The NHS does not have enough medics to staff beds in “surge hubs” for Covid patients being set up at hospitals around England, a representative of health service managers has warned.

The chief executive of NHS Providers, Chris Hopson, said that an “emergency staffing model” will be needed, with recently retired doctors and nurses and experienced volunteers called in if the additional capacity is needed.

And a member of the committee of the Doctors Association UK, neurologist Dr David Nicholl of University Hospital Birmingham, warned that many clinicians within the NHS are “really, really anxious” about the rising pressure on staffing within the service.

“The biggest threat is staffing at every level,” Dr Nicholl told BBC Radio 4’s Today programme. “Speaking to my colleagues in critical care, they tell me they have less staff than they had 12 months ago. 

“That, frankly, is because people are burned out from last winter. A lot of people are really, really anxious about what what’s going to happen next.”

Read the full article here

Ministers are being urged to grant migrant NHS workers the indefinite right to remain as the health service braces for what could be one of the most difficult winters it has ever faced.

Cross-party MPs, along with medical bodies including the British Medical Association (BMA), have backed calls to change the law so that foreign health and social care staff are given the right to stay in the UK in honour of their commitment during the pandemic.

Liberal Democrat Christine Jardine, who is pushing the second reading of a private members’ bill that would make this happen, warned that failing to provide “certainty” to these healthcare workers would risk “fuelling the winter crisis with an exodus of staff”.

Dolin Bhagawati, interim co-chair of the Doctors’ Association UK, said it was “time the government assures [migrant NHS workers] that they will not be callously cast aside as a political inconvenience”.

“These are dedicated professionals who have performed heroic service over the last 18 months. Yet they live with the potential for deportation over their heads at any instant. The country they have sacrificed so much for should be welcoming them home,” he added.

Read the full article here

Doctors and their staff working in GP surgeries across England are reporting a torrent of abuse from patients, with some receiving hate mail while others have been left shaking and in tears by physical and verbal attacks.

Some family doctors have told The Independent they fear coming to work, and have seen staff quit over the threats they are receiving almost daily.

Some surgeries have been subjected to bomb threats, while others have been daubed with graffiti. Staff at one practice in London have received hate mail threatening workers over their role in the Covid vaccination rollout. Other were sent abusive text messages describing staff as “Nazi b*****ds”.

GPs say the majority of problems are being caused by the system being overwhelmed with demand, and a false perception among some patients that GPs are closed and seeing fewer patients in the wake of the Covid crisis.

Delays in being able to get appointments due to a workforce crisis in GP numbers and surges in patients wanting to see doctors means that some patients are having to wait weeks for non-urgent appointments.

But GPs are facing a relentless workload, with many on duty for long hours, dealing with increasingly complex cases and more administration, as rising numbers of patients left waiting for hospital treatment because of growing NHS backlogs turn to their GPs for support.

A recent survey by the British Medical Association found that half of doctors, and two-thirds of GPs, had seen colleagues experience violence or abuse.

One GP practice in London has reported hate mail it received to the police, after staff received multiple photocopies of a notice telling doctors and nurses they would be “put on trial for war crimes and held accountable”.

The practice said: “This was photocopied numerous times, and put in envelopes, and individually addressed to each of our clinicians, and posted through the door after dark.

“We have had a number of abusive responses on text, via email, by phone and in person as we try and keep all patients updated.”

The Independent has spoken with GPs working in surgeries across England who fear the increasing levels of anger they are seeing from the public will drive more GPs to quit their jobs, deepening the crisis already facing primary care.

Dr Emily Ball, a GP working in Liverpool and a member of the EveryDoctor group, said she had been left shaking and tearful after a tirade of abuse from a patient angry at delays to his hospital appointments.

In another incident earlier in the year, police had to be called when a man demanding antibiotics physically forced his way into the practice and followed staff while verbally abusing them. The man was not even a patient at the practice.

Dr Ball said: “We did have to call the police. It was frightening and that member of staff has unsurprisingly left now.

“It’s the more insidious daily verbal abuse that’s a real problem, and it’s led to staff going off sick. It’s not a day ending in ‘y’ unless somebody is reduced to tears by a patient. It’s making it very difficult to retain staff.”

She is supposed to work 31 hours a week but has calculated she is currently doing an average of 65 hours a week.

“We are on our knees. Yet there is this perception that we have stopped seeing patients face to face and we haven’t. We have seen people who have needed to be seen, all the way along.”

Describing her own experience of abuse from an angry patient, she said: “He told me that I was ‘fucking useless’, that I shouldn’t be practising, and it was a disgrace that we didn’t care about our patients. Several times he said he thought I should be reported to the GMC. I was physically shaking after.”

Dr Ball, a GP of 14 years, warned the longer-term impact was going to worsen the existing crisis for GPs as their numbers have failed to keep pace with the rise in population and demand.

“When you’ve got an already demoralised workforce, and then they start getting kicked by the very people they are literally killing themselves trying to help, what happens is that people start burning out, they start going off sick; and that means that there’s more pressure on the doctors who are left, so they burn out, they go off sick, and before you know it you’re not going to have a workforce.”

A survey of more than 330 GP practices across London in June found more than half said the current demand on them was unmanageable, with 82 per cent warning it was affecting staff wellbeing. Four-fifths of practices said patient satisfaction was being hit.

Almost half of practices had vacancies for GPs, with some practices forced to consider closing their doors – a move that would hit 22,500 patients.

Birmingham GP Lizzie Croton, a member of the Doctors’ Association, said there were now more ways for patients to contact GPs via digital services, which she said meant more “cognitive load” on doctors.

“We’re experiencing increasing amounts of demand from patients. All the people that I see believe that they need to see us, and they’re in some sort of distress.

“Our doors are wide open electronically and also physically, but every contact generates workload. I am working an extra couple of hours every day and I rarely have a lunch break.

“There have always been waits in the NHS, but what’s different at the moment is that people are not being given dates, or if they are it’s months away. We’ve had verbal abuse, especially the reception and admin staff, mainly because of waits. Most of the time it’s very understandable and you share the patients’ frustration, but we have had some where it has been personal.

“People are less tolerant about having to wait to speak to someone.”

As well as frustration over waiting times and patients demanding faster appointments, GPs have also been on the frontline of a backlash against the Covid crisis and vaccination schemes.

One GP in London described how a patient who had been sent a vaccination reminder letter “barged” into a back office and began shouting at staff.

They said: “The man was aggressive enough that we called 999 – shouting, swearing, getting very close and ‘squaring up’ to us. He filmed part of the incident, despite our requests for him not to, and the video later found its way onto Twitter.

“This is just the worst of a number of incidents. We have had reception staff in tears several times in the last few weeks because patients or relatives have been so unpleasant.”

Many GP practices have been told by the NHS to send out text messages and reminders to residents to encourage them to get vaccinated.

The Independent has been shown multiple examples of aggressive and rude messages sent to surgeries in response.

Dr Michelle Drage, chief executive of Londonwide Local Medical

Committees, said: “NHS England and the government need to get the message out at a national level that general practice is working as hard as it can, and those on the other side of the reception desk, the consulting room or at the end of the phone are people, not a faceless sounding-board for frustrations.

“London practice staff are receiving profanity-filled text messages in response to vaccination reminders, and those making calls are getting abuse and threatened with being reported to regulators, all just for doing as instructed by the NHS. Even those people who are merely hesitant about vaccinations have been known to become abusive after repeated contacts.”

The Royal College of General Practitioners (RCGP) said there was a serious misconception about the work being done by GPs, who were still seeing patients when needed. He said practices were busier than ever while simultaneously delivering two-thirds of all Covid vaccinations.

Professor Martin Marshall, chair of the RCGP, said: “It’s entirely unacceptable for anyone working in general practice to be at the receiving end of abuse of any kind, let alone the threat of physical violence.

“General practice has been open throughout the pandemic, and face-to-face appointments have been offered wherever safe and appropriate.

Read the article here.

The guilt of of burdening my colleagues and abandoning patients was overwhelming. But I was going to break if I didn’t stop and take time to heal away from the pressures of the current climate

“I first realised I was burnt out when I was reduced to tears at work, after being asked to “squeeze in” an extra patient in my already overflowing clinic. I ploughed on, but the tears told me that I had reached breaking point.

Burnout is the physical, mental and emotional exhaustion caused by extreme and prolonged periods of stress in the workplace. Even before the pandemic, GPs and emergency department doctors had higher burnout scores than any other group of doctors. Now things are even worse, with burnout rates 20 per cent higher and an average of three GPs leaving the profession every day.

The demand is unrelenting. GPs are routinely working 12-15 hour days, reporting 40 or more patient contacts – way above what is considered safe. In March last year as the pandemic hit our shores, NHS England mandated the move to “total triage” in primary care to limit the spread of Covid-19, protecting both patients and staff. Almost overnight, we moved to remote telephone, video and online consults, establishing hot hubs to enable ongoing face-to-face contact if the clinical need arose.

We delivered, at short notice, 75 per cent of a mass new vaccination programme. We dealt with the backlogs resulting from cancelled secondary care work. Data from NHS Digital confirms, contrary to the reports of being closed, general practice was and is busier than ever before. Despite this, we are being shouted at by patients frustrated with delays, and being vilified by large sections of the press. This all takes its toll and GP suicide rates are now four times the national average.

I didn’t go into medicine to defend myself against untruths that general practice has been closed for 18 months (we really haven’t). I’m trying my best and working my hardest to advocate for patients in a chronically underfunded system. If I was able to simply do my job and focus on practising medicine, I could do it. But we are bombarded with so much more than clinical care on a daily basis. Then after a 13-hour day, returning home to see social media comments about GPs refusing to see patients when you’ve just seen, spoken to, or messaged 80 in that one day alone.

Our leaders are unsupportive. NHS England has informed GPs about changes in their contract via the newspapers, and the government claims to provide more funding in general practice, but attach so many strings about when, where, and how it can be spent, when actually most practices just need an extra GP or practice nurse to help take the strain.

We’re constantly hearing that we need to be resilient. Resilience is being able to recover from setbacks without brooding on them; to bounce back from pressure to your starting position. It’s not about working harder with fewer resources, or being able to shrug off abuse. Elastic is very resilient – it stretches a long way, then bounces back to its original form. But even elastic will snap if too much pressure is applied. And this is what is happening to GPs right now. We stretched and now we are getting dangerously close to breaking. And as I found, it’s only going to take one more request, one more adjustment, one more hurdle, before we snap. Every GP who burns out is one less GP to see patients, to advocate, and to care for them. It has already started, and it will continue unless things change.

I didn’t want to have time off. The guilt of burdening my colleagues and abandoning the patients I was caring for was overwhelming – I would be letting them all down. But I was going to break if I didn’t stop and take time to heal away from the unrelenting pressures of the current climate.

Burnout can be eased with medication or time off, but ultimately, for someone to recover, there needs to be changes within the workplace that caused the condition to start with. The entire system needs to change. The workload of individual clinicians needs to be reduced to a safe level without adversely affecting patient care, and to do this we need more funding, alongside more vocal support from government and leaders. If we don’t make changes, there won’t be any GPs left to see patients.”

Dr Rosie Shire has resigned from her NHS GP job

I didn’t join medicine for the money, in fact quite the opposite. But during the the past 10 years, junior doctors have faced pay cuts by as much as 30 per cent in real terms. During the same period, our honourable MPs have voted to give themselves no less than eight pay rises.

Most “junior doctors” earn less than tube drivers, self-employed plumbers and construction workers, among many others. Compared to professionals such as city bankers and lawyers, it the difference is even starker.

When you picture a junior doctor, you probably think of someone in the first year out of medical school. In reality it’s any doctor who’s not yet a GP or consultant, which takes years of work. Specialties such as psychiatry and surgery require a minimum of 8 to 10 years after graduating and passing annual assessments and exams.

For other specialities, it’s closer to 15 years, and many are still termed “junior doctors” into their late 30s and 40s – especially if training is done part time, or doctors change specialty.

A survey of members of the Royal College of Nursing (RCN) across the NHS and independent sectors – released in June last year – found that 36 per cent of respondents were thinking of leaving the profession. Of those thinking of leaving, 61 per cent cited pay as a factor. A different survey, released in December, found that 30 per cent of nurses asked planned on leaving the profession within 12 months thanks to the impact of the Covid-19 pandemic. Many had visited food banks, while 39 per cent had skipped meals to feed their family or save money.

The RCN has set up a £35m industrial action fund to support its members through a loss of earning should they decide to strike over this. NHS staff generally don’t like talking about money, but a 1 per cent pay increase for NHS staff is pretty appalling when you consider this actually means a real-terms rise of potentially just £3.50 a week.

Almost all the medics I know in the UK say they wouldn’t recommend the profession to their children. Yet, in countries where doctors are paid better – being a doctor is still something to aspire to. The NHS hospitals, mental health services and community providers are currently faces a shortfall of 84,000 full-time equivalent (FTE ) staff.

Burnt out frontline workers are retiring early, going off sick, or emigrating to countries where they will enjoy a better quality of life. My cousin, who is also a junior doctor, earns almost 600 per cent of my salary in another country. We graduated the same year and work the same hours.

It’s time to recognise and value the contribution made by NHS staff. Between March and December last year, more than 850 health and social care workers died of Covid-19 in England and Wales, yet staff continue to do their jobs to the best of their ability.

In recognition of the efforts of thousands of migrant workers within the NHS, The Doctors’ Association UK today launched “Overseas NHS Workers Day”, to celebrate the contributions of those who have propped up our health service during the pandemic, and to raise awareness of the issues they face.

Fairer pay for all NHS staff would be a starting point in view of the sacrifice made by so many during the pandemic.

The author is using a pseudonym. He is a GP trainee

Today marks the first ever Overseas NHS Workers Day, organised by Dr Pushpo Hossain, of the Doctors’ Association UK, and supported by the Unison trade union and a number of other organisations.

Almost 14 per cent of NHS staff identify as non-British, with nearly 200 different nationalities represented within our health service. Among NHS doctors, 30 per cent were born overseas. The international medical community has formed a massive and crucial part of the NHS frontline, with members risking their lives to look after patients with Covid-19.

As an overseas NHS worker myself, I have felt the impact of being alone during a pandemic, more than 5,000 miles from home and family. I’m delighted by an initiative which celebrates the contribution of the international medical community during this crisis, and raises awareness of some of the issues international staff face.

Chief among these issues is immigration status. Indefinite leave to remain (ILR) or permanent residency is currently awarded to those with Tier 2 visas who have lived in the UK for a qualifying period of five years. I’m originally from Kerala, India, where I was born into a family of doctors who inspired me to gain international experience within the NHS after completing medical school in India. I will only be eligible for ILR in 2023, which as a frontline worker, adds an extra layer of stress to be uncertain about my fate in this country.

Many of my NHS colleagues have faced delays in obtaining a Biometric Residency Permit, without which we cannot rent accommodation, apply for a training post, enrol our children in school, apply for a driving licence, or even open a bank account. It’s not unusual for DAUK to be contacted by doctors unable to travel home to see dying relatives because of delays receiving this permit.

I’m currently a trainee in psychiatry in the Oxford Deanery. Being an international doctor in training on a Tier 2 visa is not straightforward. To apply for any out of programme experience, research, or training, brings with it mountains more bureaucracy. I truly believe that international minds could devote more energy towards boosting clinical innovation within the NHS if we didn’t have to worry endlessly about our expiring visas, and research repeatedly shows the material and psychological benefits of gaining permanent residency.

The NHS has significant staffing and retention issues, with more than 88,000 vacancies in England alone; vacancy rates are approaching 10 per cent in some areas. Visa challenges and uncertainties contribute to these issues and have a drastic impact on the attractiveness of working as a doctor in the UK.

Progress of sorts has been made – for example exempting international NHS staff from the immigration health surcharge, which was a huge financial burden for doctors waiting to start work or renewing their visa. This came as a huge relief. 

The government has also introduced ILR for the dependents of staff who die during the pandemic while caring for Covid-19 patients, though not for staff who survive. I feel this is morally reprehensible and not in line with British values of fairness and respect. 

I can truthfully say that not once did I think of stepping back from the frontline. The call of duty has driven me to give the best to my patients. This is a spirit that all doctors and other NHS staff share. But we expect this to be recognised, and our hope is that us “Covid Soldiers” will be rewarded with ILR, showing that we are valued, and our sacrifices appreciated.

I would like to proudly call the UK my “home away from home”.

Dr Alex Vallakalil is a trainee psychiatrist and part of the Doctors’ Association UK

Read the original article here: https://www.independent.co.uk/voices/nhs-covid-nurses-immigration-doctors-b1812892.html

The NHS is buckling under the pressure of Covid-19, with tens of thousands of doctors and nurses across England now off sick because of the virus – accounting for almost half of all staff absences.

The UK’s daily coronavirus deaths have reached four figures for the first time since April. The staffing crisis has become so severe that NHS bosses have been pleading with doctors and nurses to work extra shifts.  

Yet at the same time, there are qualified health workers sitting at home who are desperate to be on the front line helping to tackle the crisis but who are being prevented from doing so.

Many are waiting for the Home Office to issue their biometric residence permits (BRP), which prove a visa holder’s right to work in the UK – with some having already waited months when the process should, according to the government, take seven to 10 days.

Others are asylum seekers who have been waiting on their claims for over a year – at which point they should be allowed to work in shortage occupations, which include all medical practitioners – but they are facing delays receiving evidence of their right to work from the Home Office.

Dr Dolin Bhagawati, a neurosurgeon and editorial lead for Doctors’ Association UK, said he knew of about 40 cases of qualified medical staff currently being unable to work because to delays in their BRP cards being issued.

“Right now, the UK is crying out for all the trained staff we have available, even calling up retired NHS workers and students. However, by not doing all it can to allow foreign doctors with valid visas to work as soon as possible, the Home Office is failing to do its part in a nationwide effort to fight this virus,” he said.

Dr Bhagawati said a “simple” solution would be to grant indefinite leave to remain for all NHS and care workers and their dependents in order to “simplify this process, cut down on bureaucratic excuses and allow everybody to get on with their jobs”.

Read the full article here: https://www.independent.co.uk/news/uk/home-news/doctors-migrants-covid-nhs-home-office-b1784054.html

When did it all go so wrong? It’s still dark on the long drive home from the night shift. It might be freezing but all my windows are down, in the hope breeze on my face will be enough to keep me awake. 

Somehow we have found ourselves back where we were in April in the NHS. Except this time it’s worse. We now have more patients with Covid-19 in hospital in England than ever before. 

I wish I could show you what is going in inside hospitals in the southeast; it is unlike anything I have ever seen in my career. To say that emergency departments are overflowing would be an understatement. They are wall-to-wall. My heart sinks when I see a trail of ambulances queuing around the corner.

Resuscitation departments have been consumed by Covid. We often have to keep patients ventilated in A&E as we have no space in ICU upstairs. A wholesale team effort has been underway to create surge areas. But now even those are full.

This has resulted in a desperate scrabble to find an intensive care bed, anywhere, to try and move patients and decompress the southeast. Critical care doctors have been asked to transfer patients as far away as Yorkshire.

We haven’t even felt the impact of mixing over Christmas yet. But NHS staff are fearful of what’s to come in January. Even without this cases are rising as the variant of the virus takes hold and it’s only getting worse. 

But finally, there is a light at the end of the tunnel. The Oxford-AstraZeneca vaccine announcement this morning has prompted widespread relief throughout the NHS. This is a truly incredible feat achieved in such a short space of time, alongside the Pfizer-BioNTech vaccine. For those of us on the front line it can’t come soon enough.

You might be surprised to learn that NHS workers are currently not part of the highest priority group for the Covid-19 vaccine. This is a significant oversight that must be remedied as a matter of urgency if we have any hope of effectively fighting the tide of cases we will see in the coming weeks. We cannot afford our already wafer-thin workforce to be stretched even further by rising rates of staff sickness.

The system truly is at breaking point, and so are its staff. There is considerable anxiety that already watered down PPE guidance will not protect them effectively against the new strain. We have already lost over 650 colleagues. The fear and the exhaustion is palpable. 

Yet at a time NHS staff most need support it appears to be slipping through their fingers. Measures support in place to support workers have already been taken away.

Worse still, clinicians trying to speak up on social media are met with walls of disinformation, and are even facing abuse. Just this morning I have seen people planning New Year’s Eve parties on social media in open rebellion. Exhausted, I wanted to cry. If people saw what I see every day on the NHS frontline, the damage that Covid-19 can do, would this be happening?

The virus does not discriminate. Young, fit, healthy people are coming in to us struggling for breath, leaving us no choice but to put them on a ventilator. 

My heart breaks when I think back to a conversation I had with a doctor in the US who treated a whole family for Covid-19. They had gone against the recommendations and had everyone over for Thanksgiving. They risk a few empty chairs there next year. 

So many of my colleagues are broken. I’ll be ushering in the new year at midnight on ICU this year. But as much as we all wanted a new year in 2021, I can’t help but fear it is going to get worse before it gets better. 

Yet the mental health of staff is already at a tipping point. Without more support now we will be facing an new epidemic of burnout and moral injury among healthcare workers at the end of all of this.

This will be the year they want to forget, but can’t. 

The NHS was struggling to cope before Covid struck, so the scale of the crisis quickly widened the cracks. It has highlighted the communication silos that slow progress between community care services and hospitals, and exposed the red tape and inefficiencies that exacerbate staff shortages and waiting lists. Clinicians are exhausted, patients are being let down, and the situation is set to worsen, as GPs scale back care to ramp up the vaccination programme.

The expectation is that GPs will start to deliver vaccinations as early as December. It will be a monumental logistical and human effort, consuming hundreds of hours of clinical time. We’re incredibly lucky to have so many skilled individuals poised to deliver this essential function. But stretched GPs will be forced to funnel yet more resources into the Covid response, worsening backlogs and reducing already limited community care provision.  

More public money (in excess of £150 million) will be spent reacting to the crisis and bolstering our defences. This is essential expenditure, but we also need funds to simultaneously start building a brighter and better functioning future for the NHS. Covid might become more manageable once enough of us are vaccinated, but there’s a long way to go before the NHS will be released from the virus’ grip.

Our healthcare workers themselves are another crucial piece of this complex puzzle. Without them, we have no NHS. Without them, we have no hope of recovery. But in the throes of the most debilitating health crisis in the NHS’ history, the prognosis is looking increasingly grim for the individuals at its heart.

Preliminary research has shown increased instances of depression, anxiety and insomnia in frontline workers, who have been up against the pandemic since March. A recent Doctors’ Association survey found that more than 1,000 doctors have seriously considered quitting this year, with 45 per cent of those asked citing the crisis’ impact on their mental health. Gruelling 12-hour shifts, exhaustion and burnout are also leading growing numbers of nurses to quit within three years of joining the profession.

Full article here: https://www.independent.co.uk/voices/nhs-covid-funding-vaccine-patient-care-b1721861.html

The Doctors’ Association UK are hearing every day that staff on the frontline feel that they are being desperately pitched against each other in order to receive the vaccine.

We hear stories of vans driving past hospitals and GP surgeries in London with the highest numbers of cases of Covid-19, only to stop at other hospitals and surgeries in areas with nowhere near such risk for healthcare workers. Delivery of the vaccine appears patchy at best.

Heading into the toughest winter the NHS has ever seen, the announcement of a new, more transmissible strain of Covid-19 could have disastrous impacts on frontline staff and patients if the government does not act now. It is essential that the mistakes of the first wave are not repeated.

Doctors and nurses on the front line of the fight against coronavirus at the Royal London Hospital – which has the largest number of Covid patients in the capital – have been denied the Pfizer vaccine.

Hospital bosses at Barts Health Trust have written to staff today expressing their frustration over the decisions by NHS England, which meant the northeast of London – where the rate of infections and hospitalisations are worst – has not been given access to any vaccines.

The Doctor’s Association UK has written to Matt Hancock expressing its concern over the way the NHS is being distributed.

In the letter vice chair, Dr Jenny Vaughan said they were “hearing every day that staff on the frontline feel that they are being desperately pitched against each other in order to receive the vaccine”.

Ms Vaughan continued: “We hear stories of vans driving past hospitals and GP surgeries in London with the highest numbers of cases of Covid-19, only to stop at other hospitals and surgeries in areas with nowhere near such risk for healthcare workers. Delivery of the vaccine appears patchy at best.”

She said frontline A&E staff and intensive care nurses and doctors should be a priority because of sickness and self-isolation significantly affecting nurse to patient ratios and available beds.

The letter added: “Heading into the toughest winter the NHS has ever seen, the announcement of a new, more transmissible strain of Covid-19 could have disastrous impacts on frontline staff and patients if the government does not act now. It is essential that the mistakes of the first wave are not repeated.”

The rest of the article can be read here.