In response to Health Secretary Matt Hancock’s statement regarding his unlawful management of PPE during the pandemic: ‘I won’t apologise because to apologise would imply that I’d do something differently’ DAUK’s Dr Katie Sanderson spoke out:

This is a pandemic not an election

How are we going to learn from this if we can’t be honest about what happened? It’s grossly offensive to the families of healthcare workers who got COVID and died, and I think it should be retracted immediately. 

Can you imagine what it feels like if you are the son or daughter of a doctor who died after getting COVID at work to hear that?

Dr Katie Sanderson – LBC Radio

38% of doctors who should have had FFP3 masks were saying they didn’t have them
47% saying they did not have access to long sleeved gowns 
>20% didn’t have eye protection
>60% had not been fit tested, so even if they had an FFP3 mask, it may not be protecting them because it may not have fitted 

Matt Hancock has been criticised for a “disgustingly disrespectful” claim that there was never a national shortage of personal protective equipment during the pandemic.

Doctors and MPs condemned the UK health secretary as “deeply insulting” on Tuesday after he insisted that his team had delivered protective equipment for frontline NHS staff in the “teeth of a pandemic”.

Doctors groups said they had helped deliver 45,000 masks to hospitals that lacked adequate supply at the start of the crisis and that the families of healthcare workers who lost their lives to Covid had raised concerns about the protection they received.

Amid the first wave of coronavirus, NHS staff were photographed with poorly fitting PPE, with some having to make gowns themselves from bin bags.

Hancock said that while there were “individual challenges in access to PPE”, they “never had a national shortage, because of my team”.

He was addressing a high court ruling over failings in publishing details of coronavirus-related contracts. He told BBC Radio 4’s Today programme: “This has all been looked into in great detail. It’s only because of the transparency that I support that we can ask questions about these contracts.

“And what’s more, it’s easy to ask these questions, but what is hard is to deliver PPE in the teeth of a pandemic.”

Dolin Bhagawati, from the medical campaign group Doctors’ Association UK (DAUK), said Hancock’s comment that the NHS did not face a national shortage of PPE during the first wave of the pandemic “is disgustingly disrespectful to the memory of frontline colleagues who died from Covid-19 while raising concerns about inadequate PPE”.

He said frontline staff did not imagine having to provide their own makeshift protective equipment, “raising our concerns for weeks only for them to be ignored”.

DAUK delivered 45,000 masks to hospitals that lacked adequate supply. “We are not imagining mourning the colleagues that treated Covid-19 patients with inadequate PPE,” Bhagawati said.

He added: “This callous disregard for the experience of shell-shocked NHS staff in order to save political face is beneath contemptible.”

Read the full article here: https://www.theguardian.com/world/2021/feb/23/hancock-criticised-for-claim-there-was-no-national-covid-ppe-shortage

Health Secretary Matt Hancock has said that, as of Sunday morning, three quarters of all people over 80 in the UK have been vaccinated.

“(This) is absolutely brilliant progress,” he said, speaking to Sky’s Sophy Ridge On Sunday.

“Similar number of care homes, around three quarters and in fact we’ve vaccinated more people in just the last three days than France has in the entire history of this disease.”

Mr Hancock also defended the Government’s decision to delay the second doses of those receiving the Pfizer vaccine.

Mr Hancock said the responsible course of action was to get “as many people protected… as quickly as possible” he said.

Mr Hancock said that case numbers were “incredibly high” and the NHS remained under intense pressure.

“There is early evidence that the lockdown is starting to bring cases down but we are a long, long, long way from being low enough because the case rate was incredibly high,” he told Sky News’s Sophy Ridge on Sunday programme.

“You can see the pressure on the NHS – you can see it every day.”

It came in response to concerns over delaying the Pfizer vaccine by up to 12 weeks.

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.”

“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

Read the full article here: https://www.mirror.co.uk/news/politics/hancock-reveals-75-over-80s-23375171

As frontline GPs working in primary care we, like the rest of the country, are both excited and relieved that a vaccination for COVID-19 is in sight. Over the last week we have received some news regarding what a COVID-19 vaccine program may look like, and some primary care networks (PCNs) and GP surgeries are poised to take on this role and sign up.

Whilst this is brilliant news, the current offering from NHSE in terms of the Direct Enhanced Scheme (DES) falls short of making it feasible for many more GP surgeries and PCNs to deliver, with a huge number being unable to take up the offer. This will have significant implications for us all, and could threaten the success of the vaccine program as a whole. It is imperative that we act now and remedy these issues, in order to give us the best chance of defeating this virus.

Background

We must understand the background and atmosphere in which we are rolling out this programme, in order to identify possible pitfalls and problems. Prior to the pandemic, the Health Foundation reported In March 2020 that workload pressures were growing across general practice. Despite a 2015 target for 5,000 additional GPs by 2020, the number of qualified permanent full-time equivalent GPs in the UK has fallen. There are now 1,700 fewer qualified permanent GPs than in 2015.

Recently, the DAUK ran a survey of almost 900 GPs in which 78% reported the pandemic has had a negative effect on their mental health. Additionally, only 1.8% of respondents felt well-supported by NHSE. Furthermore, the Medical Protection Society (MPS) found 1 in 3 GPs report being subjected to verbal abuse during the pandemic.

All of this is occurring against a background of rising health inequalities, and a stalling life expectancy. Currently, primary care is working at maximum capacity, dealing with issues as a result of the pandemic as well as ongoing routine work. This limited workforce, with a limited capacity, needs to be kept at the centre of any plans to roll out a vaccine whilst recognising the current issues we are facing.

Issues and recommendations

We welcome the introduction of a potential vaccine and believe primary care has an invaluable role to play in its delivery, having seen the innovation with which those working in general practice have managed to roll out this year’s biggest ever, seasonal flu vaccine. It is this expertise we need for the COVID-19 vaccine, but it is imperative that we set primary care up for success in the delivery of this.

Below we list the current limitations of the DES based on the information we have received so far, which means many practices are struggling to agree. We set out what the potential solutions are, which would ensure higher primary care take-up and thus a greater chance of success in our only way out of this pandemic.

Flexibility and further information

Without the full specifications of the program being released it is difficult to ask GPs to commit to delivering the vaccine. We need the full details of the DES to be released to GPs in a timely manner, in order to allow them to make a decision regarding whether or not they are able to take this on. If this is not possible, there must be flexibility to sign up at this preliminary stage, but if it proves difficult to safely deliver the vaccine alongside routine clinical care, there must be the option to step down from this responsibility.

Funding

On the current DES, all payments for the vaccine program will be made retrospectively. This is a huge undertaking and poses a significant financial risk to primary care, who will have to shoulder the financial burden. We cannot ask this of GPs when so much is at stake nationally. We need significant, upfront funding to allow surgeries to purchase equipment needed, pay for temporary staff, and make urgent renovations to their buildings in order to be able to deliver this vaccine safely. Additionally, primary care needs to fully cost this service. There needs to be a higher fee to acknowledge the huge ask and realistic costs of this programme.
Additional further funding is necessary to cover delivery of the vaccine to housebound and nursing home patients, as this will require higher time constraints.

Furthermore, we need clear guarantees that if a patient chooses not to attend for the second vaccine, payment will still be made. The time, logistics and practicalities of delivering this program will otherwise incur high costs that primary care cannot singlehandedly shoulder.

We have seen the significant funds that the government has pumped into other areas including the private sector, for services such as Track and Trace. The funding that has been allocated to this DES is hugely insufficient and significantly lower in comparison.

Working hours and logistics

The DES specifies practices must be open from 08:00 – 20:00, 7 days a week to deliver the vaccine. We believe more flexibility needs to be allowed. Each year, practices deliver successful flu vaccine programmes, dependent on the local needs of their respective communities. Some practices run late evening or Saturday clinics, whereas others provide it in hours; these decisions are influenced by local factors which GPs take into account in order to best serve specific communities. Practices need to have the flexibility to provide a service they feel confident they can provide, for a population they know well.

The information around the vaccine also states that we will need to reconstitute the vaccine, counsel the patient and have them be observed, socially distanced, for 15 minutes after having the vaccine. All of this has not been adequately taken into account within the PCN DES, setting unrealistic expectations of the numbers vaccinated each week. Workforce and time available within primary care need to be taken into account and funded accordingly.

Reduction in workload

In order to enable a maximum number of staff to be utilised for the vaccine program, we need to reduce workload by stopping CQC inspections, making appraisal voluntary and stopping other forms of bureaucracy. This vaccine programme represents a significant workload during a global pandemic, when GPs need to rightly be focussing on appropriate clinical care.

We need urgent clarification as to what other methods are to be employed in delivery. We recognise there are plans for additional support and mass vaccines centres, but this needs to be clear and set up alongside the PCN DES with primary care input, rather than separate to it.

Information around COVID Vaccine

We are already seeing appropriate questions from both the public and clinicians on the data behind these vaccines. To ensure good uptake, we need the research data to be available to clinicians in an appropriate timeline before full agreement to the PCN DES. Without this we, as clinicians who will be rightly asked questions around the vaccines by patients, cannot morally engage in this vaccination programme. We need time to absorb, discuss and question the data before fully signing up to the DES.

Recommendations

1) The research data needs to be released to clinicians with sufficient time to allow them to analyse the data and before signing up to the DES.
2) The PCN DES needs to be delivered in conjunction with, and not separate to, bigger strategies around mass vaccination centres and additional workforces.
3) Improved funding allocated for possible hiring of venues, hiring of more staff, improving current primary care estates, purchasing necessary equipment, transport for vaccinations and storage and that this funding is allocated upfront to allow proper planning for this programme.
4) Improved funding for the administration of this vaccine to take into account the complexity and time required.
5) No restriction of funding if the patient does not attend for the second vaccine
6) Funding to be increased for the administration of the vaccine to housebound and nursing home patients.
7) Flexibility over the time and days for these vaccine centres to be open under the PCN DES.
8) Flexibility over current workload and ask of primary care to recognise this huge task being allocated under this PCN DES.

Summary

In order to enable more GP practices to take up the DES we need to allow more flexibility and limit financial risks to individual GPs.
We hope that by making the above changes to the DES, aiming to reduce the risks in signing up to the program, this will lead to a significant improvement in the ability of primary care to take up vaccination delivery which will ultimately benefit the population. Primary care wants the vaccination programme to work and is rightly placed to deliver it. However, we need to ensure that the exit strategy is realistic and appropriately supported so that it is a success.
Signed,

Dr Vinesh Patel
GP Partner, Sutton

Dr Lizzie Toberty
Salaried GP, Sunderland

Dr Kaveri Jalundhwala
GP Trainee, Thames Valley

Dr Zainab Najim
GP Trainee, Norfolk

DAUK GP Committee

If you feel this is just another example of how disconnected those making the decisions are to those working on the frontline, please sign the attached letter.

The health secretary Matt Hancock has repeatedly failed to respond to concerns that his local hospital is bullying and intimidating senior doctors to prevent them raising serious issues of patient safety, the Guardian can reveal.

Doctors at West Suffolk hospital have complained of harassment after trust bosses demanded they give fingerprints as part of a “witch-hunt” to identify staff members who blew the whistle on potentially botched surgery.

The family of Susan Warby, who died five weeks after an operation in August 2018, was sent an anonymous letter highlighting errors in her procedure.

After conducting a serious incident investigation into her treatment, the trust threatened senior medics with possible disciplinary action if they failed to give their fingerprints and samples of their handwriting.

The trust insisted this request was not threatening but a note to staff warned that refusal to consent “could be considered as evidence which implicates you in writing the letter”.

Consultants at the hospital, in Bury St Edmunds, are so angry at the threats and what one called a “culture of bullying from the top down” that they have written to the trust’s chairwoman raising “grave concerns”. They accused the management team of denying staff the freedom to speak about their concerns over care, which has been an enshrined right for NHS staff since theMid Staffordshire scandal.

Details of the treatment of staff have been passed to Hancock. However, he has rebuffed on three occasions attempts to discuss the deep-seated problems at the trust with those who have raised concerns, including a senior clinician who was asked for fingerprints.

His refusal to engage threatens to undermine his claims to be a champion of NHS whistleblowers. Earlier this year he tweeted his determination “to end the injustice of making NHS staff choose between the job they love & speaking [to] the trust to keep patients safe”.

Dr Rinesh Parmar, chair of the Doctors’ Association UK, which campaigns to improve doctors’ working conditions, said: “These are utterly extraordinary and unprecedented behaviours from an NHS trust that fly in the face of everything learned from Mid Staffs. Threats, secrecy and a toxic culture towards dedicated NHS staff where whistleblowers are persecuted serve only to move us further away from a just culture and threaten patient safety.”

Dan Sharpstone, a consultant gastroenterologist at the hospital who is also Suffolk’s assistant coroner, suggested to the staff medical meeting that the letter-writer could have approached the family because the hospital’s procedures “don’t work”, and he was worried that “every whistleblower will now be treated like this”.

The trust’s hunt for the whistleblower comes after senior doctors expressed concern about an earlier potentially botched operation. After conducting a serious incident investigation, the trust accepted that its care of that patient was substandard.

However, we are concerned that such laudable statements do not tally with last week’s budget, suggesting yet more cuts to public health funding that covers prevention initiatives run by Public Health England. We understand Mr Hancock is not expected to announce any measures to aid health prevention, and therefore we must question how this will be funded.

In addition doctors are concerned that asking people to take more responsibility for their own health pushes the blame for diseases such as diabetes, heart disease and and cancer onto patients, who do not choose to develop these illnesses.

Dr Samantha Batt-Rawden, Chair of DAUK, said “Mr Hancock’s aims are admirable, and doctors would be the first to support the old adage of ‘an apple a day keeps the doctor away’. You cannot prescribe any medication to replace a healthy lifestyle, and doctors have long been giving patients advice on how to keep well such as stopping smoking and eating healthily. However, we must recognise that such choices are complex, and many of these lifestyle factors are associated with poverty.”

Dr Alan Woodall, GP & Public Health lead for DAUK, said: “Personal responsibility is not the main driver for improvement in health. Without funding and policy change to reduce the obesogenic environment, further reduce smoking and drug use, improve social cohesion and recognise wider political policy impacts on health, this strategy unlikely to succeed.”

CONTACT

Contact@dauk.org

A doctor-led lobbying group has urged the health secretary to review the GMC’s ability to appeal its own fitness-to-practice tribunal.

In a letter to Matt Hancock, the Doctor’s Association UK said the GMC’s right to appeal the MPTS has led to ‘significant unwelcome and unintended consequences’.

Earlier this year, the Court of Appeal overturned a GMC-led High Court decision to strike-off Dr Hadiza Bawa-Garba, after the MPTS had called for her suspension following the death of Jack Adcock.

Following the case, the Government launched a ‘rapid review’ into the use of gross negligence manslaughter charges in medicine, concluding that the GMC should no longer have the right to appeal MPTS decisions.

However, Pulse revealed that the GMC is not intending to halt appeals against the MPTS until the law is changed.

The letter, which is co-signed by other lobbying groups including GP Survival and Doctors in Unite, said the case made doctors ‘feel that we too, could be pursued through the courts for errors made whilst simply trying our best’.

It said: ‘We, the undersigned, all agree that the GMC cannot be trusted to take a balanced and considered approach in the sanction of doctors who have made honest mistakes in the context of system failures.’

The letter added: ‘We are concerned that should the GMC’s action continue unchecked, that there will be a further breakdown in trust between the medical profession and its regulator, and the NHS will continue to move towards a culture of fear and blame, rather than one of learning.’

The association then urges Mr Hancock to:

• Call upon the GMC to cease appealing MPTS verdicts

• Confirm that the GMC’s right to appeal MPTS verdicts will be repealed, as per the recommendations of the Williams Review

• Set out a timeframe for when and how this legislation will be changed

The letter comes after the appeals court told the GMC to show ‘restraint’ after it quashed another GMC-bid to sanction a doctor last month.

In a letter to health and social care secretary Matt Hancock, the Doctors Association UK (DAUK) and others including campaign group GP Survival voiced ‘collective concern’ over the GMC’s decision to continue to appeal decisions by the Medical Practitioners Tribunal Service (MPTS) in court following the Bawa-Garba case.

The government set out plans to strip the the GMC of its power to appeal decisions made by the MPTS after a review triggered by the damaging, high-profile case of Dr Hadiza Bawa-Garba – struck off after a GMC appeal against a tribunal ruling, but later reinstated.

The government review warned GMC appeals had created ‘fear and mistrust’ among doctors and were ‘deterring reflection and learning from errors to the detriment of patient safety’.

Tribunal appeal

However, the government has yet to pass legislation to remove the GMC’s power of appeal, and GPonline revealed last month that the regulator is currently appealing four tribunal decisions.

In each of these cases, the GMC is asking the Court of Appeal to replace an MPTS decision with a more severe sanction. In three cases it is recommending – as it did in the Bawa-Garba case – that suspension be substituted for erasure from the medical register.

The letter, signed by 14 representatives from 11 different organisations, urged Mr Hancock to ‘call upon the GMC to cease appealing MPTS verdicts’ and confirm when the regulator’s right to appeal will be repealed, as recommended by the Williams review earlier this year.

The letter reads: ‘We, the undersigned, all agree that the GMC cannot be trusted to take a balanced and considered approach in the sanction of doctors who have made honest mistakes in the context of system failures.

read the full coverge

These concerns relate to cases being brought to the Court of Appeal by the GMC in an attempt to overrule the findings of doctors’ tribunal proceedings, in order to have doctors erased from the medical register. DAUK and its affiliates are calling for the Health Secretary to undertake an urgent review of the current and ongoing actions of the GMC, and to put a stop to such appeals being brought, pending a review of relevant legislation.

This call for action has come following the landmark case involving Dr Hadiza Bawa-Garba. The GMC had sought to overturn a decision made by the Medical Practitioners Tribunal Service (MPTS), in order to erase Dr Bawa-Garba from the medical register. To the relief of the medical profession, the Court of Appeal unanimously rejected the GMC’s case, and ruled that Dr Bawa-Garba ought to be reinstated to the medical register, thus allowing her to continue to work as a doctor.

The Bawa-Garba case resulted in the launch of the Williams Review, with recommendations being made in June of 2018. Professor Norman Williams stated that the GMC ought to have its right to appeal MPTS verdicts removed, and noted that granting the GMC this right of appeal in 2015 had come with significant unwelcome and unintended consequences. DAUK concludes that the GMC cannot be trusted to take a balanced and considered approach in placing sanctions upon doctors in circumstances such as those faced by Dr Bawa- Garba – doctors making honest mistakes in the context of system failure.

The Doctors’ Association UK are alarmed to learn that, despite the outcome of the Bawa-Garba case, along with the recommendations of the Williams Review, the GMC has continued to appeal MPTS verdicts in the courts. Within the last weeks, the GMC has been urged to show “restraint”, and judges have expressed “regret” at such cases having been brought to the Court of Appeal. DAUK understands that there are a further four appeals due to be heard, all of which involve the GMC appealing to overturn tribunal verdicts.

The Doctors’ Association UK believes that the continuation of such unchecked action by the GMC will lead to a further breakdown in trust between the medical profession and its regulator, with a progressive move towards a culture of fear and blame, rather than one of learning. DAUK urges the Health Secretary to request that the GMC halts its appeals against MPTS verdicts forthwith. Furthermore, DAUK asks the Health Secretary to confirm that the recommendations of the Williams review will be upheld, and that the relevant changes to legislation are made without delay.

read the full letter here