they could get their hands on at that point – as the Calderdale GPs Need Scrubs appeal showed.
There was presumably no point asking the Clinical Commissioning Group, because as NHS England’s letter makes clear, they were in the same boat as GPs.
British Medical Association survey finds many doctors haven’t reported PPE and other shortages because it would be futile
The British Medical Association ‘s latest survey of 16,343 doctors in England between 28 and 30 April is the biggest one of frontline NHS staff during the coronavirus crisis. The survey data revealed almost a third (30%) of doctors in England who were questioned said they had not reported or spoken out about issues relating to PPE, staff shortages, testing or drug shortages because they did not think anything would be done about it if they did.
Asked how safely protected from coronavirus they felt at work, just under two thirds (65%) said they felt only partly or not at all protected.
Overall, 48% of doctors reported having bought PPE directly for themselves or their department, or had a donation from a charity or local firm.
The problem appeared to be higher among GPs, with 55% of them saying they had to do so, compared to 38% of hospital doctors.
The reasons for the government’s failure to supply enough PPE, that meets WHO standards, are the subject of a future blog post. [Link coming soon]
They are also the subject of a legal challenge from doctors.
Doctors’ legal fight with Hancock for NHS PPE
Dr Meenal Viz and Dr Nishant Joshi are challenging the lawfulness of the PPE guidance published by the Department of Health and Social Care and Public Health England, and the Government’s failures to source such PPE domestically and from the EU.
If you want to support this legal challenge and have any spare dosh, here is the CrowdJustice fundraiser
The doctors believe the current guidance exposes them and other NHS and social care workers to Covid19 and the risk of death. As of 09:00 on 2/5/2020, at least 171 health and social care workers are now believed to have died of COVID-19.
The doctors say,
“The government claims to be guided by science. It is clear that their failure to supply the right PPE in sufficient amounts is making them adjust the guidelines on the use of PPE that do not meet WHO or Health and Safety standards.”
Their lawyers have sought an urgent review of the PPE Guidance and have asked the Secretary of State to confirm that he is urgently taking appropriate steps to source PPE.
Their pre-action letter invites the government to:
- Review current PPE Guidance and bring it in line with WHO standards
- Confirm that urgent steps have been taken to engage with the EU’s PPE bulk buying programme
- Investigate the deaths of healthcare workers, in particular why BAME healthcare workers are disproportionately affected
They have also requested disclosure of the research and evidence base which informed changes to the PPE guidance on 17th April, particularly because the Royal Colleges were not consulted before these amendments were introduced.
If the Government do not revise the guidance and take adequate steps to source PPE to prevent the unnecessary loss of life among health workers, the doctors plan to pursue the action to a full Judicial Review hearing if necessary.
You can read their lawyers’ press release here
Urgent need for PPE as key workers and family members testing Covid19+ outnumber positive tests of hospitalised patients
On 3rd May, the number of key workers and members of their families who tested positive for Covid-19 was double the number of sick people testing positive in hospitals – which also includes some NHS and care staff. This has prompted renewed calls for health and social care workers to have they PPE they need.
The government’s chief scientific adviser, Sir Patrick Vallance, warned MPs that there was a risk of infections breaking back out into the community from hospitals and care homes.
A Royal College of Nursing (RCN) spokesperson said: “The reality is that health and care workers are at increased risk from this virus simply by doing their job.
“These figures reinforce the urgent need for proper fitting protective equipment to be provided to all healthcare professionals, so they can protect themselves, their families and their patients.”
Updated 2.5.2020 with info about NHS England’s 27 March GP Preparedness letter to Clinical Commissioning Groups and GPs
Updated 3.5.2020 with info about doctors’ PPE legal challenge to Secretary of State and BMA survey of doctors