Open access article
The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.
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Public Health England (PHE) has changed its guidance on personal protective equipment (PPE) amid confusion around when pharmacists should be wearing fluid-resistant (Type IIR) surgical masks (FRSMs).
The guidance, which was only published on 2 April 2020, was updated on 10 April 2020, to recommend that pharmacy staff should only wear PPE when in “contact with possible or confirmed cases of COVID-19”. The original version of the guidance made no mention of possible cases, and simply stated that FRSM was recommended if social distancing could not be maintained.
The updated guidance now states: ”If social distancing of 2m is maintained there is no indication for PPE in a pharmacy setting. If social distancing is not maintained, though, direct care is not provided, sessional use of FRSM is recommended for contact with possible or confirmed cases of COVID-19”.
The update comes after Susan Hopkins, national incident director for COVID-19 at PHE, told community pharmacists during a webinar on the use of PPE, that FRSMs should only be worn when pharmacists are “dealing with patients … who are coming in and potentially have symptoms”.
However, the advice is markedly different to that offered by pharmacy bodies, who have told The Pharmaceutical Journal that they disagreed with Hopkins’s comments and were concerned about the potential confusion following PHE’s original advice.
Following the guidance published on 2 April 2020, both the Pharmaceutical Service Negotiating Committee (PSNC) and the Royal Pharmaceutical Society (RPS) advised pharmacists to wear FRSMs when working around staff, as well as patients, if a distance of two metres cannot be maintained.
But Hopkins said during the webinar on 8 April 2020 that PHE is “not recommending those who do not have frontline contact with individuals, who may be sick, to wear masks.”
“That’s particularly important potentially in areas like a small dispensary where you will have staff working together in the back,” she said.
“Those staff are not recommended to wear masks. We recommend people stay out of work if they’re unwell.”
“If you cannot maintain the two metres social distance, then that is the only place that we recommend the mask and it’s only for those people dealing with patients … who are coming in and potentially have symptoms. It is not for dealing with other staff members,” she clarified.
The PSNC said in a statement to The Pharmaceutical Journal that it was “very concerned about the potential confusion”.
“We don’t agree with what [Hopkins] said in the webinar and believe that clause 8.12 [of the PHE guidance] is ambiguous,” it said, adding that the PSNC has raised the issue with pharmacy minister Jo Churchill.
Current PSNC guidance recommends community pharmacists wear masks “even though direct care may not be being provided to a patient”.
Robbie Turner, director of pharmacy and member experience at the RPS, said: “While some pharmacies are trying to keep staff safe by enforcing social distancing and ensure staff stay two metres apart from each other, this is not practical for many. Pharmacists and their teams urgently need the adequate PPE protection to make sure that they can continue to care for patients safely.”
Ade Williams, superintendent pharmacist at Bedminster Pharmacy in Bristol, said his pharmacy has already taken steps “beyond the current guidance” to protect staff.
Williams said he has followed guidance from the Health and Safety Executive, which “mandates that we [employers] have a legal responsibility to do everything we can to protect our team”.
“While the PHE guidance is supposed to be evidence-led, I became aware of all the steps that could be taken that went beyond the guidance [and] I felt it was only morally expected of me to try and put those things in place,” he explained.
Raj Matharu, chair of Pharmacy London — a representative body for London’s local pharmaceutical committees — said he was still recommending pharmacies follow the PSNC and RPS advice “because we can’t have social distancing in our pharmacies”.
“Wearing masks and gloves provides some protection and is reassuring for staff members who are really frightened at the moment — otherwise they will stop coming into work,” he said.
Graham Phillips, superintendent pharmacist of Manor Pharmacy Group, said the PHE guidance was “totally wrong”.
He added: “They have done no proper risk assessment of the reality in community pharmacy and they continue to trot out this rhetoric based on an armchair view of what community pharmacy is and does.”
Jill Loader, deputy director of pharmacy commissioning at NHS England and NHS Improvement, told pharmacists during the webinar that further supplies of PPE for community pharmacy would be available through wholesalers, with pharmacies expected to cover the costs of additional supplies.
“We do recognise that that is a COVID-19-related cost to community pharmacy and so that will be considered later,” she said.
Pharmacists were sent initial packs of PPE in early March 2020, with the option of ordering further supplies through the National Supply Disruption line.