In their letter to ministers and shadow ministers, DAUK’s GP Leads Dr Lizzie Toberty and Dr Steve Taylor said that patient safety was being put at risk by underfunding and staff shortages.

The letter was sent to Health Secretary Victoria Atkins, Primary Care Minister Andrea Leadsom, Shadow Health Secretary Wes Streeting, and Shadow Primary Care Minister Preet Gill.

It called for an increase in core funding for primary care, significant investment in estates and IT, and support for GPs to make “informed local decisions for their communities”.

Their letter said: “The rapid increase in non-doctor staff, the push towards working at scale, and persistent funding cuts have contributed to a rise in missed diagnoses.

“We have prioritised broad access and seeing any available clinician over the well-documented benefits of continuity of care with a GP.

“Continuity of care is known to reduce mortality, reduce the likelihood of hospital admissions, and improve patient satisfaction. If these benefits were replicated by a medication, it would be prescribed universally.

“Yet, the current conditions in primary care are the antithesis of this ideal.”

The letter highlights the fall in funding for primary care from 12% to 8% of the NHS budget.

It said: “The per-patient funding for primary care stands at £164 annually, regardless of visit frequency.

“This amount is comparatively lower than many will spend on phone contracts, festival tickets or pet insurance. Adjusted for inflation, the funding should be closer to £197 per patient.

“The consistent devaluation and defunding of general practice are now manifesting in detrimental outcomes for patients.”

Dr Toberty and Dr Taylor said DAUK stands ready for discussions with the Conservative Government and the Labour Opposition to develop plans “which enable continuity of care at their core”.

Commenting on the letter, Dr Toberty said: “We have a shortage of GPs in the UK and need sustained investment to address that.

“And we need a whole system approach based on continuity of care with a GP – and we need it now to ensure the best levels of service for patients.”

Read the letter in full.

DAUK were disheartened to read the latest SOP from NHS England to ‘support restoration of General Practice Services’.

In March last year, NHS England mandated the move to ‘total triage’ in primary care to limit the spread of Covid-19, protecting both patients and staff. GP Teams have been working harder than ever behind the scenes offering digital solutions to patients alongside face-to-face appointments when needed. The latest figures from NHS digital showed practices are delivering 3 million more appointments per month than pre-pandemic in March 2019.

DAUK Spokesperson Dr Ellen Welch said: “As GP’s, we assume it is common knowledge that primary care has changed its way of working during the pandemic to ‘remote first’, but this message been distorted, leaving the public confused, and often angry, mistakenly believing that their GP surgery has been closed all year. The wording of this SOP sadly fuels this myth, which has been disseminated by some sections of the media.”

Last month, DAUK wrote to NHS leaders, calling for an urgent review into the current demands on general practice. We have a meeting planned with Healthwatch to discuss these issues and we are waiting on a response from the government.

Dr Lizzie Toberty, GP Spokesperson said: “Primary care is not coping with the current demand and this latest communication from NHSE will only worsen this. We simply do not have enough resources to offer everyone who would like it a face-to-face appointment and surgeries should be able to utilise digital solutions at their discretion, to manage the demands of their own communities.”

DAUK have written again today to NHSE in support of our primary care colleagues:

UNDERFUNDED GPs
Sir, Your report “More patients go to A&E after ‘struggling to see GP’ ” (Apr 17) is a huge concern, confirming that the health of the nation is suffering as general practice is drowning. Our experience as frontline GPs is that demand is going through the roof. Compared with pre-pandemic levels, primary care — GPs and community services, rather than “secondary care” involving hospitals and specialists — is offering a million more appointments per week while carrying out 75 per cent of all Covid-19 vaccinations and the largest ever flu vaccination programme to date. The introduction of online consultations has made us more accessible than ever. However, general practice has been consistently underfunded over the past ten years. At present primary care accounts for 90 per cent of NHS patient contact time, but receives 10 per cent of the budget. GPs are burnt out and working beyond full capacity. Despite this, if we are clearly not meeting the needs of our population there must be an urgent review to find out why, and a national discussion on how we want to fund our health service.
Dr Ellen Welch
Dr Lizzie Toberty
Doctors’ Association UK

Read the letter here

As part of Overseas NHS Workers Day, which celebrates the almost 200 nationalities represented in staff working for the NHS, doctors’ groups have highlighted the importance of the one in six doctors in NHS general practice who qualified outside the UK.

The pandemic has highlighted the dedication of these doctors and the selfless service they give to their patients and primary care, GP leaders said.

The Doctors Association UK (DAUK) – the group responsible for launching Overseas NHS Workers Day – has called for doctors who qualified abroad to be granted indefinite leave to remain in the UK in recognition of their efforts over the past year.

GPs trained overseas represent around 18% of the 35,500-plus GPs in permanent roles in England – a figure that excludes locums and GP trainees. NHS Digital figures for December 2020 show that 6,458 GPs in permanent NHS roles were trained outside the UK – 1,300 in the European Economic Area (EEA) and 5,158 elsewhere in the world.

The number of overseas-qualified GPs practising in the UK fell from 6,949 in from September 2016 to 6,071 in June 2019 before rising to the current level over the past year. GPonline reported last year that the proportion of NHS GPs trained in the EEA had stabilised after a steady decline since the start of the decade – despite uncertainty around Brexit.

GMC figures show that 55% of doctors who joined the NHS workforce between June 2018 and June 2019 qualified outside the UK. DAUK GP advisory group representative Dr Claire Ashley said these doctors had been ‘invaluable’ in allowing NHS primary care to continue to deliver services in very challenging times.

‘NHS Overseas Workers Day is a recognition of the extraordinary contribution that people who have migrated to the UK and played an integral role in the UK’s fight against COVID-19 have made, including GPs.

Dr Claire Ashley

Pandemic efforts

‘But many of our overseas GPs are on temporary visas. Currently, if an overseas healthcare worker dies due to COVID-19, their families are granted indefinite leave to remain. However, if the worker does not die they are not granted that benefit.

‘These GPs face uncertainty about their fate in this country, but despite this they continue to show up on the NHS frontlines every day, often risking their own health to do so. At DAUK we call for the contribution of all overseas workers who have worked in any capacity during the pandemic to be recognised, and to be granted indefinite leave to remain.’

A spokesperson for the British International Doctors Association (BIDA) said an appreciation of the contribution of overseas-qualified general practitioners was ‘essential to our understanding of the history of British healthcare’.

He said: ‘They made it possible for primary care practice to function and survive – forming the cornerstone of the NHS. The pandemic has been another opportunity to recognise their dedication and selfless love for the NHS highlighted by the tremendous contributions they have made.

He recognised the ‘mammoth task’ all GPs have undertaken in delivering vaccines and adapting services during the pandemic, and added: ‘The history of contributions of the overseas-trained GPs in the NHS should be considered a cause of celebration and the Overseas NHS Workers Day today is the first step to recognise their presence.’

GMC chief executive Charlie Massey argued recently that doctors who had rejoined the NHS workforce in the pandemic must be urged to stay to help the UK cope with a drop in overseas recruitment triggered by COVID-19. His comments follow an 85% drop in the assessment of overseas doctors since March – a slowdown during the pandemic that threatens to limit the flow of international doctors into the NHS.

Read the original article here https://www.gponline.com/thousands-overseas-gps-recognised-extraordinary-contribution-nhs/article/1709182

Dr Gregor Smith, Chief Medical Officer for Scotland replied here:

Pregnant women should be included in coronavirus vaccine trials, experts have urged, as those in priority groups wrestle with whether or not to have the jab.

Doctors are considering emerging evidence that pregnant women may face greater risks from Covid-19, although they are not at present a priority group.

Professor Lucy Chappell, spokeswoman for the Royal College of Obstetricians and Gynaecologists (RCOG), said that it was not asking for this status to change but that it would discuss any risk with the Joint Committee on Vaccination and Immunisation.

DAUK’s Dr Ellen Welch said:

This is a very personal decision, for me it was important to have the vaccine in pregnancy
In pregnancy there is very little safety data for any medications&for something this new,there is clearly no long term data.However there is no current evidence of harm. Whereas there is plenty of evidence of the harm covid can do in pregnancy
for me the risks of either ending up on icu while pregnant, or having long covid with 2 small children clearly outweighed the minimal risks of having a new vaccine.
Pregnant women safely have the flu vaccine every year

Find out more- watch the MacDonald Obstetric Medicine Webinar on the topic https://www.obstetricmedic.org.uk/moms-webinar-archive/
Read the RCOG leaflet https://www.rcog.org.uk/globalassets/documents/guidelines/2021-01-12-covid-19-vaccine-info-sheet.pdf

The full article can be accessed here: https://www.thetimes.co.uk/article/pregnant-women-should-be-included-in-covid-19-vaccine-trials-n23ndqjv6

The NHS is facing a chronic shortage of GPs, as new figures show family doctors are quitting at a rate of three a day.

GP surgeries in England lost nearly 300 full-time doctors in the three months before Christmas, according to official NHS stats.

They were over-stretched even before the pandemic – expected to take on more work with no extra time to do it.

And now the extra pressures of Covid-19, including helping to deliver Britain’s world-beating Covid jab rollout, have left many facing burnout.

New doctors can’t be trained quick enough to replace them – with a shortfall of 7,000 GPs expected by 2023.

Professor Martin Marshall, Chair of the Royal College of GPs, said: “GPs and our teams want to provide safe, high-quality care to our patients and we can only do this with an adequate workforce. We desperately need more GPs working in the NHS.”

The figures, revealed in NHS Digital’s latest GP headcount, show the Tory government’s 2015 promise of delivering 5,000 new GPs by 2020 was a sham.

In fact the number rose by just 717 – from 34,429 at the end of September 2015 to 35,146 on December 31 2020.

And when looking at the number of fully-qualified permanent GPs – excluding locums and registrars – the number has actually dropped from 28,631 to 26,754.

Cheshire GP Dr Rosie Shire, a member of the Doctors’ Association UK GP Committee, said: “It isn’t surprising GPs are leaving the profession. My personal experience is that GPs are burning out through increasing pressure, struggling with low morale and looking at alternative careers.

“We are also seeing colleagues dying from Covid-19. Mental Health services that support all doctors are seeing an increase in contacts from doctors struggling to cope.

“We have been advised we can reduce some non-essential work to enable us to support the Covid-19 vaccination programme, but it is hard to find what part of General Practice work is non-essential?

“Smear tests, diabetes reviews, and baby vaccinations still need to happen to ensure we help people stay as well as they can.

“We were maxed out before the pandemic, and now we are struggling.”

She added: “When the pandemic hit the UK GPs had to change the way they operate virtually overnight.

“We are only too aware the limitations of remote consultations via telephone, video and email, and we still need to call patients to the surgery for face to face appointments.

“Remote consultations involve extra risk, so the GP needs to be even more thorough in the consultation to make sure they understand the problem and communicate the suggested treatment plan.

“This often takes longer than the standard 10 minute GP consultation, which was woefully short to begin with.

“All the staff in General Practice are working as hard as they can, and 5,000 extra GPs on the ground in 2020, would have helped ease the pressures created by the worldwide pandemic.

“Along with other frontline workers, we are struggling to get chance to rest and recharge. At the moment it feels like there isn’t any let up.”

Read the article in full here: https://www.mirror.co.uk/news/uk-news/fears-doctors-suffer-burnout-nhs-23498066

Dr Rosie Shire, a member of the Doctors’ Association UK, said studies of the Pfizer/BioNTech vaccine show two doses three weeks apart gave 90% immunity.

“What really concerns us is we don’t know what happens if you don’t give that second dose of vaccination after three weeks,” she told Sky News.

“The fact is that people are being vaccinated now and being put into what is effectively an unregulated unlicensed trial, whereby they’re receiving this vaccination on the understanding that they don’t know what’s going on.”

Dr Rosie Shire

England Health Secretary Matt Hancock defended the Government’s decision to delay the time between vaccine doses, saying that it was “essential” to save more lives, more quickly.

“We do know this policy is going to save lives,” he said, speaking on Sky’s Sophy Ridge On Sunday.

“So long as there is decent efficacy after the first dose, and we have a high degree of confidence that that’s the case, then in a situation where there is a limited supply… you want to get as many people to have as much protection as possible as quickly as possible.

Read the full article here: https://www.walesonline.co.uk/news/uk-news/unregulated-unlicensed-trial-gp-concerned-19689415

We were part of a wave one site at a hospital and it was hard work setting everything up. Once it got going it has been brilliant. Everyone who works there loves being there, because it’s so positive.

We don’t really have a typical day as it varies on how much vaccine we are given. We can’t order, we just get told: ‘You’re having this.’ So some weeks we’ll get two to three deliveries, other weeks it will be just one with one box of each of the Oxford/AstraZeneca and Pfizer vaccines.

Often you don’t know what’s coming until the week before. There have also been problems with syringes not being sent. We call people when we know what deliveries we are getting, and we’re also doing some drive-through clinics now for people who are housebound, but they can get into a car. They’re driven here and we’ll go to them in the car to give them the vaccine.

‘A real push’

Within our PCN [Primary Care Network] we’ve got quite an elderly population, so we’re ok at the moment in terms of schedule and are on groups 3 and 4 now – the over 75s and over 70s. We had a real push to get the care homes done and those were finished last week as they’re the most vulnerable.

People want to come in and are really pleased to be there. A lot of them will be saying it’s only the second time they’ve been out since March – and the first time would have been for their flu vaccination in autumn. They’re really grateful and say ‘I can’t thank you enough’.

It’s such a nice place to work because often in this job we have to tell people things we can’t do, such as having to cancel an operation, so to be able to tell people they can come in for their vaccine now has been a massive morale booster for staff.

‘Still frightened’

People are still really frightened though. It will be interesting to see what effect people having the vaccine will have on whether they feel like they can come to see their GP or go to the hospital for non-Covid related issues because so many people stayed away during the first wave.

As long we get given the vaccine we’re happy to work. We’ll be working on Saturday and will work the following weekend as well if we can, because it just gets it done. We want to get people vaccinated so they feel safer. We’re feeling incredibly positive on the ground, it’s just the bits we can’t control that are difficult.

Read the full article here: https://inews.co.uk/news/health/vaccination-front-line-dont-know-how-much-vaccine-arriving-week-before-838524