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

My day today started at 6am, faced with a roster of e-consults, alongside breastfeeding breaks and nappy changes, occasionally interrupted by a vocal toddler running in when he tires of daddy daycare. I am a part-time GP, and mother to a two-year-old and a six-month-old. It’s not how I envisioned my medical career – but it works for me, for now. In our brave new world of telemedicine and remote consulting, I was able to return to work for the NHS when my baby was only a month old, while arranging face-to-face appointments with colleagues judged on what I feel my patient needs.

Today’s plans from Sajid Javid to “ramp up” in-person consultations, are no more than a political soundbite; his offer of £250m a soggy sticking plaster which cannot buy non-existing GPs or extra consulting rooms. So am I the problem? If you want to play the government’s blame game then I’m an easy target – part-time, a remote worker. Javid announced plans to list surgeries on league tables, exposing those failing to offer appropriate “access” to patients – essentially naming and shaming practices. However, viewed another way, I could be part of the solution. Flexible working needs to be welcomed within the NHS in an attempt to hold on to an ever-dwindling, increasingly burnt-out workforce. I can be a mum, provide for my family and continue to contribute to the NHS.Advertisementhttps://4800587f1a4e419d18e917774cd01981.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

“Call-centre doctor” is no one’s dream job, but this new way of working must be incorporated. Our practice gets emails every day from patients expecting e-consults. We’ll never be able to go fully back to the old system. That doesn’t seem to have got through to the government yet. I believe politicians should leave to healthcare professionals the decision on returning to face-to-face consultations. The health secretary has provided no evidence or modelling on the current supply and demand in primary care to warrant a return to “blanket face to face”. Nor has he given the public realistic expectations on how long they might wait to see a GP face to face, as opposed to undergoing a telephone triage – it might be a month’s wait, instead of two hours. Much of what I deal with remotely doesn’t need to be seen in person: fitness notes, contraceptive pill checks, follow-up of blood tests and discussions about mental health problems. With e-consults, patients can submit their queries via email and have a response within 48 hours, without the risk of picking up Covid from a crowded waiting room – if they now request a face to face appointment as “their right”, that’s fine, but they will be waiting a lot longer for a response.Javid’s GP rescue plan will fail to ‘turn the tide’, says former Tory health secretary Jeremy Hunt – as it happenedRead more

Things haven’t all been great with work-from-home: the notion of set working hours has gone out of the window, for one. But GPs and their teams need to be trusted to deliver care in the most appropriate way for their local populations. Face-to-face care in general practice never stopped when needed. Remote consulting was mandated during the pandemic to protect patients and, according to NHS England’s patient survey in July, they are happy with the care they received. The benefits of telemedicine have been embraced for years by private companies such as Babylon and GP at Hand, and the NHS is only just catching up, ensuring the limited resources provided by the government get to the people who need them most.

We have a crisis in general practice which goes way beyond money. Despite government promises in 2019 to deliver 6,000 more doctors, GP numbers have fallen – through burnout, early retirement and emigration. Most GPs are working 12 hours or more a day, and “part-time” GPs clock up the same number of hours as most 9-5 workers. Abuse has become endemic. Last month, four practice staff in Manchester were hospitalised – one with a skull fracture – from a disgruntled patient. I’ve been screamed and shouted at down the phone on more occasions than I can count. Much of this abuse has been legitimised by some sections of the media with their clickbait anti-GP campaign. Politicians have not been blameless, with Boris Johnson, Sajid Javid and Jacob Rees-Mogg all making it clear in recent weeks that they expect GPs to go back to pre-Covid working conditions. But we’re still battling a pandemic. With winter approaching, I fear for our vulnerable patients. Is it right to encourage them to sit in doctors’ waiting rooms? Yet another example of our leaders being out of touch with general practice.Advertisement

This needs to stop. Blaming GPs deflects attention from this week’s damning Commons inquiry which exposes the failures of the UK government in the handling of the pandemic. The NHS was underfunded before this crisis hit, and the pandemic has only made the cracks in the system more visible. We need an independent investigation into the real problems around GP access, with GPs involved in the plan. It is worth remembering that GPs want nothing more than to provide good standards of care for patients.

If general practice fails, the NHS fails. There are solutions to this crisis, but the health secretary’s gestures today are sadly adding to the problems rather than solving them.

Read the original Guardian piece 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

full article by Alicia Clegg in the FT

At the start of the pandemic, trainee GP Kaveri Jalundhwala was working on a hospital placement. By the end of March, she had become infected with Covid-19, which then developed into long Covid and forced her to pause her training. With stories emerging of how healthcare workers in makeshift masks and gowns — and sometimes no protection at all — were paying for failures to provide adequate personal protective equipment (PPE) with their health, Jalundhwala looked for a way to support her colleagues.  She joined Doctors’ Association UK (DAUK), a grassroots lobbying group. And rather than “just get angry at home”, Jalundhwala got involved with their “Protect the frontline” campaign. Its aims include to inform the public about conditions in the fight against Covid and press the government to give healthcare workers appropriate PPE and support.

The DAUK grew from doctors joining together to support a junior paediatrician, Hadiza Bawa-Garba. In 2015, Bawa-Garba was convicted of manslaughter by gross negligence after the death of six-year-old patient and was then struck off by the General Medical Council. But many medical professionals did not see a doctor who had failed, rather an overstretched colleague who was put in an unsafe situation and scapegoated. “Any one of us could be Bawa-Garba,” says Jalundhwala. It often feels that doctors are “a faceless number on a rota where [our] individual voice does not matter to the people who make decisions,” she adds. Bawa-Garba has since returned to medical practice, while the DAUK developed its “Learn not blame” campaign to improve the culture of the NHS so it can learn from mistakes “in a constructive and fair manner”.

When the pandemic hit, DAUK started its “Protect the frontline” campaign. As part of this, it broke the story of NHS staff being warned not to discuss PPE problems on social media or speak to the press. It also created an app that enables doctors and GPs to report on PPE supplies. In April 2020, DAUK also led calls for an independent public inquiry into healthcare worker deaths and PPE supplies, with its petition gathering more than 100,000 signatures. When this received no formal response from government, DAUK started legal proceedings with the Good Law Project.

“When something needs doing, we do not sit on it,” says Pushpo Hossain, who joined DAUK to amplify the voice of doctors working in the UK who qualified abroad.

In May, when a DAUK member heard about a plan to upload all NHS patients’ medical records to a central database that could be shared with third parties, the organisation joined forces with Foxglove, a digital rights campaign group, to help force a delay. “In less than a week we had decided to take legal action [later paused],” says Rosie Shire, a GP who led DAUK’s response to the plans. The scheme has now been postponed to allow time for more consultation with no new date for implementation.

Read the full piece by following the above link

From July 1 the way NHS Digital collects data from GPs will change to give researchers and planners easier access to anonymised medical records.

This data has already been collected for over a decade, NHS Digital say, for bespoke requests related to planning of healthcare services and medical research.

Now the medical histories of 55 million patients, including information on mental and sexual health, will be collated into one database.

But campaigners have warned better communication around the plans to pool the data is needed amid concerns it could damage patient-doctor relationships.

The Doctors’ Association UK said it could “erode the doctor/patient relationship, leaving patients reluctant to share their problems due to fears of where their data will be shared”.

Dr Ellen Welch, a GP and the editorial leader of DAUK, told The Guardian: “NHS Digital has failed to publicise this adequately to patients or healthcare staff, and we feel more time is needed to explain to patients how exactly their data will be used, who will benefit from it and what implications it may have for individuals.”

The Royal College of GPs is broadly in support of the plans, but has written to NHS Digital urging it to improve communication to the public.

Professor Martin Marshall, chair of the RCGP, told the newspaper: “The job of informing the public must not be left to busy GPs, especially at a time of extreme workload pressures and focus on the Covid-19 vaccination programme, so we have written to NHS Digital urging them to undertake greater communications with the public about this new collection and their options for opting out.”

Patients have until June 23 to opt out of the new scheme, this can be done by filling in a form and taking it to their GP.

An NHS Digital spokesperson said: “Patient data is already used every day to plan and improve healthcare services, for research that results in better treatments, and to save lives.

“During the pandemic, data from GPs has been used to benefit millions of us: helping to identify and protect those most vulnerable, roll out our world leading vaccine programme, and identify hospital treatments which have prevented people dying from covid.”

The spokesperson added they engaged with doctors, patients and privacy experts to design the new system and the data will only be used for health and care planning and research purposes.

“We take our responsibility to safeguard patient data extremely seriously. Researchers wanting to access this data will need each request to be approved by the Independent Group Advising on the Release of Data (IGARD) and a GP Professional Advisory Group (PAG), with representatives from the British Medical Association and the Royal College of General Practitioners,” they added. 

“The fact that politicians stood on the doorsteps of No 10 clapping while treating NHS staff with such contempt has angered even the most mild-mannered of my colleagues.
And it is this deep, impassible feeling of betrayal which has made people feel they have no option but to leave. A mass exodus from the NHS is no longer a case of if, it’s a case of when.
Staff morale will probably never recover fully. But there is a small window of opportunity now that, if lost, will never be regained. If we don’t start caring about our staff now, there will be no one left to care for our patients.”

– Dr Samantha Batt-Rawden, DAUK founder

Read the full article in The Guardian

Two directors at Matt Hancock’s local hospital are to step down, it has been announced ahead of the publication of a delayed review into a “witch-hunt” for a whistleblower involving an unprecedented demand for fingerprints from senior clinicians.

In January 2020 a “rapid review” was ordered into claims of managing bullying at West Suffolk hospital trust which the health secretary had to recuse himself from because of his friendship with the trust’s chief executive, Steve Dunn.

Days before the review is expected to be published, Dunn emailed staff to announce that two of his colleagues on the board were due to stand down early.

Dr Jenny Vaughan, chair of the Doctors’ Association UK, said: “Doctors that approached DAUK said they felt persecuted. The concern is that this long awaited report has still not seen the light of day and less than 60% of West Suffolk staff feel they are treated fairly when they raise patient safety concerns.

“We note recent events but we agree that family should come first for the medical director. The report we hope will be totally rigorous when it comes to examining the actions of the executive. We look forward to seeing the report as soon as possible.”

Dr Jenny Vaughan

Read the full article here

Doctors in a survey have unanimously rejected proposals to create an apprenticeship-style scheme as an alternative way of training doctors.

Members of the Doctors’ Association UK have voiced their opposition to the proposed new Health Education England doctor apprentice scheme in a survey, stating that the training is likely to be “inadequate.”

Health Education England (HEE) is creating an apprenticeship programme allowing candidates to receive an undergraduate medical degree without taking the traditional course.

During the programme, students could earn money alongside their studies, making entering the profession more financially accessible, HEE says.

HEE say the government-funded apprenticeship will “retain the same high standards of training”, and the British Medical Association say the proposals are “interesting and worthy of consideration”.

However, in a survey, Doctors’ Association UK members have voted unanimously to reject the proposals.

Chair of the association, Dr Jenny Vaughan, says: “Whilst we do not disagree with the general consensus of the scheme, which aims to diversify and widen participation in medicine, the question raised, is why it is necessary, considering there is a surplus of fully trained final year medical students unable to secure FY1 placements.”

She believes: “It is the background of several years of both theoretical learning and practical experience that doctors draw upon which enables them to deal with complexity.

“The current apprenticeship proposals are unclear about how standards will be achieved and maintained, meaning we are concerned apprentice trainees will lack this basic grounding and could be hazardous for patients.”

Dr Lizzie Toberty, of the Doctors’ Association UK, commented: “This apprenticeship scheme risks spending a lot of time and money to develop inadequately trained doctors. Without a thorough and rigorous grounding in the sciences we risk dumbing down our health system. If patients do not have access to doctors with adequate clinical knowledge their treatment will suffer.

“We strongly recommend HEE focus on making current medical school places more affordable and accessible to those from all backgrounds.”

Read the article here

The NHS has been urged to rethink safety for thousands of frontline staff after new research suggested that Covid patients’ coughing is putting them at far greater risk of catching the virus than previously thought.

The study found that coughing generated at least 10 times more infectious “aerosol” particles than speaking or breathing – which could explain why so many NHS staff have fallen ill during the pandemic.

The research has led to fresh demands that anyone caring for someone with Covid-19, or suspected Covid-19, should be provided with the most protective equipment – including FFP3 respirator masks – and that hospital ventilation should be improved.

Health workers are up to four times more likely to contract coronavirus than the general population, with infection rates among those on general hospital wards approximately double those of intensive care unit (ICU) staff – who do have access to the most protective PPE.

This access to higher-level PPE was based on the assumption thatICU wards are more dangerous because treatments such as continuous positive airway pressure (CPAP), used to support patients’ breathing, generated large amounts of aerosols – which linger in the air and can be breathed into the lungs.

Staff working in other hospital areas, GP surgeries and care homes are issued with looser-fitting surgical masks, which afford little protection against these tiny particles, but block larger virus-carrying droplets.

The new research, which has not yet been peer-reviewed, turns these assumptions on their head.

The research may also boost efforts to force a public inquiry into Covid-19 deaths among NHS staff and care workers. In December, Doctors’ Association UK (DAUK), which represents frontline medics, escalated its threat of judicial review against the government. “Inquiries must be initiated to investigate any factors that may have led to healthcare workers’ deaths,” a spokesperson said.

“We feel that there would be fewer infections among healthcare workers, and fewer deaths, if people had proper masks,” said Dr Katie Sanderson, a junior doctor and committee member of DAUK. “Acute medical wards and A&E, which is where most Covid patients are being cared for, have much lower standards of ventilation than intensive care units, and generally people are coughing all the time.

“This issue affects GPs as well, because most GP commissioners have refused to let GPs have access to proper masks.”

Read the article in full here: https://www.theguardian.com/world/2021/feb/03/covid-coughing-study-suggests-nhs-staff-at-far-greater-risk-than-thought