UNION

NHS and COVID-19: Frequently Asked Questions

GMB's advice specifically for members in the NHS & Ambulance Service

Working in the NHS and COVID-19

Update: Tuesday 26 May

Covid-19 is affecting all GMB members, none more so than those working in the NHS & Ambulance Service, including private contractors’ and private ambulance services. Please be assured that GMB has been working to ensure you are protected throughout this unprecedented Covid-19 pandemic.

General advice for GMB members is available on the GMB hub and covers a wide range of issues to help you understand what you need to know, self-isolation and shielding, rights at work, school closures and personal protective equipment (PPE).

All coronavirus advice

NHS employers guidance


Guidance for NHS organisations has been issued by the Department of Health & Social Care, NHS England & NHS Improvement, Public Health England, Health Education England and NHS Employers. Trade unions on the NHS Staff Council Executive have been consulted on this and will continue to be in any future amendments. This guidance applies to all NHS organisations in England and is intended to be an additional resource to supplement local organisational plans.

This guidance is regularly updated so please keep checking on line.

Read more

The current guidance includes information on:

  1. Health, safety & wellbeing – staff wellbeing and support; infection control; fatigue; mental wellbeing; supporting our most vulnerable people; NHS staff council; occupational health; supporting staff following the outbreak.
  2. Communicating with staff.
  3. Bringing staff back.
  4. Increasing workforce supply – bank staff; medical trainees in academic placements; military reserves; agency staffing; volunteers; healthcare learners and doctors in training; pharmacists; system leadership organisations.
  5. Enabling staff movement – includes a link to the enabling staff movement toolkit.
  6. Pre-employment checks and Assurance – disclosure and barring system; indemnity and litigation.
  7. Training.
  8. Staff terms and Conditions – including advice on annual leave and bank holiday arrangements.
  9. Partnership working and facilities time – employers should ensure reps are allowed the time and facilities needed to carry out their trade union duties and be fully involved in local partnership arrangements to best support staff.
  10. Life Assurance Scheme (Death in Service) 

Terms and conditions


The latest guidance on terms and conditions issued by NHS Employers applies to all NHS organisations, outsourced services and NHS services commissioned from non-NHS organisation.

The aim of this guidance is to ensure that the operation of national terms and conditions reflect the unprecedented nature of Covid-19 and the reliance on NHS staff at this time.

The overriding principle is that staff should not feel forced to work if they become unwell and as much flexibility should be given as is possible to help staff maintain their health and wellbeing. 

This guidance applies to NHS Organisations and Outsourced Services in England. It contains information on:

  • Recording Covid-19 absences on ESR
  • Self-Isolation
  • Sickness Absences
  • Other Absences
  • Annual Leave
  • Additional Work
  • Returning to work in the NHS
  • NHS Pension Scheme
  • Working Hours and Working Time Regulations
  • Reprioritising existing work

The advice is published online and can be accessed here.

Other useful links

 

 

Self-isolation, social distancing or shielding

  • Self-isolation – you should stay at home. More details can be accessed at:

https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection
 

  • Social distancing is reducing the social interaction between people to help prevent higher risk groups of contracting Covid-19.

Full details of who should be social distancing and what it is can be found at- https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults
 

My Trust isn't following Government advice


If you have concerns about how your employer is implementing advice in your workplace, please raise your concerns with your local GMB Representative.

Pregnant workers


Detailed information for pregnant women can be accessed here.

As a precaution, you should follow government advice about social distancing; stay away from public places and avoid anyone who has symptoms suggestive of coronavirus. If you are in your third trimester (more than 28 weeks pregnant) you should be particularly attentive to social distancing and minimising contact with others.

I am pregnant and have been advised to social distance. What does this mean?

If you are less than 28 weeks pregnant (1st / 2nd Trimester) you can continue working in patient facing roles, providing that all necessary precautions are taken.

If you are more than 28 weeks pregnant (3rd Trimester) you can continue to work but avoid where possible any direct patient contact. Avoid where possible caring for patients suspected of, or who have been diagnosed with Covid-19. This should be done by risk assessment identification and the correct use of PPE.

Other health conditions


People with underlying health conditions can continue to work but should avoid where possible patient facing roles, unless you have been medically advised to be shielded.

Redeployment should be considered into non patient facing roles and employers should be as flexible as possible to accommodate this. Risk assessments should be carried out for staff with underlying health conditions and people should be redeployed into a more suitable environment if possible. If this is not possible they will need to be sent home, on full pay.

Vulnerable family members


I live with a vulnerable person, what should I do about attending work?

The GMB has been working with NHS Employers for more detailed guidance. This can be accessed at - https://www.nhsemployers.org/covid19/staff-terms-and-conditions/staff-terms-and-conditions-faqs/pay#Shielding

In brief, employers need to consider all options for working from home or a temporary voluntary move into alternative accommodation. The employer needs to be considerate of care arrangements and they are encouraged to use maximum flexibility to ensure that the needs of both staff and the service are met.

PPE – guidance from Public Health England


Information on PPE can be accessed here on the GMB Hub

New guidance has now been issued by Public Health England and can be accessed here

You can also view easy to read tables on the appropriate PPE for different workers. 

Table 1: Healthcare workers by secondary care inpatient clinical settings, NHS and independent sector. 

Table 2: Primary outpatient and community care by setting, NHS and independent sector. 

Table 3: Ambulance staff, Paramedics, other patient transport services and pharmacy staff. 

Further supplementary advice has been issued specifically for the ambulance service can be accessed here. 

Table 4: Additional considerations, in addition to standard infection prevention and control precautions.

There is also a PPE visual guide here.

A Frequently Asked Questions document about PPE has also been produced by Public Health England can be accessed here.


UPDATE: Public Health England Amendment – Considerations for PPE Shortages (17th April 2020) 

Guidance has been changed by Public Health England for situations where PPE is in short supply. This is aligned with World Health Organisation advice and provides details specifically on sessional and the reuse of PPE.

The Health and Safety Executive have agreed that this guidance is appropriate within Health & Safety Legislation and provides appropriate protection for health and care workers, despite it not reflecting their standard approach.  

Public Health England has confirmed to the GMB that this guidance is only for circumstances where there are extreme shortages of PPE only. It does not replace the previously published guidance above. The temporary guidance focusses on sessional use and re-use of PPE. Details below: 

Sessional Use: 1 worker, 1 shift. The same PPE can be worn if leaving ward areas to continue care for a patient or transferring them. 

Face masks / respirators, gowns / coveralls and eye protection should only be changed when taking a break or when visibly contaminated or damaged. 

Reuse: Same item, same worker, with appropriate precautions. 


Fluid repellant surgical face masks (FRSM) and disposable respirators (FFP3/FFP2/N95): Sessional use is dependent on individual factors such as heat, activity and can be between 2-6 hours. They must be disposed of if damaged or moist. They can be reused providing they are not damaged, soiled or hard to breathe through. Masks with elastic ear hooks are more appropriate to be reused than those that are tie on. 

Face masks should be carefully folded so the outer surface is held inwards and should be stored in a clean sealable bag / box marked with the persons name. Fit checks should be performed each time a respirator is donned if it is reused. 


Gowns and coveralls: Fluid repellant gowns or coveralls for the use for the care of patients in high risk areas, where aerosol generating procedures (AGPs) are being performed. 

If gowns are not available: 1) reserve disposable fluid repellant gowns coveralls for AGPs and surgical procedures; 2) disposable, nonfluid-repellant gowns or coveralls with a disposable plastic apron for high risk settings and AGPs. 3) reusable (washable) surgical gowns or coveralls (or similar suitable clothing) with a dispoable plasic apron for AGPs and high risk settings. These would need to be washed in a hospital laundry. 

Sessional use – to be worn until the staff member takes a break or leaves for a non clinical area of the ward, unless transporting a patient. Plastic aprons and gloves to be changed between patients. If the gown becomes soiled it must be disposed in infectious waste.  

Reuse – disposable gowns to be retained for high risk AGPs. Where there are no disposable gowns, alternatives are reusable gowns; reusable (washable) laboratory coats; reusable (washable) long sleeved patient gowns; reusable coveralls. 


Eye Protection: Goggles are typically reusable and visors are available in both disposable and reusable options. 

Sessional use – eye protection should be removed upon exiting the ward area as per standard practice. 

Reuse – Single use items can be reused in circumstances of extremely short supply. A detergent product either combined / sequentially with a decontamination product should be used to clean the item, rinsed thoroughly and left to dry. 


Gloves: Single use only and must be disposed of after each use. Sessional use or reuse should be avoided. 


Aprons: Re-use of aprons is not recommended. 

The new guidance can be accessed here.

 

What is the GMB position on the new Public Health England PPE Guidance? 

The GMB welcomed the amended guidance published on 2nd April as it addressed some of the concerns that we raised on behalf of GMB members. However, we do believe there are still more improvements that are needed. 

Supply of PPE remains a huge issue. Despite what the government are stating with regards the supply of PPE, it is still not being received by many of our frontline workers that need it and urgent action needs to be taken by Government to ensure this issue is resolved. 

Unfortunately, the Government has been unable to resolve the huge supply issues and therefore this has resulted in the guidance being amended again for acute PPE shortages, specifically with regards advice on sessional and reuse of PPE – detailed above. The GMB does not agree with this latest downgrading of PPE and believes it leaves our members extremely vulnerable and in harms way. 

Read our response

Public Health England has now confirmed to GMB that this latest guidance was produced to be followed in circumstances of extreme shortage of PPE only and not at any other time. At all other times the previously published PPE guidance should be followed. 

The Resuscitation Council UK (RCUK) have also expressed their concerns about Public Health England's guidance, specifically with regards them not considering chest compressions to be an Aerosol Generating Procedure (AGP). You can read their statement on this issue here.

Public Health England informed GMB during a PPE briefing on 21st April 2020 that they had discussed this area of concern with RCUK and although they did not agree on this matter, they did respect that RCUK were the experts in the field of resuscitation. Therefore, the PHE advice was guidance only and local employers would be free to follow RSUK guidance on this issue if they choose to. 

You can access guidance and resources issued by RSUK during Covid-19 here.

In NHS Trusts there are concerns that due to the supply chain issues and lack of available PPE, the necessary PPE is being held back and rationed, out of fears that it will run out in the higher risk areas. There are also concerns that full PPE is not provided to staff working on Covid wards and these staff are left with access only to the most basic of protection.

It is felt by many members in these areas that head covers would be a better form of protection. The lack of available PPE is also resulting in unequal access to PPE amongst NHS Trusts and even between departments within the same Trust. 

In Ambulance services, the new guidance is a positive move forward as it empowers workers by allowing them to make their own risk assessments and determine the level of PPE they need. It should give all ambulance staff permission to access and use all the PPE they feel that they need and not what a manager thinks they need.  

Level 1: Standard infection control precautions. 

Level 2: Gloves, apron, fluid repellant surgical mask (FFP2), eye protection. 

Level 3: Gloves, Long sleeved gown, FFP3 Respirator, full face shield or visor. 

However, there are parts of the guidance that are not strong enough to protect our members sufficiently.  

We have concerns about the use of the term ‘possible and confirmed cases’. GMBs advice to our members is that all patients should be suspected of having Covid and therefore risk assessments should be performed by the worker before dealing with the patient for them to determine what PPE they feel they need. 

We also have concerns about the use of the term ‘staff should not wear a higher level of PPE than is required’. GMB would always advise our members to level up in PPE and not level down, to ensure their protection. 

We also have other concerns including the use of poor quality and inferior aprons, the guidance on cardiac arrests and other Aerosol Generating Procedure guidance. The GMB will be making representations to all the relevant bodies on all of these issues. 


I am being given out of date PPE, is it safe to use? 

GMB is not advising members that out of date stock is acceptable. It is however better than nothing. 

The NHS’s stockpiled PPE is checked as part of the stock management process operated through the NHS Supply Chain. This means rotating stock to make sure that items which have been there the longest are issued first. 

Some products may appear to have out-of-date ‘use by/expiration’ dates or have relabelled ‘use by/expiration’ dates. All products being issued should have passed stringent tests that demonstrate they are safe. The PPE is exposed to extreme conditions for prolonged periods, to see how the product deteriorates. All that are not up to standard should be destroyed and not distributed to trusts. 

 
What is GMB’s approach? 

All key workers must have the right PPE to protect them. Not supplying PPE is illegal and unacceptable where the exposure risk is high. Where the right PPE is not available (due to lack of supply), lower levels of PPE are acceptable short term whilst new supplies are obtained. In emergency circumstances older PPE can be used, but not on an ongoing basis. If employers are not providing PPE, then we must challenge the employer immediately. 

 
What is GMB doing? 

The GMB has been lobbying Government and employers at the highest level, utilising the press and media where needed. We have been in contact with the Department of Health and Social Care, the Association of Ambulance Chief Executives and Public Health England to raise our concerns. Local GMB Officers and Representatives have been provided with PPE checklists and template letters to issue to employers to ascertain what the current situation is in your workplace. 

As a result of GMB pressure on Government and Public Health England, the advice on PPE has now been amended to reflect the concerns of our members. We will continue to engage with the Department of Health and Public Health England to continue raising concerns and in pursuit of further improvements. 


What should I do if I have concerns about PPE use in my workplace? 

GMB has launched the ‘Get Me PPE Toolikit’ to advise and guide you on this. You can access information and resources to help you raise your issues with formally with your employer. Please involve your local GMB Representative in any formal communications on health and safety concerns you have with your employer. 

Access the toolkit
 

The GMB has a PPE survey and all members are encouraged to complete it.  

The GMB have now launched a PPE survey and all members are encouraged to complete it. 

Take GMB PPE Survey 

Ambulance guidance


Guidance for ambulance service trusts can be accessed here.


Will I be paid section 2 unsocial hours if I have to take time off work?

One of the reasons that the GMB rejected the three year pay deal was due to the removal of unsocial hours enhancements when not at work. This issue was raised direct with NHS England and we asked that unsocial hours payments should continue to be paid to any staff having to take time off work due to Covid.

We successfully secured this agreement and the NHS employers guidance clearly states that “It is essential for infection control purposes that staff members who are told to self-isolate, do so as quickly as possible. NHS England & NHS Improvement wrote to Chief Executives on 2 March 2020, stating staff should receive full pay whilst in self-isolation. This includes bank staff and sub-contractors, who have to be physically present at an NHS facility to carry out their duties.” 

The guidance continues to state “Full pay must be interpreted as paying what the staff member would have otherwise earned if they were not in isolation, which would include any pay enhancements.”

Industrial issues


Formal meetings are going ahead. Do I have to attend? Management aren’t attending so why do we have to?

GMB believes that all formal meetings should be postponed until the end of the Covid-19 Pandemic. Please speak direct to your local GMB Representative should you be invited to attend a formal meeting with your employer.

This position has now been confirmed by the Social Partnership Forum and you can read our joint statement on Industrial Relations here. 

What is GMB’s opinion of Testing for Staff? 

The GMB is calling for testing for all NHS and Social Care Workers. Guidance has been issued to NHS Trusts and Ambulance Services on how to prioritise staff for testing. We are still concerned about the low numbers of staff being tested and the length of time it is taking in some areas for results to be received. The GMB will continue lobbying Government on this issue. 

GMB will be keeping members up to date as and when new guidance and advice is issued. Please ensure that your membership details are up to date and that we have an email address and mobile phone contact details for you so we can continue to communicate at this time.

Please keep checking the GMB Hub for the latest advice.

Visit the GMB advice hub


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Do you want to be a GMB contact point during Covid-19 so that you can ensure all GMB members in your workplace are receiving the most up to date information? Email NHS@gmb.org.uk

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