GP mythbuster 1: Resuscitation in GP surgeries

Page last updated: 2 September 2024
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We have updated this mythbuster to include details of The Circuit, a scheme to identify the location of the nearest registered defibrillator and speed up the response to an out-of-hospital cardiac arrest.

This box only lists significant updates, for example where we are updating the factual content of our guidance. We do not include minor changes, such as editorial corrections.

Resuscitation of adults and paediatrics

All GP practices need the knowledge, skills and equipment for managing medical emergencies. This includes resuscitation.

All staff must have training as appropriate. This can include online training. They must understand their responsibilities in an emergency, including:

  • where to find equipment and medicines
  • how to get help.

See updated resuscitation guidelines (Resuscitation Council UK), including:

Quality standards

Practices should have:

  • immediate access to appropriate resuscitation equipment and drugs when needed
  • away for all staff to call for help
  • staff trained to use equipment, according to their roles
  • local risk assessment overseen by a designated resuscitation lead
  • personal protective equipment (PPE) and sharps boxes
  • a reliable system to check and replace equipment that follows the manufacturer's instructions.

See quality standards for cardiopulmonary resuscitation (CPR) practice and training (Resuscitation Council UK).

Resuscitation equipment

Minimum suggested equipment

The following items should be available for immediate use:

  • automated external defibrillator (AED). See Guidance: Defibrillators (Resuscitation Council UK)
  • adhesive defibrillator pads – a spare set is also recommended
  • oxygen, including cylinder with key and tubing where necessary
  • pocket mask (adult) with oxygen port – infants may use if inverted
  • protective equipment where necessary
  • stethoscope
  • absorbent towel – to dry chest if necessary
  • razor – to shave chest to apply pads if needed.

See the minimum suggested equipment (Resuscitation Council UK) to support CPR in primary care settings. This is not a full list – providers need to assess the risks in their own individual practice. This is because the needs of each practice will vary.

See 2021 Resuscitation Guidelines (Resuscitation Council UK).

Personal protective equipment

Providers and clinicians should agree on local policy about the availability and use of PPE in resuscitation situations. This is to provide proper protection for staff. Local decisions need to be:

  • transparently agreed
  • understood
  • shared
  • adequately resourced.

Oxygen and oximetry

Oxygen must be available and should be prescribed according to a target saturation range with monitoring.

Pulse oximetry must be available in all locations where emergency oxygen is in use.

See the British Thoracic Society (BTS) Guideline for oxygen use in adults in healthcare and emergency settings.

Staff who administer oxygen should have suitable training.

For the use of oxygen in Asthma see the BTS/SIGN British Guideline on the management of asthma. 

Pulse Oximetry

Do not delay oxygen therapy if there is no pulse oximetry available. But start monitoring as soon as it becomes available.

Pulse oximetry is a useful non-invasive investigation that is easy to perform in a primary care setting. It rapidly detects changes in oxygen saturation before the patient is compromised. But it is not an infallible test and needs clinical judgement. Pulse oximetry must not be used in isolation, or without training, but used to support a comprehensive assessment and examination.

See the Primary Care Respiratory Society’s guidance on pulse oximetry.

NICE guideline 51 on treating adults and children with potential sepsis includes:

  • treating in community settings if equipment is available
  • where taking a measurement does not delay assessment or treatment.

Practices need to consider an appropriate pulse oximeter. For example, an adult pulse oximeter has a license for use on people aged 12 years and over. Whereas a paediatric pulse oximeter should be available in services that provide healthcare services to children under 12 years of age. Follow the individual manufacturer’s guidelines.

See guidance on The use and regulation of pulse oximeters (Medicines and Healthcare products Regulatory Agency).

Where to keep resuscitation medicines

Resuscitation medicines and equipment should be readily accessible in an emergency and not locked away.

  • Keep emergency medicines in an accessible container clearly marked 'for emergency use'.
  • Containers should be tamper evident.

Resuscitation training

Resuscitation Council UK recommends staff in primary care, including non-clinical staff, should receive regular training in adult and child resuscitation appropriate to their role.

Training should enable staff to:

  • recognise cardiorespiratory arrest
  • call for help
  • start cardiopulmonary resuscitation (CPR) with defibrillation as appropriate
  • receive annual training updates that include assessment.

Practices must keep evidence of approved and completed resuscitation training. There is no specific requirement for a particular type of training, and each practice can tailor it to local needs.

There are good examples of ‘in-situ’ simulation training where staff can practice in their premises. This training tests the physical environment for delivering resuscitation and highlights human factors. There is evidence that this training has:

National Early Warning Score

National Early Warning Score (NEWS) is an objective assessment that:

  • complements clinical judgement
  • helps communication with ambulance and acute services, where it is widely used and understood
  • is endorsed by the National Quality Board as a standardised system for assessing the severity of acute illness in adults
  • provides a ‘common language’, so it helps communication between clinicians.

Royal College of Physicians NEWS can be used in primary care.

NHS England promotes the benefits of using NEWS.

The Circuit

The Circuit is a national defibrillator network. It provides the NHS ambulance services the ability to identify the location of the nearest registered defibrillator when you call 999 in response to an out-of-hospital cardiac arrest.

This enables bystanders quick access to the nearest defibrillators (which can be found at CQC registered premises) during those crucial moments after a cardiac arrest to help save lives.

Healthcare providers, regulated by CQC, may opt to join this scheme, and we recommend that Healthcare providers consider registering their device on The Circuit.

Should providers opt to join this scheme, we expect them to:

  • appropriately risk assess the decision
  • ensure measures are in place to respond to the use of a defibrillator.

This includes the replacement of any equipment used in an emergency. For example, ensuring the replacement of replacement pads and other consumable items within a reasonable period.

It's also important to make staff aware that bystanders may request the defibrillator and that it can be released to them.

See:

What we look at

We use these regulations when we review if the practice is safe, effective, responsive, caring and well-led.

This guidance relates to:

We consider how practice staff respond to emergencies, and how they recognise and manage patients who are:

  • critically ill
  • at risk of deterioration
  • in cardiac or respiratory arrest.

We expect each GP practice to have a named resuscitation lead to make sure:

  • staff have access to resuscitation advice, training and practice
  • quality standards are maintained
  • equipment is regularly checked.

Further information

GP mythbusters