Writing a column for Metro online, Dr Welch, former co-chair of the Doctors’ Association UK (DAUK), said its staff was the health service’s most-valuable resource.

But she said that after ‘years of disinvestment, poor workforce planning, rock bottom staff wellbeing and plummeting retention – we have a chronic workforce crisis’ as she put the NHS firmly on the election agenda.

Dr Welch was responding to an announcement by Wes Streeting that Labour planned to cut NHS waiting lists by asking staff to deliver  ‘40,000 more appointments a week through evening and weekend clinics’.

Staff pressures

She said: “In March 2024, there were the equivalent of 1,790 fewer fully qualified full-time GPs than there were in September 2015. In secondary care – as of December 2023 – there were 110,781 unfilled posts, which in itself piles the pressure on existing staff who are already doing their level best to stay afloat.

“With 7.54 million people now on waiting lists for treatment (3.23 million who have been waiting more than 18 weeks), and GPs delivering over 1.49 million appointments on average per day: NHS staff are already working to exhaustion.

“They are already doing the work of at least two people, covering unstaffed rotas, missing their weddings and time with their children. But let’s ask them to work more shall we?

“It seems our politicians are oblivious to the current experience of staff on the ground. While tackling waiting lists is a worthy goal – the idealism of these political promises may appeal to some voters, but these sound bites are not grounded in reality.”

Dr Welch, a GP and member of DAUK’s GP committee, reminded politicians that 1.5 million people work in the NHS in England.

Skilled NHS staff

“That is a lot of votes,” she said. “There are also a lot of skilled, knowledgeable professionals who have so much to offer our health service.

“Asking them to simply work harder, rather than recognising how difficult it already is to work within the NHS right now is not going to win an election, or solve this crisis. 

“Invest in the staff – pay them better, improve working conditions, eradicate box-ticking soul-crushing bureaucracy which takes time away from the actual job.”

Read Dr Welch’s column in full.

Dr Welch will be taking part in a briefing for prospective MPs on Wednesday 19 June to discuss the crisis in general practice and things that could be done to tackle it.

DAUK election briefing

The briefing, Why Can’t I See My GP? The Great British Paradox, is based on her book Why Can’t I See My GP?, a copy of which we sent to all 650 MPs in March.

Dr Welch will be joined in the briefing by colleagues from DAUK’s GP committee, including its chair Dr Lizzie Toberty, and members Dr Steve Taylor and Dr Sarah Jacques.

DAUK is asking people to invite the candidates standing in their constituency to attend the briefinf. Find out the candidates in your constituency at https://whocanivotefor.co.uk/

This election is vital to the future of the NHS.

Find out more about the briefing.

Become a DAUK member and support our work.

We invite all MPs and MP candidates to join the Doctors’ Association UK (DAUK) on Wednesday 19 June (10am to 11am) for an online briefing:

Why Can’t I See My GP? The Great British Paradox

Listen to four NHS GPs share their thoughts on the problems, the solutions, and just why general practice is worth saving.

Based on the book Why Can’t I See My GP?, a copy of which we sent to all 650 MPs in March, we ask our leaders to join us ahead of the general election to ensure GP teams are at the heart of their manifestos.

We need YOUR help.

An MP is much more likely to attend if a constituent asks them to, so we’re asking you to take two minutes to click the buttons below to tweet and email your MP to ask them to attend. Thank you!

More than 2,800 doctors have signed a letter to the General Medical Council (GMC) over fears the proposed regulation of physician associates (PAs) will undermine healthcare standards and put patients’ safety at risk.

Published today (Tuesday 31 October), the letter from the Doctors’ Association UK (DAUK) urged the GMC to reconsider the plans, describing them as “unsafe, premature, and lacking the necessary safeguards”.

DAUK said the GMC needed to address “the inconsistency between the stringent requirements” for doctors to be regulated and the proposed transition for PAs and anaesthesia associates (AAs), which will see them “moved to a statutory GMC register without undergoing equally rigorous checks”.

In their open letter, DAUK co-chairs Dr Matt Kneale and Ms Helen Fernandes said proposals to assign PAs and AAs with a registration number similar to those used for medical doctors risked creating “unnecessary confusion” and “muddling the distinct roles of various healthcare professionals”.

“This ambiguity could inadvertently foster scope creep, putting patients at risk due to uncertainty about practitioners’ qualifications,” they said.

“Furthermore, the absence of a clearly defined scope of practice for PAs and AAs, set by the GMC, is alarming.

“Allowing local settings to establish these boundaries could lead to further confusion and possible exploitation of both doctors and PAs, as well as compromise patient safety.”

Commenting on the letter, Dr Kneale said: “The urgency and seriousness of this situation can’t be understated.“

“The rapid move to incorporate PAs and AAs into the GMC’s regulatory oversight not only jeopardises public safety but also undermines their trust in the system.“

“The resounding support of 2,870 healthcare professionals speaks volumes about the pervasive concern within the medical profession.”

“We need a complete reexamination of a flawed system that has lost the confidence of many.”

The DAUK has set out four recommendations in its letter:

• The GMC should immediately inform the Government about the growing discontent and advocate for reopening the consultation process with the Department of Health and Social Care
• If the regulation of PAs by the GMC goes ahead, distinct GMC numbers should be allocated to PAs to distinguish them from medical doctors
• All PAs transferring from the voluntary Royal College of Physicians register to the GMC’s statutory register must undergo thorough verification and checks, especially with regard to Fitness to Practise procedures
• The GMC must establish a clearly defined scope of practice for PAs and AAs, eliminating the option for these to be set locally.

Dr Kneale added: “We urge the GMC to immediately address these critical issues, maintain the high healthcare standards the public rightly demands, and request that the Department of Health and Social Care put the brakes on the issue and reopen the consultation on physician associates and anaesthesia associates regulation.”

Read the DAUK letter in full.

————————

Notes to editors

The Doctors’ Association UK (DAUK) is the voice of frontline doctors. It’s a non-profit professional association run by volunteer NHS doctors which advocates for the medical profession and the wider NHS.

Contact:

For more information and interview requests, please contact Andy Mann on 07399 164557 or email press@dauk.org

The petition urges an independent regulator to be formed to hold NHS managers accountable for decisions affecting patient safety. Most managers are dedicated professionals, but some are not held responsible when their decisions negatively impact care. The petition highlights the recent Lucy Letby case, where multiple consultants raised concerns early but subsequently had their concerns dismissed without merit.

It has received the backing of one of the consultants at the centre of the Letby case at The Countess of Chester, Dr Ravi Jayaram who said:

“A corporate manslaughter charge against the Countess of Chester as an organisation might result in a large fine but this ultimately punishes the patients cared for there, whilst the individuals whose actions facilitated this situation face no sanctions and can continue to work on highly paid NHS executive posts.”

“There needs to be a system in place so that top-level NHS managers are subject to scrutiny through an independent professional regulatory body just as frontline healthcare professionals are regulated”.

Dr Matt Kneale, DAUK Co-Chair, said:

“We believe new accountability through regulation will improve NHS patient safety. Doctors and other healthcare professionals already answer to regulators if care quality drops — why do we not hold managers to the same standards when they control resources affecting care?”

The petition aims for regulation letting patients and families refer complaints about managers.

Dr. Matt Kneale went further saying:

“Managers must make difficult decisions on whistleblowing concerns, but shouldn’t escape responsibility for unsafe practices or outright neglect of concerns. Regulation would help to ensure transparency and accountability for those with such responsibility.”

DAUK believes that managerial regulation could improve care across the NHS and other healthcare providers.

The Doctors Association UK advocates for frontline doctors. It has launched a petition to create new laws regulating healthcare managers via an independent body. DAUK believes this will make managers more accountable for patient safety impacts from their decisions.

View and sign our petition here: https://petition.parliament.uk/petitions/642631

ENDS

Contact:

Lucy Stratton, DAUK

press@dauk.org

The chronic underfunding and understaffing of the NHS over the past decade has left it struggling to keep pace with demand even before the COVID-19 crisis hit. The Government’s plan to redirect patients to the independent sector is little more than a deflection from addressing the fundamental issues plaguing our health services.

We see some merit in collaborations between the NHS and the independent sector, but without robust regulation, these alliances risk becoming a breeding ground for mediocrity in education and training, and can jeopardise patient safety. Further, it establishes a precedent for privatisation of the NHS via the backdoor.

In a statement, Dr Matt Kneale, Co-chair of the DAUK, expressed his frustrations:

“This abdication of responsibility by the Government towards the NHS is troubling. We urge the Government to confront the core issues contributing to the elective backlog, through sustainable investments in the NHS workforce, infrastructure, and capacity. The need of the hour is an increased focus on training and retaining more doctors, nurses, and other healthcare professionals, with fair compensation for their dedication and hard work.”

Dr Matt Kneale, Co-chair

It is DAUK’s view that without a comprehensive review and overhaul of the NHS’s long-term workforce plan, outsourcing more care could lead to an economic burden on taxpayers, with a risk of spiralling costs in the future. The Government must stop taking the easy way out and instead equip the NHS with the resources and manpower it urgently needs to reduce waiting times sustainably.

END

For further information or comment, please email press@dauk.org

The Doctors’ Association UK (DAUK) was deeply unsettled to hear about the recent, devastating case of patient mortality that ensued following a missed diagnosis by a Physician Associate (PA). This unfortunate event underscores the critical necessity of clear differentiation in healthcare roles, and paramount awareness on the part of the patient about their treating practitioner’s qualifications. Our condolences go out to Emily Chesterton’s friends and family at this immensely difficult time.

Committed to a just working culture, DAUK focuses on examining the systems within which errors occur in order to enhance patient safety. In recent years, there has been a huge increase in the number of different types of clinicians working across the NHS, but particularly in general practice. General practice is a very demanding specialty, seeing a new undifferentiated problem every 10-15 minutes. Most are benign, but some are life threatening and separating these cases out, using clinical acumen, is a key skill for working in GP.

It is our view that it is not safe for the UK government to utilise any alternative healthcare provider as replacements for fully trained doctors. There is a role for allied professionals within healthcare but not at the expense of medical expertise.

Physicians Associates (PAs), while holding an important place within the NHS infrastructure, do not undergo the extensive, rigorous training nor accumulate the depth of experience that defines a doctor’s professional capacity. It is imprudent and potentially hazardous to use PAs as replacements for doctors in clinical environments. In light of this, we support calls for the title to revert back to “Physician Assistant” and insist on their consistent supervision, either direct or indirect, due to the limitations of their knowledge, time, and expertise for independent practice.

It is our belief that titles such as “Physician Associate” create misleading impressions for patients, potentially conflating the distinct professional roles of PAs and doctors. This could engender patient decisions built on misinformation, adversely affecting their healthcare journey. Similar, yet distinct, arguments can be made for Allied Health Professionals using the term ‘Consultant’.

DAUK proposes that all healthcare providers should be required to have complete transparency regarding their professional titles, qualifications, and experience during consultations. Patients should not only be informed but also encouraged to raise queries about their treatment procedures and the professionals responsible for them.

Further, DAUK urges the government to take necessary steps to reinforce the unequivocal understanding of non-doctor roles amongst patients, and mandate the disclosure of professional titles and qualifications in all consultations. We also advocate for the immediate, stringent regulation of both the medical apprenticeship model and Physician Assistants, ensuring explicit awareness among patients of their treatment by a student doctor or PA.It is our conviction that these measures are indispensable to safeguard patient welfare and ensure the delivery of the highest quality of care.

Dr Matt Kneale, DAUK Co-Chair, said:

“Rooted in our core principle of ‘Learn Not Blame’, we stand firm on the importance of drawing insights from missteps, thereby enhancing patient safety. The case in question resonates with the crucial need for greater public understanding of non-doctor roles, ensuring patients are well-informed about where their treatment is coming from. We hope that this statement helps to illuminate these issues, and foster improvements in patient safety norms.”

DAUK are delighted to see that Dr Jenny Vaughan has been honoured with an OBE in the King’s New year’s honours list. Her work has centred around highlighting the importance of a ‘Just Culture’ within the NHS, in the wake of what happened to Mr David Sellu and Dr Hadiza Bawa-Garba. Between 2013-2016 she led David’s ultimately successful appeal against conviction for gross negligence manslaughter at a time when cases were rising against healthcare workers. She was instrumental, with others, in drawing national and international attention to the injustice of what happened to Dr Hadiza Bawa-Garba and calling for a fairer analysis of the whole system rather than making scapegoats of vulnerable individuals.

More recently she has worked to assist many more healthcare workers who have fallen victim to injustice in the NHS, especially those from Black, Asian and Minority Ethnic  backgrounds, such as Dr Manjula Arora. She has also drawn attention to the plight of international medical graduates working for private locum agencies in unfair conditions. Much of this work has been done as part of the team at the Doctor’s Association UK and is continuing. If you would like to support our work please do consider becoming a member of DAUK https://www.dauk.org/membership/

Dr Vaughan said today:

“I am truly humbled and grateful that our work on ‘Just Culture’ which is so important has been recognised. I accept this award on behalf of my whole team. This includes all of those who supported the journey to overturn what happened to both David and Hadiza and those who have supported our more recent work on seeking basic standards of fairness in the workplace for international medical graduates and anyone under unfair sanction. Our ‘Learn Not Blame’ campaign calls for renewal of the core values in the NHS that promote learning from adverse events and prioritise fairness, openness and the wellbeing of both patients and health care professionals.  It seeks to empower everyone working in healthcare to do what they can within their own sphere of influence to ensure a better NHS to work in and one that is also better for patients. Everybody recognises that a just culture is what we should be achieving in the NHS.”

Dr Jenny Vaughan

Exclusive The media regulator has ruled that Mail Online did not breach journalist code by publishing an article claiming that GPs have ‘fuelled’ a crisis in England’s A&E departments.

In June, the Doctors’ Association UK (DAUK) raised a formal letter of complaint to the Independent Press Standards Organisation (IPSO) about the ‘misleading’ anti-GP coverage,which garnered 2,395 signatures. 

It said that Mail Online’s story breached the ‘accuracy’ clause of the Editors’ Code of Practice (Clause 1).

But following an assessment of the complaint, IPSO today concluded that it ‘does not raise a possible breach of the Editors’ Code’.

Our initial letter, IPSO’s response and our appeal can be viewed here

Read the Pulse coverage here and here

The four founders of the campaign: Top Left: Penny, Top Right: Trisha, Bottom Left: Michaela, Bottom Right: Eilidh.

The #LiveableNHSBursary campaign was created by Eilidh to help raise awareness about the substantial drop in funding medical students face in their fifth and sixth years and the drastic effect it is having on students across the country. Penny described how the cut comes at perhaps the most crucial part of their course: “As you’re going into your final year, your most difficult year, you’re essentially taking a £5,000 pay cut.”

Currently, medical students are provided with full funding for their first four years of study, once they move into fifth and sixth year the funding plummets by half, from around £10,000 to just under £5,000. This is due to Student Finance England only fully funding students for four years of study.

Once medical students progress to fifth and sixth year they transfer onto the NHS Bursary system, but, unlike most other healthcare students, they are not entitled to the same level of funding. Medical students are only allowed to take a maximum “top up” student maintenance loan of £1,975 per year, roughly £8,000 less than the standard for all other students. 

Medical students do, however, receive a means-tested NHS bursary which can vary from anywhere between £2,207 to £3,191 with an additional non-means-tested £1000 grant. But other healthcare students, such as nursing students, receive a £5,000 non-means-tested NHS bursary for each academic year. This NHS bursary has proved invaluable for some and has supported them whilst they pursue their careers in healthcare. 

When asked about the financial support available for medical students, a University of Manchester spokesperson said: “The University has invested in one of the most generous support packages in the UK for students in financial hardship; approximately a third of all our undergraduate UK students will receive bursaries of up to £2,000 per year. This includes the University’s Living Cost Support Fund and more information is available here and here. The Royal Medical Benevolent Fund also offers specific support to medical students.

The #LiveableNHSBursary campaign aims to achieve: parity between medical students and other healthcare courses, have the means test removed, and give all medical students full access to the NHS learning support fund.

Medical students are also expected to complete unpaid clinical placements alongside their studies which often leads to students struggling to juggle their responsibilities. Penny explained the lengths some students are going to in an attempt to pay their bills: “You’re on placement five times a week on 9 til 5 shifts, going home and studying for three or four hours or going straight to work. Some students work night shifts and double weekend shifts just to make ends meet.”  

On the subject of clinical placements, a University of Manchester spokesperson said: “All clinical placements form part of a medical student’s studies; it is an essential part of learning to be a doctor and preparing to practise medicine safely. As students become more senior, they take on more tasks, safely supervised, within the clinical teams they are on placement with – this is so they are ready to start working as a doctor when they graduate.”

Penny told us the goal of the movement on Twitter “ … is about encouraging people to share their stories of living on such a small amount in their final year.” The hashtag has already garnered considerable interest on Twitter with several students’ stories going viral. She said, “we’ve already seen stories of people working two jobs, people not being able to pay their rent and people struggling to plan their jobs/lives around placement rotas.”

A post shared on Twitter by a medical student confirmed the struggles faced by many students “I currently have two jobs to help fund Uni. This is on top of balancing placement time, academic opportunities and socialising/relaxing. I feel like I have no time to destress and my mental and physical health has suffered as a result. #LiveableNHSbursary”. 

A total of 791 final year medical students were placed on the reserve list for the UK Foundation Programme (UKFPO) last week, after not being allocated a placement for FY1.1 This is the largest reserve list to date and an increase of 300 from last year, despite official figures showing that the NHS in England is short of almost 8,200 doctors.2 It costs £230 000 to train a single medical student.3 So why, in the context of an understaffed NHS with worsening rates of workforce attrition due to the covid-19 pandemic, can we still not provide timely job security to all final year medical students?

Ten years ago, the General Medical Council (GMC) stated that: “students who enter medical school have a legitimate expectation that if they pass their examinations and graduate, they should have the opportunity to qualify as a doctor.” For the hundreds of students on the reserve list, this is not the case, and they have been left waiting for posts to become available. In previous years everyone on the reserve list was eventually offered a place, but faced uncertainty while they waited to find out.

The Doctors’ Association UK (DAUK), a grassroots advocacy group for doctors and medical students, received numerous accounts from final year students expressing their distress and frustration at being placed on the reserve list last year. Listening to these testimonies, revealed that students who applied for special circumstances, due to ill health, caring responsibilities, or financial constraints, appear to be disadvantaged. Even if a post becomes available for them, if it is not within the geographical area they selected, they face the predicament of choosing medicine over their personal circumstances, and are left unsure of where they will be living and working.

The UKFPO says it expects all applicants will be allocated a post this year “as in previous years” but these promises fail to address the existing flaws in the system, and risk compounding the mental health crisis facing junior doctors.

One final year student with carer responsibilities told DAUK that their special circumstances were not considered because the application form stated they were the “main carer” instead of the “primary carer.” A subsequent appeal was rejected. The DAUK has heard from other students with family responsibilities, which make it impossible to move away from home, who have said that they feel overwhelmed with the uncertainty.

For students who do not get allocated a foundation job and have to take time out of training, the financial strain is untenable for many. The average medical graduate has £70 000 of student debts and cannot afford a year out of training with no steady income. There are many existing barriers for students from financially strained backgrounds to complete medical school.4 Lack of an appropriate post is an obstacle to postgraduate training and does not recognise the challenges that medical students face trying to combine their responsibilities as carers alongside their medical training.

For final year students, who have worked tirelessly for half a decade, being placed on the reserve list is hugely undermining and anxiety provoking.

Unless action is taken, the UKFPO will remain oversubscribed and students who require special circumstances will continue to be disadvantaged if we do not address current flaws in the system.

As the NHS recovers from the covid-19 pandemic, there is no better time for change. The current recruitment issues need to be addressed swiftly, to optimise the local workforce and for fair treatment of candidates.

Footnotes

• Competing interests: EW and FR none declared. AB was a reserve list candidate last year.