Conducting face-to-face consultations

The following steps should be taken to minimise spread of COVID-19:

• Consider whether a consultation outside might be practicable. If not practicable:
  • enhance air flow by opening windows and doors (where and when appropriate), and optimising fresh air flow by reducing or avoiding air recirculation
  • consider possible ways to avoid patient contact with staff and other non-COVID-19 patients – this could include having the patient use an allocated entry, waiting in the car until the GP is ready to consult and clearing corridors prior to patient entry
• Prior to seeing a patient with COVID-19, the GP must don appropriate PPE, which must include:
  • gloves
  • P2/N95 mask (ideally fit tested, and fit checked)
  • gown
  • eye protection (goggles or a face shield)17
• Consider:
  • the most appropriate location to don and remove PPE
  • how to safely dispose of PPE after the consultation.
• Ensure the patient is wearing a surgical mask, at a minimum.
• Conduct as much of the assessment as possible remotely, and spend only the minimum amount of time as possible in the assessment area with the patient. Maintain physical distancing of at least 1.5 m when possible.
• If the necessary PPE is not available, do not undertake a face-to-face consultation. Instead, contact your local public health unit or hospital for advice on where to direct the patient.

Refer to the Department of Health’s Guidance on the use of personal protective equipment (PPE) for health care workers in the context of COVID-19 for detailed advice on PPE selection.

If an in-practice consultation is deemed necessary, contact with the patient should be limited only to essential clinicians who have donned appropriate PPE.

Staff should prepare the space for face-to-face consultations in a general practice. Before seeing any patients:

• remove all non-essential items from exposed surfaces
• remove all soft furnishings (if possible)
• tape a line on the floor 1.5 m from the doctor’s/nurse’s chair/desk as a physical indicator to maintain social distancing when possible
• ensure PPE is available, including spare items
• check the room has handwashing facilities/hand sanitiser
• place a clinical waste disposal bin in a location appropriate for PPE removal (i.e. near an exit)
• ensure all relevant pathology forms, examination tools and other necessary items are available in the consultation room to avoid exiting and entering the room during the consultation
• have the following health and follow-up information ready to give the patient:
  • COVID-19 information
  • isolation guidance
  • referral information
  • any follow-up details that might be required.

Cleaning the consultation room after seeing a COVID-19-positive patient should include:

• general practice staff removing PPE immediately to avoid cross-contamination
• donning new PPE, including non-contaminated gloves, a surgical mask and eye protection, before cleaning the consultation room
• removing and disposing of, or laundering, removable fabric items, such as curtains
• wiping down surfaces with both a detergent and a disinfectant – use a cleaning detergent followed by a disinfectant, or use a two-in-one product with both cleaning and disinfecting properties, and allowing to dry
• wiping down any touched surfaces (including door handles, desktops, stethoscopes and otoscopes)
• mopping the floor
• steam cleaning soft furnishings
• disposing of contaminated waste appropriately in contamination bins
• removing PPE, preforming hand hygiene and reapplying PPE to clean reusable cleaning equipment, such as mop handles
• removing PPE and performing hand hygiene18