General practices, out of hours centres, and walk-in centres are unlikely to see imported cases of Ebola from Africa, but it is not impossible that individuals infected in DRC could arrive in the UK while incubating the disease and develop symptoms once here. While a fever in someone arriving from the affected countries is more likely to be malaria or typhoid fever, staff are advised to remain vigilant.

A patient who telephones—Anyone who has visited an affected country in the past 21 days and reports a fever of more than 38ºC within the past 24 hours should not visit health premises. Instead a clinician should refer the patient to the local acute hospital.

A patient visits any primary care service—Signs should be clearly displayed to encourage patients to tell receptionists on arrival if they are unwell and have travelled from an Ebola-affected country within the past 21 days. Any patients suspected of having Ebola should not sit in the general waiting area and should be isolated in a side room (cleared of removable items to reduce decontamination requirements if Ebola is confirmed).

Hand hygiene is an important infection control measure; the Ebola virus is not a robust virus, and is readily inactivated, for example, by soap and water or by alcohol. It is important to remember that transmission of Ebola from person to person is only through direct contact with the blood or body fluids of a symptomatic infected person. There is no evidence of Ebola transmission through intact skin or through small droplet spread, such as coughing or sneezing.

Primary care services should record the name and contact details for their local infection specialist is (details available from their local health protection team) and if a suspected case presents, contact the specialist who will lead the risk assessment and arrange clinical review. Patients should be sent to hospital in an ambulance, and paramedics should be warned of the possibility that the patient is infected with Ebola virus. GPs also need to alert the hospital that Ebola is suspected.

All waste, including cleaning equipment such as gloves, paper towels and mops, should be put into plastic waste bags and stored in a safe place, where they will not be touched, until the case has been assessed. The local health protection team will also advise on decontamination procedures. It may be necessary to quarantine the room for up to 24 hours while Ebola is confirmed or excluded. No one should use the room or touch any potentially contaminated areas, including toilets and door handles, until they are decontaminated. Public areas where a patient has just passed through do not need to be specially cleaned.

If Ebola is confirmed by laboratory testing, the local health protection team will review any contacts at the primary care service.

If a patient has symptoms limited to fever with no vomiting or diarrhoea, high contact surfaces like touch screens and door handles should be wiped using standard disinfectants or household bleach but the surgery does not need to be closed. The room in which the patient has been assessed and the toilets, if they have been used by the patient, should not be used pending diagnosis. The clinician may continue to consult in a different room but should ensure they have washed their hands thoroughly with soap and water. If the patient has symptoms such as vomiting, diarrhoea or bleeding the surgery should be closed pending a risk assessment by the infection specialist. Patients and staff should leave the surgery but a record should be kept of people present during the time that the patient was on the premises.