Covid-19 - Staff Risk Assessments
Risk Assessment Frameworks for
Staff in General Practice during Covid-19
Covid-19 has presented a significant challenge in assessing and mitigating risks to all staff in healthcare settings. The early data from Italy indicated a high rate of infection and death amongst healthcare workers and sadly this has been replicated in the UK.
Despite the pandemic crisis employers remain bound by their duty under the Health and Safety at Work Act and the Management regulations to manage the hazard of Covid-19 infection and reduce risk to all staff.
As Covid-19 is a novel virus infection our understanding of it and the control measures that should be put in place have been evolving rapidly. This has led to some frustration about the lack of definitive guidance. At the time of writing (20/05/20) we are still waiting for the NHSE guidance for Primary Care. Much of the attention has been focused on PPE but this is only one of the control measures that should be introduced.
The Faculty of Occupational Medicine have produced helpful guidance on the general risk assessment of all NHS staff.
Covid-19 has affected different populations in different ways and as well as considering the risks for the whole team then each member of staff requires an individual risk assessment. Those at highest risk should be removed from the possibility of contracting infection at work as the first control measure. Employers and employees need an evidence based, fair and non-discriminatory tool to do this that would provide the appropriate protection for staff and mitigate the risk of any action against employers failing in their duty under the Health and Safety at Work Act.
Initially, in the the absence of a national tool, the LMC would like to draw your attention to three individual risk assessment tools that you may wish to consider whilst assessing your staff.
The first has been produced by a private Occupational Health company called Team Prevent and shared with national LMCS. It includes a risk table and proforma for completing the assessment. They have agreed that this can be shared with practices.
The second paper specifically looks at the higher risk of BAME community and includes a risk score.
Also, a research paper has been published on MedRxiv on the 9th of May by a variety of authors including senior clinicians within the BMA, Hospital Trusts, University College London and the University of Exeter. It examines the Covid 19 related deaths in the population and uses this to provide a risk stratification tool for Doctors. This paper has not been peer reviewed and as such should be used only as a guide to help decision making.
The risk assessment table is summarised below and can be printed from the full document.
Pregnancy irrespective of score: Women who are less than 28 weeks pregnant should practise social distancing but can choose to continue working in a patient-facing role, provided the necessary precautions are taken and their risk score indicates that they are low or medium risk.
Women who are more than 28 weeks pregnant, or have underlying health conditions, should avoid direct patient contact and
it is recommended that they stay at home.
Deployment of staff as a result of risk stratification.
Both papers lead to staff being placed in low risk, medium or higher risk groups.
Low risk staff are suitable to work in all areas with appropriate control measures such as hand hygiene, PPE and importantly minimising both the number and duration of any face to face contacts.
Medium risk staff should be deployed in cold sites away from the Covid-19 environment for face to face work.
High risk staff should be deployed in non-patient facing roles such as telephone triage, digital consultations etc. and, if possible, work from home.
This is intended to support managers in conducting an initial risk assessment of staff. It is not intended to be a definitive guide and each individual needs to be considered in the context of their health and the specifics of the role that they perform at work.
If you have any staff that you are unsure about their individual risk or if you feel are at very high risk of the consequences of Covid-19 infection then the LMC suggest that you seek Occupational Health advice.
The LMC cannot offer any specific Occupational Health advice to practices.
Post publishing note 29.5.20 :-
NHS Employers have published updated guidance on risk assessment, particularly for at risk and vulnerable groups within the workforce. This includes staff returning to work for the NHS, and existing team members who are potentially more at risk due to their race and ethnicity, age, weight, underlying health conditions, disability, or pregnancy. NHS Employers have taken an inclusive approach and have described that the guidance is applicable, with appropriate local adaptations, in all healthcare settings.
The BMA have also produced a document on the "Principles and priorities for supporting staff who are shielding to return to work".
The Society of Occupational Medicine (SOM) has now published a COVID-19 return to work guide for Health Professionals advising Patients and Employers.