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

Doctors have warned that plans to pool medical records on to a database and share them with third parties could erode the relationship between them and patients.

The warning came as the Royal College of GPs wrote to NHS Digital urging it to better communicate with the public about the plans and their options for opting out.

Critics have voiced concerns over the NHS Digital plans, which would put the medical histories of more than 55 million patients into a database available to academic and commercial third parties for research and planning purposes.

Privacy campaigners have already spoken out against the proposals, which include sharing anonymised mental and sexual health data, criminal records, and more sensitive information. The records would be scraped from every patient in England registered to a GP clinic by NHS Digital, which runs the country’s healthcare IT systems.

The Doctors’ Association UK (DAUK), a campaigning and lobbying organisation comprised of doctors, said it was concerned this would “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, said: “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.”

Prof Martin Marshall, the chair of the Royal College of General Practitioners (RCGP), said it supported the principle of improved sharing of data for important healthcare planning and research, but it was “critical that this is transparent and that patients have confidence and trust in how the NHS and other bodies might use their information”.

He said the RCGP and the British Medical Association were engaged with the planning of the new data collection, adding it would continue to lobby “NHS Digital to ensure appropriate safeguards are in place for how the data collected is used”.

Marshall said: “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.” 

The health secretary, Matt Hancock, first announced the plan in April via blog posts on the NHS Digital website and flyers at GP surgeries.

However, the advocacy group MedConfidential told the Financial Times: ‘They’re trying to sneak it out, they are giving you six weeks nominally and if you do not act based on webpages on the NHS Digital site and some YouTube videos and a few tweets, your entire GP history could have been scraped, never to be deleted.”

The data will be anonymised and given “codes” that can be used to reveal the identity of the data’s owners if there is a “valid legal reason”. Privacy campaigners have said the plans are “legally problematic” and patients have been given a limited window to opt out. The deadline for opting out is 23 June and can be done by patients completing a form and giving it to their family doctor. 

The digital rights campaign group Foxglove has written to the Department of Health and Social Care. “Very few members of the public will be aware that the new processing is imminent, directly affecting their personal medical data,” their solicitor, Rosa Curling, said in the letter.

A spokesperson for the British Medical Association said it was engaged in the planning for the collection and “made representations on behalf of GP practices” to “ensure stronger arrangements were put in place over the security and intended uses of the data collected, and to minimise administrative burden for practices”.

“We will continue to hold NHS Digital to account,” they said.

The UK’s data regulator is reportedly producing a data protection impact assessment about the plans.

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.

“We have engaged with doctors, patients, data, privacy and ethics experts to design and build a better system for collecting this data. The data will only be used for health and care planning and research purposes, by organisations which can show they have an appropriate legal basis and a legitimate need to use it.”

They added: “We are exploring further options to expand our communications approach and remain committed to being transparent with patients and the public about the collection and use of data.”

Plans for the largest seizure of GP data in NHS history are unlawful and the government faces an urgent legal challenge unless the scheme is stopped and changed, says a pre-action letter sent today on behalf of five organisations and a Conservative MP. 

Tech-justice nonprofit Foxglove are supporting this group – Just Treatment, Doctors’ Association UK, the Citizens, openDemocracy and the National Pensioners Convention, as well as David Davis MP – to take the scheme to court. 

The coalition’s legal letter, sent today to the Department of Health and Social Care and NHS Digital, warns that unless the government pauses the grab of confidential patient data from GPs and seeks meaningful patient consent, the group will seek an injunction to halt the scheme. 

The urgent move follows a decision by DHSC and NHS Digital to seize the entire GP record of all 55 million patients in England. 

A deadline of just six weeks, by 23 June, has been set for patients to learn about the scheme and opt-out if they want by submitting a form to their GP. If a patient fails to opt out by the deadline their health record goes into the central store on 1 July and will not be deleted. 

The coalition bringing this case say that rushing this major change through with no transparency or debate violates patient trust, and that doing so without patient consent is unlawful. 

The government admits companies will be allowed to access the data – without being clear which companies, for what purposes, or what safeguards apply. The health data being collected is not anonymous; it is pseudonymous, so people’s records can later be re-identified. The government’s documentation admits that re-identification will be permitted in some cases. 

The pre-action letter says that this rushed process gives patients no meaningful chance to opt-out, and excludes older people and others who may not be online. It also says patient rights to opt-out only have meaning if the government is clear and transparent about which third parties will access the data – and for what purpose. Without patient consent, the letter says, the process is unfair and likely to undermine people’s trust in their GPs. For these and other legal reasons, the letter says, the scheme must be paused and a real process for informing and involving patients must be built in. 

On 12 May, the government announced the scheme, called ‘General Practice Data for Planning and Research’ (GPDPR). Using a Direction of the Health Secretary to NHS Digital, and a legal notice to all English GPs, the scheme orders GPs to hand over their full medical record on every man, woman and child in their practice. The data being taken includes sensitive issues like depression, autism, STIs, erectile dysfunction, and addiction – for planning, commissioning, and commercial research. 

The scheme is in many ways a repeat of the disastrous 2014 care.data system, in which the government last tried to collect partial GP records, but did not explain to people the terms on which companies would access the data. The new scheme is broader – it collects more sensitive records on people – and it doesn’t even send people an individual leaflet to give them a chance to opt out.

The groups are today launching a crowdfunder to cover the cost risk of the legal claim: https://www.crowdjustice.com/case/stop-the-nhs-gp-data-grab/

“GPs were barely informed of this major change – how are patients expected to know about it? DAUK supports safe, consensual uses of patient data, including for health research. But we want to see it done in a way that keeps faith with patient trust and won’t erode the relationship between clinician and doctor. Patients need to give informed consent to their data being used. We can’t see why the government won’t do this in a less rushed and more transparent way.” 

Dr Rosie Shire, a GP at Doctors’ Association UK,

“Look, if everyone from senior citizens to GPs to Tory MPs are prepared to sue over this process, something’s terribly wrong. Trust is everything in the NHS, and the way the government has rolled this scheme out has eroded patient trust. We’re having to go to court urgently because of the government’s decision to bounce us all – giving everyone just six weeks to decide what we want done with our health data. We hope the government will see sense but if not, we’re ready to fight for patients’ right to decide – and to defend the relationship of trust between patients and their family GP.” 

Cori Crider, Foxglove Director,

Foxglove is a non-profit that exists to make tech fair. Their prior successful legal challenges include NHS contracts to controversial US data firm Palantir, an algorithm the Home Office used to process millions of visa applications, and the disastrous A-level algorithm. 

Patients who wish to opt out can do so with the help of medConfidential’s guide here: https://medconfidential.org/how-to-opt-out/

The coalition’s lawyers are Rosa Curling, Foxglove Director as consulting solicitor at Scott-Moncrieff & Associates, and Robert Palmer QC and Julianne Morrison of Monckton Chambers.

The Doctors’ Association UK (DAUK) are supporting overseas doctors from COVID-19 red list countries who are unable to travel to the UK to complete an exam required to be eligible for medical training in the UK. 

The forthcoming exam -The Stage 2 Clinical Assessment run by the UK Foundation Programme Office* (UKFPO) overlooks current travel limitations enforced by the COVID-19 pandemic, which have left many overseas applicants unable to progress their applications for the Foundation Programme, to enable them to work in the UK. 

Passing the Clinical Assessment is mandatory for candidates who graduated before August 2019 and now wish to apply for a foundation doctor post. The second stage of this Assessment is a test of a doctor’s clinical skills by way of an Objective Structured Clinical Examination (OSCE)-style, face-to-face exam, due to take place on the 26-27^th May this year. 

Pandemic restrictions currently limit travel from countries in the Red List (including Pakistan, Philippines, Bangladesh, Kenya, Zimbabwe and most recently, India), meaning that candidates cannot travel from these countries to participate in the exam.

A candidate who wished to remain anonymous from one of the listed countries raised concerns with DAUK saying, “this directly goes against the UKFPO duty of fair treatment for all applicants and discriminates against those who are unable to travel due to extenuating circumstances.” “Prior correspondence reassured that no candidates would be disadvantaged for their circumstances. However, the UKFPO have indicated its intention to withdraw myself 

(and other applicants in red list countries) if we fail to attend the assessment in person in May, despite having paid the non-refundable assessment fee (£850) and already being allocated to a UK foundation post for August.”

This doctor and colleagues wrote an open letter to the UKFPO proposing reasonable adjustments to the examination, including rescheduling the date of the assessment and/or adapting the format for delivery via an online platform to enable participants from overseas to complete the assessment. These suggestions have been rejected.

Dr Jenny Vaughan, DAUK Chair:

“DAUK supports the adjustments proposed in the letter, to enable experienced international colleagues to join our NHS workforce. These candidates have already invested significantly in the process of coming the work in our system and many have served resignation notices in their current posts. Passing this exam is their key to taking up roles in the UK, and we urge the UKFPO to find solutions for these candidates, to enable them to contribute to an NHS that is much in need of their skills.”

Freya Rhodes, Medical Student Representative DAUK:

“This is huge concern for these qualified doctors who are ready to work in the UK. 1 in 7 NHS workers are from overseas and their vital contribution to the workforce must be recognised.”

“It is a very challenging time to be entering the NHS. Considering current workforce shortages and high levels of staff burnout, inadequate exam provision is an unnecessary obstacle. The UKFPO must make reasonable adjustments to ensure equal access to training and allow as many new doctors as possible to start work in August.”

CONTACT 

Press@dauk.org

FURTHER INFORMATION

*The UK Foundation Programme

-The UK Foundation Programme Office (UKFPO) manages the Foundation Programme – a two-year structured programme of workplace based training for junior doctors, that forms a bridge between medical school and higher specialty training, and allows trainees to practice as a fully registered doctor in the UK.

-The UKFPO is responsible for allocating places on the programme to all qualifying medical graduates in the UK. They also manage applications for non-UK graduates who are eligible to apply.

-The Clinical Assessment is a mandatory requirement for anyone who qualified from medical school on or before 4^th August 2019. This includes many overseas doctors who may have qualified before this date, and gained valuable experience practising as doctors elsewhere.

The Williams review concluded that removing the GMC of its right to appeal against MPTS decisions would help to address the mistrust of the GMC among doctors and contribute to a culture of openess that is central to improving patient safety.

Article from Practice Management Magazine

It’s 4am and resus looks like a bomb has hit it. We have had to open almost every piece of kit available to keep the patient in front of us alive. Wearily, I register there’s blood spattered across my shoes.

It’s been a long night, and there’s still another five hours to go.

“What will you do after this?” the nurse asks. I’d love to say I’ll go for a run before crawling into bed. But on night shifts it’s all I can do to eat, sleep, work, repeat.

“No, I mean after intensive care,” they say. “I think I’m going to retrain.”

It’s a conversation I am having more and more. Some days, it seems like all of my colleagues are making exit plans. I can’t blame them, really.

How did things get this bad? In truth, it was years of neglect of both the NHS and its staff. Decisions made under the previous health secretary came home to roost as the pandemic hit. Cost-cutting was a gamble, and ultimately the NHS paid the price. Months later, the UK would end up with one of the worst death rates in the entire world.

The psychological harm of this is barely talked about, but it is palpable every day in the ICU. While some people are suffering from post-traumatic stress disorder, almost everyone is experiencing some form of moral injury, our own epidemic among healthcare professionals.

There is no doubt that our jobs are hard, but they are made so much harder by things that really should have been fixed a long time ago. These are called the “legacy issues”, well known secondary stressors that exacerbate moral distress.

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.

“None of this is normal in the NHS. At our trust, we have three times the level of ICU patients that we had at the same time last year. We have converted several floors of our hospital to intensive care. We have redeployed multiple members of staff consultants…people from all specialties have been redeployed in the roles that they don’t normally fulfil”

“There is an immediate, short, medium and long term consequence that needs to be looked at. The immediate term consequence is our ridiculously high numbers of coronavirus cases that’s going on at the moment. Our short term goal is vaccination to try and drive that down…and our long term is to deal with our ballooning waiting lists and our mental health crisis”.

He also went on to respond to comments made by a senior MP earlier this week:

“This is basically a crisis situation…I would hope that an elected member of parliament who has people dying in his constituency would help to acknowledge that””It is not an admission of defeat to accept that one was wrong in making comments in the past…that is something which is difficult to do in politics, but unfortunately it is necessary to do in health. Otherwise we don’t learn from our mistakes. And if we do not learn from our mistakes in a pandemic situation, people die.”

“MedSuppyDrive UK started last year. There was PPE in our labs not being used and I thought we could redirect it to the frontline. We’re volunteer run. We started off writing to labs and businesses—the donations came flooding in and we had 100 volunteers within a week. To date we’ve circulated around 380,000 items of PPE.

“More recently we started thinking about something more sustainable.

“In the US, they have guidelines for reusables and for decontamination. Why don’t we have guidance here? PPE provision to the NHS frontline has not been adequate. The government says there are not enough FFP3 masks to go around. Our solution? Look at reusables. Anyone who’s facing covid positive patients more than six hours a day should be thinking about reusables. Intensive care units are very well facilitated, but the forgotten few are staff in theatres and those in emergency departments, covid-19 positive wards, and acute medicine wards that see admissions.

“As a charity, our fundamental mission is to protect workers. We’re hoping that we can get the backing of the medical bodies and unions. We’re grateful to be working closely with the Doctors’ Association UK, which has supported us and advocated for us with stakeholders nationally. Changing culture and normalising reusables is one of the main things we want to do. There is almost a stigma associated with their use. We’re also working with manufacturers to see if we can innovate and help them make their masks—which have been geared to the construction industry—more appealing to the healthcare industry.

“We’re hoping trusts will pick this up so we can trial getting people trained up and fit tested for reusables, and then have regular auditing feedback from users on how we can improve compliance, on decontamination matters, and on how we can streamline. There’s a centralised NHS procurement team who are, I am told, looking into this nationally. Having a centralised stamp of approval is what everyone has been looking for, so that the legal concerns that everyone has will hopefully disappear. The main inertia is that no one is willing to put their stamp on it to say, ‘look, this could work’.”

She explained that: “I have had abuse on social media, I am lucky, unlike my colleagues, this has not happened in person. But this is a small but vocal minority, and we so appreciate the vast majority of the public who support us and those staying at home.”

She went on to speak about the video which recently emerged of members of the public obstructing patient care based on misinformation, adding that “They put themselves at risk. They put the staff at risk. And ultimately, what we really care about as doctors; they put the patients at risk.”

In response to a senior Tory MP saying that figures are being manipulated to exaggerate the scale of Coronavirus, Dr Samantha Batt-Rawden spoke about her dismay, and challenged the MP to volunteer in her local ITU.

In the latest example of a growing trend, a group of people were ejected by security from a Covid-19 ward last week as one of them filmed staff, claimed that the virus was a hoax and demanded that a seriously ill patient be sent home.

In the footage, a man behind the camera remonstrates with a consultant, who tells him that a patient will die if his oxygen tube is removed. When asked about what treatment is being given, the consultant explains that the patient has coronavirus pneumonia affecting both of lungs and is being treated with steroids and antibiotics.

The man behind the camera says that patient should be brought home and the treatment replaced with vitamin C, vitamin D and zinc, but is told by the consultant: “None of those are proven treatments for coronavirus.”

The Doctors’ Association UK (DAUK), a union representing frontline medics, said it was unacceptable that staff working themselves into the ground to keep patients safe were having to worry about a new threat from Covid deniers and anti-maskers. It said Twitter and Facebook had a responsibility to ensure those breaking into hospitals to film footage were not given a platform.

“Staff are exhausted and are running on fumes. They should not be having to deal with abuse and even death threats on social media,” said Dr Samantha Batt-Rawden, the president of the DAUK.

“Nor should they be worried about turning up for their shift due to crowds of people chanting ‘Covid is a hoax’ outside hospitals full of patients who are sick and dying. This is decimating morale, but worse still, could be obstructing patient care.”

The incident at East Surrey hospital, where police issued fines and warnings and continue to investigate what they described as an “escalation” on social media, comes after the arrests earlier this month of four men allegedly filming inside hospitals in the West Midlands and Worcestershire, and of a woman in Gloucestershire.

Read the full story here.