The A&E doctor 
8am I arrive for my sixth 12-hour shift in the emergency department this week — and I have already worked 54 hours. Today is a bank holiday, but there is no holiday for us. In fact, on a bank holiday I will be the lowest paid member of staff in the hospital. This isn’t overtime or a busy week, it is standard for a junior doctor.

As I walk through the door the consultant asks me to attend the resuscitation bays — there is a cardiac arrest en route and we have six minutes to prepare. Doctors and nurses gather equipment for what could be anywhere from a few minutes’ to a few hours’ work.

Paramedics enter and hand over. Tragically the 52-year-old father of two has been in arrest for more than an hour. It takes just a few minutes to confirm his passing. The consultant takes me to speak with the family and the corridor is filled with agonised screams.

There is no time to recuperate and let the trauma settle. There are already 79 patients in the department — well over capacity — with some waiting eight hours overnight. Our 12 monitored cubicles are full and the corridors are packed beyond capacity. There are seven or eight ambulances waiting, with some crews there for hours.

By the time my shift ends, I have seen close to 10 patients, on average one an hour. In that time, as a team, we have seen more than 10 times that but there are now 80 patients in the department.

The pace is relentless; the strain upon doctors never greater. Not only are traumatic experiences ever present, but they are now accompanied a fear of mistakes and constant agonising over decisions made under pressure.

On days like these I wonder whether the hard work is worth it. I am underpaid, and working endless nights and weekends takes its toll on relationships. Missed weddings, missed first steps of my 14-month-old daughter. 

Read the full article in The Times

listen to Matt speak to Times Radio here

Nothing happens quickly within the NHS, but it seemed last week that the longest of the health service’s many queues was of patients lining up to complain about their GPs. “It’s impossible to get through to my doctor’s surgery by phone,” says David Wishingsky, a 60-year-old care-home chef from Hastings who is worried about side-effects from his antidepressants.

Megan McGinty, a 19-year-old Glasgow student, developed “horrible” abdominal pain a week ago. “The earliest appointment I could get was October 18,” she said. “It just seemed to me they weren’t even listening to my symptoms or how I felt, just put me on the back burner and told me to wait.”

There are so many stories like this, and so many patients desperate for medical treatment; it is clear that something has broken down in the relationship between Britons and their doctors.

“I understand the system is under immense pressure at the moment, so I don’t like to blame the NHS per se,” says Rhys Harding, 25, who works in digital marketing in Gloucester and has to wait until October 15 for his next chance to talk to his doctor. “But it has been a struggle to see a GP for many years now, and it seems like it’s getting worse.”

Doctors in turn have been horrified to find themselves portrayed as surly fat-cats, raking in six-figure salaries for a reduced working week while steering a wide berth around their patients.

“I hugely resent the idea that I am lazy, workshy and doing my best to wriggle out of seeing patients when, in reality, I’ve never worked harder,” says Dr Elizabeth Croton, a Birmingham-based GP and committee member at the Doctors’ Association UK. Nor can the crisis be wholly blamed on the after-effects of Covid-19.

“The NHS is at a watershed moment,” claims Dr Simon Hodes, 49, who has worked as a GP in the same Watford practice for 20 years. “GP teams cannot be everything to everyone and our resources are finite. There is clearly a mismatch between supply and demand.”

The number of patients per practice is now 24 per cent higher than in 2015. In these circumstances, it is not surprising appointments are hard to come by. “Of course I can understand people’s frustrations about remote consultations,” Croton says. “I struggle daily with a hollow feeling of not having the resources to do my job properly.”

The roots of the current GP crisis stretch back almost 20 years to the 2004 decision by John Reid, the Labour health secretary, to allow GPs to opt out of 24-hour responsibility for their patients.

Read the full piece here

Senior doctors and nurses have condemned abuse directed at healthcare workers after the head of the Royal College of Midwives received death threats for encouraging pregnant women to have the Covid vaccine.

Health organisations that represent hundreds of thousands of NHS staff are speaking out against a “sinister tide” of abuse and aggression they say has grown in the past few months.

In a letter published in The Times today, the group, which includes the Academy of Medical Royal Colleges, the NHS Confederation, the Royal College of Midwives and Unison, hit back at a “small, aggressive minority”.

“As health and care professionals, we have been moved by the support given to us by the public throughout the pandemic. However, a small but sinister tide has been rising of people who, at best, seek to undermine the important public health advice we give, and, at worst, incite abuse and violence against us,” they write.

This week Gill Walton, chief executive of the Royal College of Midwives, was subjected to death threats and abusive messages likening her to the child killer Myra Hindley. She had made a public call for pregnant women to come forward for vaccination.

Ruth May, the NHS chief nursing officer for England, said the abuse was unacceptable while Dr Ellen Welch, of the Doctors’ Association UK, said it had become endemic.

She added: “As a GP, the false stories about primary care being closed all year have become fact for many, and I start a shift almost expecting a confrontation. Staff have been physically and verbally assaulted and one surgery was even subject to an arson attack. This needs to stop.”

Read the full story in The Times here

We have sent the attached letter to the heads of NHS England, the Health Secretary and Chair of Healthwatch England requesting a review into why access to primary care is problematic, when as frontline GPs, we are consulting more patients than ever.

DAUK are happy to collaborate to share the views of our members on this issue and work together to find a solution that benefits both patients and the health service as a whole.

Dear Colleagues

CC. Sir Robert Francis QC, Rt Hon Matt Hancock, Sir Simon Stevens, Dr Nikita Kanani, 

We were very concerned to read the recent report in The Times, which states that patients are increasingly having a negative experience in terms of accessing their GP, leading to increased attendances to Emergency Departments. 

This report from HealthWatch confirms 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.

General practice is currently carrying out 7 million appointments per week, while delivering 75% of all Covid vaccinations and the largest ever flu-vaccination programme to date. Compared to pre-pandemic, primary care is offering a million more appointments per week. 

If primary care is having contact with 10% of the population each week and this is still not meeting demand there must be an urgent review to find out why. 

The introduction of e-consults has made us more accessible than ever, and has opened the gates to a lot of trivia, which still uses GP time and resources, sometimes inappropriately.

GPs are working flat out, and it is incredibly demoralising to find that our best is not enough. It is clearly not acceptable for huge proportions of patients to attend ED, when GP would be more appropriate. However, Practices are working at and beyond full capacity which has led to unprecedented levels of burnout, sick leave and tiredness amongst GPs. 

General Practice has been consistently underfunded over the last 10 years. Currently 90% of NHS contacts happen within primary care for less than 10% of the total budget. We desperately need a huge funding increase to aid much needed innovation, improvements in IT and infrastructure, and to increase staffing levels. 

We urgently call today for a reduction in bureaucracy, a focus on GP burnout and staff retention, and most importantly an analysis into why patients are struggling to access care so we can work towards finding a solution that involves the whole health service working together.

We would welcome a collaboration on this issue and would be happy to meet to discuss the views of our members to find a way forward together.

We look forward to your response

Dr Elizabeth Toberty

Dr Ellen Welch

On behalf of The GP Committee

Doctors’ Association UK

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

The pandemic has demonstrated how vital the contribution of international staff is for the NHS. 1 in 7 healthcare workers is from overseas. They have carried out their jobs in extremely difficult conditions, risking their lives during this crisis despite being on temporary visas. The government made a promise that bereaved families would get permanent residency status if these workers were to die due to COVID-19. Such a bereavement scheme is hurtful for the overseas workers who have fought so bravely. These workers bring highly specialised and sought after experience in addition to contributing to our economy through their taxes, investment in property etc.Currently indefinite leave to remain (ILR) is granted to the families of healthcare workers if they die. This sends a message that these heroic people only deserve recognition in the event of their dying in service, which is simply not in keeping the British Values of Fairness. These heroes deserve the right to call the UK their home and should not have to die to have this recognised. The French have granted citizenship to key workers – the UK cannot be seen to lag behind! On 5th March 2021 we are set to celebrate NHS Overseas Workers to recognise the efforts of ALL our international staff –  which is not limited to doctors and nurses but includes huge numbers of vital clinical, laboratory, clerical and estates staff. We invite Sunday Times readers to join us in acknowledging this extraordinary group of people.

Dr Pushpo Hossain, Doctors’ Association UK

As featured in The Sunday Times

Find out more about Overseas NHS Workers Day and how you can get involved 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 Doctors’ Association UK said no studies had been done to prove a single dose of a vaccine, or two spaced very far apart, would reliably prevent cases of Covid.

It comes as Matt Hancock today boasted Britain has given more than 5million doses to 4.6million people across the UK – around one in every 14 people. 

Around 2million vaccines were dished out last week — and one in ten inoculated Brits have received their second dose.

The Joint Committee on Vaccination and Immunisation (JCVI), which sets the ground-rules for the vaccine programme, has said the country should get first doses of the jabs to as many people as possible.

Although a single dose of the two-dose vaccine regimes will not offer as much protection, it may still prevent many people from getting Covid-19.

The JCVI claims that one dose of Pfizer’s vaccine could prevent as many as 89 per cent of illnesses.

But new data emerging in Israel suggest this initial dose’s protection could be as low as 33 per cent, meaning two thirds of people given the single vaccine dose could still catch Covid if they were exposed to the virus. 

This has not yet been verified in a publicly available scientific study, but raises concerns about Britain’s strategy.

When the UK made the decision to split the doses with a wider gap than Pfizer had intended, both the company and the World Health Organization refused to endorse the policy because they said there was no proof the jab would still work.

Doctors’ Association UK has warned the move risks patients’ health and there is no reliable science to prove the vaccines work when given in this way.

The organisation gave its warnings in a letter address to health bosses including Matt Hancock, Professor Chris Whitty, vaccines minister Nadhim Zahawi, and Sir Simon Stevens, chief executive of the NHS, The Times reports.

It said: ‘We must be clear that it is completely unacceptable to ignore the need for a second vaccination. 

‘All studies confirm the need for this to provide reliable and lasting immunity. 

‘It must be noted that there is currently no data around the reliability of the immune response if vaccines are interchanged.’

They added: ‘We understand the rationale for the delay in scheduling the Pfizer-BioNTech second dosing from three to 12 weeks. 

‘The concerns arise from decisions being made without acknowledging the consequences of enacting them on the front line.

‘We are concerned that there are no clear plans to follow up and monitor the immunity of these patients, to ensure the 12-week booster will be adequate, given that this schedule goes against the advice of both the manufacturer and WHO.’

Read the full article here: https://www.dailymail.co.uk/news/article-9168549/Coronavirus-UK-NHS-hospitals-banned-Covid-vaccines-second-doses.html?fbclid=IwAR3v1d8H8_D4iWHquTUv1wUojY511ePU3ufc-sDKeOrKdHEWvOJMPxfb3iY

Doctors have written to ministers expressing severe concerns about the coronavirus vaccine schedule, warning that patients are at risk if they do not receive a timely second dose.

In a letter sent to the health secretary, the minister in charge of vaccines and the head of the NHS, doctors criticised the lack of guidance around the decision to change the period between doses of the Pfizer-Biontech vaccine from three weeks to 12 weeks.

Heads of the Doctors’ Association UK (DAUK), which represents frontline medics, have demanded immediate explanations of what steps are being taken to keep track of patients who have had the first dose because of fears that the follow-up could be missed.

“We must be clear that it is completely unacceptable to ignore the need for a second vaccination,” they said. “All studies confirm the need for this to provide reliable and lasting immunity. It must be noted that there is currently no data around the reliability of the immune response if vaccines are interchanged.”

The letter was sent on Monday to Matt Hancock, Nadhim Zahawi, Sir Simon Stevens, Chris Whitty, the chief medical officer for England, and other figures responsible for the UK’s mass vaccination programme. DAUK has not yet received a reply.

“We understand the rationale for the delay in scheduling the Pfizer-Biontech second dosing from three to 12 weeks. The concerns arise from decisions being made without acknowledging the consequences of enacting them on the front line,” the doctors wrote.

“We are concerned that there are no clear plans to follow up and monitor the immunity of these patients, to ensure the 12-week booster will be adequate, given that this schedule goes against the advice of both the manufacturer and WHO.”

They called for a government guarantee that all patients will be given their second immunisations by 12 weeks “at the absolute latest” with the same brand of vaccine they initially received.

Both the Pfizer and Oxford vaccines require two jabs, which the manufacturers say should be had three or four weeks apart. Britain has increased the gap to up to 12 weeks to ensure that more vulnerable people get at least some protection over the winter, despite warnings from the companies that there is little data to justify the change.

Ministers followed guidance from the Joint Committee on Vaccination and Immunisation that the Pfizer vaccine is 89 per cent effective after one dose, from a study of people who received their second dose within three to four weeks. Analysis from Israel suggests that the effectiveness of a single dose may be as low as 33 per cent.

Doubt was cast on whether everyone would be given a second dose when Dominic Raab, the foreign secretary, refused this week to guarantee that all people who had received a first dose would get a second within 12 weeks. He instead said the government was “aiming for” everyone to get a second jab.

Read the full article here: https://www.thetimes.co.uk/article/delaying-second-covid-vaccine-dose-puts-patients-at-risk-insist-doctors-m53jjg7bx

In a letter to the health secretary, the groups say that there is no legal protection for doctors faced with “surges in demand for resources that temporarily exceed supply”.

Doctors fear that they could face prosecution for unlawful killing because of decisions they are forced to make in such a situation, they add.

In November Boris Johnson gave warning that should the NHS be overwhelmed “the sick would be turned away because there was no room in our hospitals”, with doctors and nurses potentially “forced to choose which patients to treat, who would live and who would die”.

This month the chief medical officers said that the NHS was at high risk of being overwhelmed within weeks.

The Medical Protection Society co-ordinated the letter, which has been signed by the Doctors’ Association UK, British Association of Physicians of Indian Origin, British Medical Association, Hospital Consultants and Specialists Association, Royal College of Surgeons of Edinburgh and Medical Defence Shield.

They say that although doctors had a range of guidance to follow when administering and withdrawing treatment “this guidance neither provides nor claims to provide legal protection”.

They add: “It also does not consider Covid-19 specific factors such as if and when there are surges in demand for resources that temporarily exceed supply. There is no national guidance, backed up by a clear statement of law, on how clinicians should proceed in such a difficult situation.

“The first concern of a doctor is their patients and providing the highest standard of care at all times. We do not believe it is right that they or other healthcare professionals should suffer from the moral injury and long-term psychological damage that could result from having to make decisions on how limited resources are allocated, while at the same time feel vulnerable to the risk of prosecution for unlawful killing.”

A survey this week of 2,400 doctors found that 61 per cent were concerned about facing an investigation as a result of a clinical decision made under pressure, with 36 per cent concerned about being investigated should they decide “to withdraw or withhold life-prolonging treatment due to capacity and resource constraints”.

The letter says healthcare professionals “should not be above the law” but they should be protected over “decisions made in good faith, in circumstances beyond their control and in compliance with relevant guidance”.

Any emergency law should apply retrospectively from the start of the pandemic, they add.

Read the rest of the article here.