Public Health England changes guidelines on wearing masks in community pharmacies amid confusion


Public Health England now advises pharmacists to only wear fluid-resistant surgical masks when dealing with patients who may have COVID-19

Public Health England (PHE) has changed its guidance on personal protective equipment (PPE) amid confusion over when pharmacists should wear fluid resistant (type IIR) surgical masks (FRSM).

The guidance, which was only published on April 2, 2020, was updated on April 10, 2020, to recommend that pharmacy staff wear PPE only in the event of “contact with possible or confirmed cases of COVID-19”. The original version of the guidelines made no mention of possible cases and simply stated that FRSM was recommended if social distancing could not be maintained.

The updated guidelines now state: “If social distancing of 2m is maintained, there is no indication of PPE in a pharmacy. If social distancing is not maintained, however, direct care is not provided, session use of the FRSM is recommended for contact with possible or confirmed cases of COVID-19.”

The update comes after Susan Hopkins, National Incident Manager for COVID-19 at PHE, told community pharmacists during a webinar on the use of PPE, that FRSM should only be worn when pharmacists “ deal with patients… who come in and potentially have symptoms.”

However, the advice is significantly different from that offered by pharmacy organizations, which have said The Pharmaceutical Journal that they disagreed with Hopkins’ comments and were concerned about potential confusion following PHE’s original advice.

Following the guidelines published on April 2, 2020, both the Pharmacy Services 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 meters cannot be maintained.

But Hopkins said during the April 8, 2020 webinar that PHE “does not recommend that those who do not have front-line contact with people, who may be ill, wear masks”.

“That’s potentially especially important in areas like a small clinic where you’ll have staff working together in the back,” she said.

“It is not recommended that these employees wear masks. We advise people not to work if they are not feeling well.

“If you can’t maintain the social distance of two meters then that’s the only place we recommend the mask and that’s only for people caring for patients… who come in and potentially have symptoms. It’s not to deal with other staff,” she clarified.

The PSNC said in a statement to The Pharmaceutical Journal that he was “very concerned about potential confusion”.

“We do not agree with this [Hopkins] said in the webinar and I think clause 8.12 [of the PHE guidance] is ambiguous,” he said, adding that the PSNC had raised the issue with Pharmacy Minister Jo Churchill.

Current PSNC guidelines recommend that community pharmacists wear masks “even though direct care may not be provided to a patient.”

Robbie Turner, Director of Pharmacy and Member Experience at RPS, said: “While some pharmacies are trying to keep staff safe by enforcing social distancing and ensuring staff stay two meters each other is not convenient for many. Pharmacists and their teams urgently need adequate PPE protection to ensure they can continue to care for patients safely.

Ade Williams, superintendent pharmacist at Bedminster Pharmacy in Bristol, said his pharmacy had already taken action ‘beyond current guidelines’ to protect staff.

Williams said he had followed the advice of the Health and Safety Executive, which “requires that we [employers] we have a legal responsibility to do everything in our power to protect our team.”

“While the PHE guidelines are meant to be evidence-based, I became aware of all the steps that could be taken beyond the guidelines [and] I felt like it was only morally expected of me to try to put these things in place,” he explained.

Raj Matharu, chairman of Pharmacy London – a representative body of London’s local pharmaceutical committees – said he always recommends pharmacies follow the advice of PSNC and RPS “because we cannot have social distancing in our pharmacies “.

“Wearing masks and gloves provides some protection and reassurance for staff who are really scared right now – otherwise they will stop coming to work,” he said.

Graham Phillips, superintendent pharmacist at Manor Pharmacy Group, said the PHE guidelines were “totally wrong”.

He added: “They have not done any proper risk assessment of the reality of community pharmacy and they continue to spout this rhetoric based on an informal 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 the community pharmacy would be available through wholesalers, with pharmacies expected to cover additional supply costs.

“We recognize that this is a COVID-19 related cost to community pharmacy and therefore will be considered later,” she said.

Pharmacists received initial packs of PPE in early March 2020, with the option to order additional supplies through the National Supply Disruption Line.

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