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by Steve Field
5 August 2014

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Blog: Oh to be in England…

Dr Steve Field, CQC chief inspector of general practice’s blog now features a ‘myth-busting column’ about the use of defibrillators, oxygen and oximeters in GP surgeries from the CQC senior national GP advisor

I recently got back from a week’s family holiday in Derbyshire and I’m feeling refreshed and full of energy.

It was incredibly hot and the scenery was wonderful. It made me wonder why people travel abroad when England is so beautiful, the people so friendly, the ice cream so tasty and you can have a wonderful meal and a pint of beer with the family at a local pub – what more could you want!

A busy week

So there I was on Monday morning with my satchel, ready to go into work at CQC, only to find that my taxi did not turn up to take me to the station. After some 40 minutes of waiting on my doorstep, I jumped in the car and rushed across the city to the station to get the train to London! Needless to say, this was a busy start to a very busy week!

There have been some really productive meetings including the GP advisory board, which includes the Royal College of General Practitioners (RCGP), National Institute for Health and Care Excellence (NICE), Public Health England, Healthwatch and the General Practitioners Committee of the BMA.

Nigel Sparrow, our Senior National GP Advisor has been doing some great work for us in joint meetings with the GPC and the RCGP. We have now come to an agreement to share our regular myth busting column with the GPC so, from now on, it will be published in their regular newsletters as well as in our CQC blog and communications. Please see our contribution to this week’s myth buster below.

I had a really thought provoking meeting with Paul McDowell, Her Majesty’s Chief Inspector for Probation Services. Our teams have resolved to work together to look at issues in the health and justice sector including access to general practice for offenders. There was also a great meeting with Aroop Mozumder, who is in charge of Primary Medical Services for the Army, Navy and Air Force. It was great to share what we are doing in civvy street and hear more about the great work our medical and nursing colleagues are doing for our soldiers, sailors and air personnel.

At the CQC board meeting this week, we approved our signposting statement for dentists, which will be coming out in the next few weeks.

Nigel Sparrow’s myth buster of the week answers some frequent questions about the use of defibrillators, oxygen and oximeters in GP surgeries.

Nigel Sparrow’s myth buster

Agreed principles for defibrillators, oxygen and oximeters

We need to be assured that practices are able to immediately respond to meet the needs of a person who becomes seriously ill. Since we do not have explicit guidance around emergency equipment such as pulse oximeters, defibrillators and oxygen, having reviewed external guidance and national standards, we agreed the following with the BMA, RCGP, NCAS and MDU:

We need to consider the individual circumstances of the practice such as the practice’s knowledge and assessment of the emergency services available to them.

With regard to defibrillators: current external guidance and national standards around this issue sees defibrillators as best practice and that practices should be encouraged to have them.

With regard to oxygen, the National Resuscitation Council has the following views: “Oxygen: Current resuscitation guidelines emphasise the use of oxygen, and this should be available whenever possible.”

Oxygen is considered essential in dealing with certain medical emergencies e.g. acute exacerbation of asthma and other causes of hypoxaemia; if the practice does not have oxygen they are unlikely to be able to demonstrate they are equipped for dealing with emergencies.

With regard to pulse oximeters: the 2009 British Thoracic Society (BTS) guideline on the management of asthma recommend SpO2 monitoring by pulse oximetry as an objective measure of acute asthma severity, particularly in children. In addition the Primary Care Respiratory Society states that it should be used to assess all acutely breathless patients in primary care. The need for pulse oximeters and paediatric pulse oximeters should be risk assessed within a GP practice. In light of the above recommendations, it would be unlikely that a practice would be able to demonstrate that they are equipped for dealing with emergencies without a pulse oximeter.

With regard to training in CPR: this is mandatory. If a practice has not trained its staff that are working while the practice is open, they would have no evidence that their staff would be able to immediately respond to a person who becomes seriously ill requiring resuscitation. The above guidance relates to Regulation 9, which states that:

“The planning and delivery of care and, where appropriate, treatment in such a way as to…

Ensure the welfare and safety of the service user.”

I really do hope that you will find this series helpful and look out for the next one coming out soon.