Intended for healthcare professionals

Letters Covid-19: remote assessment in primary care

Removing the handle of the Broad Street pump: measures to slow the spread of covid-19 in primary care teams

BMJ 2020; 369 doi: (Published 12 May 2020) Cite this as: BMJ 2020;369:m1841
  1. Simon de Lusignan, professor of primary care and clinical informatics1,
  2. Tamsin Carlyon, general practice partner2,
  3. Ajit Lalvani, chair of infectious diseases3
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6ED, UK
  2. 2Woodbridge Hill Surgery, Guildford, UK
  3. 3Imperial College London, St Mary’s Campus, London, UK
  1. simon.delusignan{at}

John Snow removed the handle of the Broad Street pump to halt a cholera epidemic. His approach was not to find the organism but to block transmission.1 One way to contain covid-19 is to assess patients remotely,2 but what about transmission within primary care teams? Research reporting the effectiveness of strict infection control measures34 and about the aerosol and surface stability of SARS-CoV-2 provide5 the basis for measures to reduce transmission in general practices.

We have changed our routine as follows:

  • One person, one room for one day

  • All communication is by phone, text, screen message, or by video conference, with all staff, team, and one-to-one meetings weekly

  • Clinicians consulting face-to-face leave personal items untouched overnight and a dressing gown in their lobby; on return home clothes go into a linen bag (provided by a local school) to machine wash

  • Patient facing clinicians use a specific toilet, the kitchen, and the common room. Other staff bring their packed lunch and drink to their own room and use a different specified toilet

  • Room cleaning is done in the evening, room stocking at weekends

  • One row of consulting rooms used for patient care

  • Less face-to-face patient care. Some patients are seen in the car park at booked times Unnecessary items are left in the car. Only patients with no mobile phone ring front doorbell

  • Front door keys are kept on a separate copper cleanable fob

  • Internal doors other than consulting room doors are propped open to reduce touching.

Strict social distancing has been our removal of the pump handle. We are building on our first steps6 by introducing strict infection control measures shown effective with other problems, such as methicillin resistant Staphylococcus aureus.7 This approach might turn out to be excessive and should be tested. There is also a risk of exacerbating stress and adversely affecting staff’s mental health.8 But at the time of submission, we report low levels of staff sickness and self-isolation.


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