Dear …..,

I am concerned about the airborne spread of Covid in our work environment, especially now it is clear that the new Omicron variant is very easily transmitted through the air.

I would like to make you aware of the new updated guidance from the UK Health Security Agency, released on 21st December 2021. 

My interpretation of the guidance is that employers should make a full assessment of ventilation and air filtration in every clinical area. If adequate air quality cannot be assured, or for those who can’t keep 2m distance for patients, then PPE of a grade appropriate for airborne hazards should be provided. Local prevalence of respiratory pathogens must be taken into account within risk assessments. Currently there is a high risk that any patient or member of the public could be carrying Covid, regardless of their presenting symptoms, so airborne mitigation measures would be appropriate in all indoor spaces where patients or staff mix.

This would be consistent with the evidence that FFP3 masks reduce Covid infection in health care workers.

And with the evidence that air filters in clinical areas reduce airborne viral load.

These interventions are immediately necessary in order to fulfil legal obligations under HSE Health and Safety at Work legislation.

Financially, although some cost may be incurred in order to make these interventions, this would be more than compensated for by the savings in sick pay for staff infected at work and needing to self-isolate.

As we know, Covid is most infective just before, and around the time that symptoms develop. Daily lateral flow testing reduces the risk of someone unknowingly carrying Covid, but has a significant false-negative rate. By protecting our staff from infection, we will also be adding an extra layer of protection for patients, preventing them for getting hospital-acquired Covid.

Although not covered by this guidance, acting to reduce airborne viral load, and offering those patients who are able to wear them the option of more protective masks, would also reduce the risk to patients of hospital-acquired infection.

I would be grateful if you could implement the new guidance and evidence urgently to protect all staff and help us continue to provide excellent patient care in safety.

Yours sincerely

Harding shows just how out of touch she is with frontline workers. The NHS is already short of 84,000 full-time staff. Of the 1.28 million staff we do have, 170,000 are not British.

As we haemorrhage staff because of burnout, we need the next leader of the NHS to be someone who understands that it relies on its workforce — and this is what needs to be invested in, no matter the nationality.
Dr Ellen Welch, Doctors’ Association UK

In a letter to health and social care secretary Matt Hancock, along with the DHSC and Healthwatch – a statutory body representing patients – GPs from the Doctors Association UK (DAUK) warned that for frontline GPs, demand is ‘going through the roof’.

The group called for an urgent review after a Healthwatch report that highlighted a rise in negative feedback about GP services around the time national COVID-19 lockdowns were imposed.

The Healthwatch report said that while for many people experiences of general practice had continued to be positive through the pandemic, others had reported concerns around booking, remote consultations and access to regular checks and treatment. It highlighted ‘concerns that this would result in extra pressure on emergency services’.

GP workload

However, DAUK’s GP committee warned that if the current colossal workload being delivered in general practice was ‘still not meeting demand’, the government and NHS England must investigate.

NHS England said last month that general practice is currently delivering around 7m consultations a week including work on COVID-19 vaccinations – up around 1m appointments a week from pre-pandemic levels.

This figure is likely to be an underestimate, because data from NHS Digital do not fully reflect the number of telephone consultations in general practice – and GPonline has reported on RCGP surveillance data that show GP practice workload far outstrips pre-pandemic levelseven before COVID-19 vaccination work is taken into account.

The DAUK letter said the Healthwatch report confirmed that ‘the health of the population is suffering as general practice is drowning’.

Remote consultations

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

‘The introduction of e-consults has made us more accessible than ever, and has opened the gates to a lot of trivia, which still uses GP time and resources, sometimes inappropriately. GPs are working flat out, and it is incredibly demoralising to find that our best is not enough.’

The letter said it was unacceptable if large numbers of patients were attending emergency departments for care available from their GP practice. But it added: ‘Practices are working at and beyond full capacity which has led to unprecedented levels of burnout, sick leave and tiredness amongst GPs.

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

The letter called for reduced bureaucracy, measures to address GP burnout and staff retention, and a review into access ‘so we can work towards finding a solution that involves the whole health service working together’.

Read the GP Online article here

UNDERFUNDED GPs
Sir, Your report “More patients go to A&E after ‘struggling to see GP’ ” (Apr 17) is a huge concern, confirming that the health of the nation is suffering as general practice is drowning. Our experience as frontline GPs is that demand is going through the roof. Compared with pre-pandemic levels, primary care — GPs and community services, rather than “secondary care” involving hospitals and specialists — is offering a million more appointments per week while carrying out 75 per cent of all Covid-19 vaccinations and the largest ever flu vaccination programme to date. The introduction of online consultations has made us more accessible than ever. However, general practice has been consistently underfunded over the past ten years. At present primary care accounts for 90 per cent of NHS patient contact time, but receives 10 per cent of the budget. GPs are burnt out and working beyond full capacity. Despite this, if we are clearly not meeting the needs of our population there must be an urgent review to find out why, and a national discussion on how we want to fund our health service.
Dr Ellen Welch
Dr Lizzie Toberty
Doctors’ Association UK

Read the letter here

A coalition of medical organisations is calling for the GMC to swiftly be stripped of its powers to appeal fitness-to-practise tribunal decisions, as an FOI revealed this has happened in a further 14 cases since the Bawa-Garba fallout.

It comes as GPs were last month given 12 weeks to respond to plans for sweeping GMC reforms, including quashing the GMC’s powers of appeal. Under those plans, the law may be changed by spring 2022.

But a letter to health secretary Matt Hancock, signed by ‘coalition’ of 13 medical organisations including the Medical Protection Society (MPS), BMA, RCGP and Doctors’ Association UK (DAUK), called for this legal change to instead be included in the forthcoming Health and Social Care Bill.

The Bill is also due to start being implemented from 2022, but an MPS spokesperson told Pulse that this route would give greater certainty that the changes will actually take place, as well as likely being much quicker.

Reforms to professional regulation are often delayed and there are limits on how much reform can be introduced via secondary legislation – the proposed mechanism for the GMC reforms – while the Bill could complete its passage through Parliament by the middle of 2022, they said.

Any legislative change would deliver on a Government commitment made in 2018, when the Williams review into gross negligence manslaughter in healthcare following the case of Dr Hadiza Bawa-Garba recommended that the GMC should lose the right. 

Although the Government accepted the review’s recommendations ‘in full’, relevant legislative changes have yet to be made.

The MPS revealed that the GMC has challenged ‘at least’ 14 MPTS decision since the start of 2018, according to data obtained through an FOI request. This comes after Pulse exclusively revealed in March 2018 that the GMC had launched appeals against its own tribunal 23 times in the 10 months since gaining the right to do so in 2017 – with seven doctors struck off as a result.

MPS president Professor Dame Jane Dacre, who coordinated the letter, welcomed renewed Government commitment that the GMC should be stripped of the power but argued the move ‘should not be held up while a wide range of other complex proposals go through a round of further consultation’, almost three years after the original commitment. 

Professor Dacre said: ‘The strength of feeling on this issue from right across the healthcare community is clear to see.

‘The GMC’s power to appeal decisions made by the MPTS has led to fear across the medical profession and a lack of confidence in the GMC. Implementing this change as part of the forthcoming Health and Social Care Bill would give the profession confidence that their concerns and the recommendations of the Williams review are now being acted on.’

The powers are ‘unnecessary’ as the Professional Standards Authority (PSA) also has the authority to appeal MPTS decisions’, while the GMC is ‘the only UK health regulator’ to have such a right, she added.

She concluded: ‘There has never been a more important time to address this shortcoming.  Covid-19 has sparked discussion about the extent to which individuals should be held to account when working in pressurised and extreme circumstances, and now more than ever, the regulator needs to be able to operate in a way that instils confidence amongst patients and doctors.’

Meanwhile, Commons health select committee chair Jeremy Hunt this morning Tweeted his endorsement of the call for the ‘vital change’, saying it should be ‘actioned ASAP’.

‘[The] Bawa-Garba ruling had a chilling effect  & undermined efforts to create a learning rather than blame culture’, he said.

Last month, the Government published its plans to update legislation to enable swifter resolution of fitness-to-practise investigations, as well as quashing the GMC’s powers to appeal FTP decisions – which it has had since 2017.

A number of the proposed changes come in the wake of the high-profile case involving Dr Hadiza Bawa-Garba, which led to a review into FTP proceedings.

In 2018, the GMC said it would not halt appeals against FTP decisions until the law is changed, claiming it has a ‘statutory duty’ to do so in the meantime.

And a 2019 review found that the regulator should acknowledge its relationship with doctors has been ‘severely damaged’ from the Bawa-Garba case and that it ‘must learn’ from it.

Read the article here

(View the letter in full here)

Healthcare leaders have urged the government to speed up plans to halt GMC appeals against fitness to practice decisions – warning the regulator has used its powers more than a dozen times since its controversial appeal in the case of Dr Hadiza Bawa-Garba.

The government accepted a recommendation in 2018 from the Williams review to strip the GMC of its power to appeal against decisions by the Medical Practitioners Tribunal Service (MPTS).

The move was seen as a key step towards promoting a culture of transparency and openness in the NHS in the wake of the case of Dr Bawa-Garba. However, the regulator has yet to be stripped of its power of appeal and has continued to use it – with figures obtained by the Medical Protection Society revealing 14 appeals in total since the start of 2018.

A group of 13 healthcare organisations have now called on the government to speed up removal of the GMC’s appeal powers.

GMC appeals

The government set out plans earlier this month to press ahead with removing the GMC’s power of appeal as part of a wider programme of changes to healthcare regulation.

But the group behind the call for faster action – co-ordinated by Medical Protection Society president Professor Dame Jane Dacre – say it should be pushed through as part of the health bill currently going through parliament, and not slowed down while complex decisions are made about wider changes to regulation.

The Williams review recommendations followed the GMC’s controversial handling of the case of Dr Hadiza Bawa-Garba, a junior paediatrician convicted of manslaughter following the death of a six-year old child at Leicester Royal Infirmary in 2011.

A medical tribunal ruled that Dr Bawa-Garba should face a 12-month suspension, but the GMC appealed the ruling in the High Court and struck her off the medical register at the start of 2018 – although this was later reversed on appeal.

NHS culture

Then health and social care secretary Jeremy Hunt said at the time he was ‘totally perplexed’ at the GMC’s handling of the case – warning along with a number of healthcare organisations at the time that he was ‘deeply concerned’ about the impact it would have on efforts to create a culture of openness and transparency in the NHS around mistakes.

In a letter to current health and social care secretary Matt Hancock, 13 leading healthcare organisations have called for section 40A of the Medical Act 1983 – which sets out the GMC’s power of appeal – to be scrapped as part of the health bill currently going through parliament.

The letter was signed by Medical Protection Society, The Doctors’ Association UK, Hospital Consultants and Specialists Association, BMA, RCGP, Royal College of Surgeons of England, Royal College of Physicians, Royal College of Paediatrics and Child Health, Royal College of Surgeons of Edinburgh, Medical Women’s Federation, Association of Anaesthetists, British Association of Physicians of Indian Origin, and Medical Defence Shield.

The letter highlights the conclusion set out in the Williams review that removing the GMC’s right of appeal would help to tackle mistrust of the regulator among doctors and help to build a culture of openness – and with it improved patient safety.

Fitness to practise cases

MPS president Professor Dame Jane Dacre said: ‘The strength of feeling on this issue from right across the healthcare community is clear to see. The GMC’s power to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS) has led to fear across the medical profession and a lack of confidence in the GMC.

‘It is also unnecessary as the Professional Standards Authority has the authority to appeal decisions. The GMC is the only UK health regulator that has such a right of appeal.

‘The government agreed that the GMC should be stripped of the power in June 2018, following the Professor Sir Norman Williams review into gross negligence manslaughter in healthcare. However, until the relevant legislative changes are made to the Medical Act, the GMC can and does continue to challenge decisions.

‘The government’s recommitment to removing the GMC’s right to appeal within the recent consultation on broader professional regulation reforms is welcome. It is however almost three years since it committed to making this change, and it should not be held up while a wide range of other complex proposals go through a round of further consultation.

‘Implementing this change as part of the forthcoming Health and Social Care Bill would give the profession confidence that their concerns and the recommendations of the Williams review are now being acted on.

‘There has never been a more important time to address this shortcoming. COVID-19 has sparked discussion about the extent to which individuals should be held to account when working in pressurised and extreme circumstances, and now more than ever, the regulator needs to be able to operate in a way that instils confidence amongst patients and doctors.’

A GMC spokesperson said: ‘We have made it clear that we are not opposed to this decision [to remove the power of appeal]. The government will decide how and when to bring in these changes. As the Williams review acknowledged, we have used these powers proportionally. To protect the public we will continue to use them while our legal obligation to do so remains in place.’

Read the article here

DAUK responded promptly to Robert Colvile’s misinformed opinion piece about NHS pay in The Sunday Times.

Mr Colvile states that on average, pay increased by “2.7 per cent a year” between 2012 to 2017 for NHS workers, due to a “complex system of near-automatic individual salary bump[s] every year”.
What he is referring to is a modest annual pay increase for new staff joining a ‘banded’ job within the NHS (which incidentally, excludes 10% of the workforce, including all 120,000 doctors). It occurs for the first seven years of service in recognition of increasing responsibility-then stops.
The vast majority of NHS staff have over 7 years of service, and do not receive automatic pay enhancements, meaning an experienced nurse will have suffered a relative pay cut of 9% between 2012 to 2017, without even considering the mandatory costs involved in the job.
A 1% “pay rise” is not only insulting in lieu of the sacrifice made by NHS workers, it also does little to reconcile the chasm which has emerged by wages lagging far behind inflation.

Felix Brewer – Surgical Trainee with The Doctors’ Association UK

Read the letter here

Our full response is as follows:

Response to “Welcome to the weird world of NHS pay, where a 1% rise is a lot more than it seems” by Robert Colvile

Dear Editor,

I read with interest the commentary published by Robert Colvile in the March 07 copy of The Times, and would like to respond to number of the claims made.

Firstly, let’s talk about the “pay rise”. Public sector pay is for obvious reasons, an emotive issue. For now, let’s overlook the enormous physical and psychological cost this pandemic has had on healthcare workers, the lives lost and destroyed, and just focus on pay. 

Mr Colvile states that on average, pay went up by “2.7 per cent a year” between 2012 to 2017 for NHS workers, due to a “complex system of near-automatic individual salary bump[s] every year, and the national increase on top”

Let’s look at this in more detail using a hypothetical case study for a nurse working from 2012 to 2017. 

Jeff is a nurse who graduated in 2012 and started working in the NHS. His starting salary as a Band 5 nurse is £21,176¹. For now, let’s ignore professional fees, indemnity costs and other mandatory costs required for him to just be able do his job. At the end of his 5^th year, he would be earning £25,298, factoring in pay progression and national increases². That equates to approximately 3.6% pay increase each year. 

So Jeff, a newly qualified nurse, has done relatively well over this time period.

However, this simplified scenario ignores the fact that most NHS workers in their respective pay band will already have reached the maximum pay category (achieved after 8 years of service), and no longer receive automatic pay enhancements. If Jeff, a band 5 nurse with 8 years’ experience started work in 2012 his salary would be £27,625. By 2017, his salary would be £28,462. Relative to inflation, this actually represents a pay cut of just under 9%³.

So in reality, a 1% pay rise is not only insulting in lieu of the sacrifice made by NHS workers, it also does little to reconcile the chasm which has emerged from wages lagging far behind inflation.  

The truth is that the majority of NHS workers do not get annual pay increases. Most staff have seen consecutive pay cuts over the past decade and are now 8-10% worse off than their counterparts in the private sector⁴. 

If there really is a “flood of applications” for public sector jobs, it isn’t because of pay or pensions (the latter of which also incidentally took a significant hit with the lifetime allowance freeze announced this week).   

Finally, Mr Colvile states that “every job [in the NHS] is then placed in one of a dozen pay bands”. This is not correct. Over 10% of the workforce, including the 122,000 doctors, are not paid according to this banding system, and instead are paid according to an entirely different set of guidelines (which incidentally also lag far behind inflation). 

1. https://www.nsft.nhs.uk/About-us/Documents/Pay_Scales_2012_Final270312.pdf
2. https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/AfC-pay-bands-from-1-April-2016_FINAL.pdf
3. https://londoneconomics.co.uk/wp-content/uploads/2021/01/LE-NHS-Trade-Unions-Net-Exchequer-impact-of-increasing-AfC-pay-18-01-2021-STC.pdf
4. https://www.nuffieldtrust.org.uk/resource/chart-of-the-week-nhs-staff-pay-and-the-cost-of-living

Mr Felix Brewer

Last month, the UKFPO decided to allow SJT resits to students who had their exams terminated prematurely by Pearson Vue. While we are glad that the UKFPO listened to our letter and responded to the concerns expressed many medical students and doctors on social media, these students had by this point been left for over a month with the state of their future careers in medicine placed in limbo – yet there was no apology, and resits were offered only as a ‘gesture of goodwill’. 

DAUK remains concerned that without accountability and careful consideration of how this situation was allowed to unfold, students cannot be confident that similar situations will not happen again in the future. Unfortunately, it seems that this is not an isolated incident – just this year there have been repeated issues, including problems with Oriel during Academic Foundation Programme (AFP) applications, a lack of information about when the SJT booking system would open, and technical errors that initially prevented students from booking tests with reasonable adjustments. 

On this basis, DAUK would like to push for student representation within UKFPO, to enable students to have some say in the major decisions that affect the first two years of their training as doctors. A more collaborative relationship, and a clear point of contact within UKFPO with a defined role, could pave the way for more support, clarity and transparency in the application process. 

Please let us know if this is something you’d like to see!

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

Dr Pushpo Hossain, Doctors’ Association UK

As featured in The Sunday Times

Find out more about Overseas NHS Workers Day and how you can get involved here

Dr Gregor Smith, Chief Medical Officer for Scotland replied here: