Contrary to widespread reports, GP surgeries have remained open throughout the Covid-19 pandemic. Official NHS data confirms that more GP appointments are being offered than ever before, and GP teams continue to provide over 90 percent of all NHS consultations. 

Practices were already struggling prior to the pandemic and are now facing near-impossible challenges in the face of a “tsunami of demand”.

Attendees at this briefing heard from frontline GPs who described:

• The causes of rising demand on our services
• The increasing cases of burnout amongst GPs
• The damaging effects of unproven bureaucratic interventions
• Consequences of the demoralising, harmful narratives against our profession
• Proposed solutions to our challenges
• How you can help us help our patients

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

Dr Kaveri Jalundhwala, co-chair of DAUK, urges youths to get a jab saying Covid patients are ‘getting younger and younger’, as well as highlighting the risk of long Covid, having experienced the condition herself.

Increasing numbers of young people with coronavirus are being admitted to hospital – including to intensive care wards – doctors have said, begging them not to “suffer unnecessarily” and to get the vaccine.

During the first weekend after the majority of Covid restrictions were lifted in England there were pictures of crowded nightclubs, filled with revellers not wearing masks or social distancing. Medics raised the alarm that unvaccinated young people urgently needed to protect themselves against infection to avoid serious illness.

The warning came as scientists gave a cautious welcome to the fifth day in a row of falling Covid case rates – the first time that cases have seen a sustained fall without a national lockdown. These figures, however, do not include the impact of 19 July’s easing of restrictions.

The UK recorded 29,173 new cases on Sunday, down from 48,161 the week before. But NHS England said one-third of 18- to 29-year-olds had still not had at least one dose of the vaccine – a figure that falls to one in 10 for the whole adult population.

While young people are generally at a much lower risk of dying from Covid, doctors say they are increasingly witnessing them become severely unwell. Dr Samantha Batt-Rawden, senior intensive care registrar, said the patients they were seeing were “getting younger and younger”.

“The vast majority of those requiring intensive care are unvaccinated: some of them will die. It is heartbreaking for us as NHS staff to watch people suffer unnecessarily knowing that this almost certainly could have been prevented by the vaccine,” she said.

“We are seeing patients in their 30s, or even in their 20s, who are fit and have no other medical problems on ICUs [intensive care units]. As an ICU doctor I am begging you to have the vaccine. Please don’t let not having the jab become the biggest mistake of your life.”

Prof Adam Finn, a member of the Joint Committee on Vaccination and Immunisation and from the University of Bristol, said there had been close to 200 admissions, with a mean age of 40, in the city during the Delta variant wave.

Speaking on LBC on Sunday, he said: “We have had people under 30 on our intensive care unit and also requiring high-level oxygen therapy. This is not always trivial in young adults. There are younger people really getting seriously ill at the moment, so that’s one good reason to think about having the vaccine.

“But the other one is, these vaccines now – it’s clear – do reduce the risk of not only getting the infection but passing it on to other people.”

The latest data from the Office for National Statistics shows that coronavirus in England is now largely an infection among young adults, with cases in 16- to 24-year-olds almost six times more common than in 50- to 69-year-olds.

Many experts had urged the government to postpone the easing of restrictions to allow more adults to get both Covid doses. On Friday, Prof Robert West, a health psychologist at University College London and scientific adviser to the government, accused ministers of allowing infections to rip through the younger population in an effort to bolster levels of immunity before the NHS faces winter pressures.

Dr Adrian Boyle, vice-president of the Royal College of Emergency Medicine, said it was critical young people got vaccinated. He said that while young people getting ill with coronavirus was rare, “suddenly there’s quite a lot of them just because there’s so much Covid around”.

Saffron Cordery, the deputy chief executive of NHS Providers, which represents hospital trusts, said members were reporting “a much higher proportion of younger patients, under 40”.

Cordery also warned of the risk of long Covid. Government data published last month suggested more than 2 million adults in England have experienced coronavirus symptoms lasting more than 12 weeks, although the risk was found to rise with age. “It is important that everyone – whatever their age – understands the risks of remaining unvaccinated,” she said.

Dr Kaveri Jalundhwala, co-chair of Doctors’ Association UK, a campaigning and lobbying group, also highlighted the risk of long Covid, having experienced the condition herself. “Even if only 5% of people are getting long Covid, that’s going to be a huge number of people having a very debilitating condition that might last for a year or longer,” she said.

“It’s more debilitating than people realise. People can’t do their normal jobs any more, they can’t do normal activities, people struggle to walk or do any kind of exercise. We absolutely recommend everybody to get both vaccines as soon as possible, especially with the Delta variant just everywhere at the moment.”

The shadow health secretary, Jonathan Ashworth, described levels of infection among young people as alarming, saying: “Ministers must do more to promote vaccination, ensure young people have time off to get jabbed and open more pop-up vaccination clinics targeted at young people.”

The impact of Covid, and particularly the Delta variant, on young people is also of increasing concern in other countries. In the Netherlands, curbs on bars, restaurants and nightclubs were reimposed after new cases rose sevenfold.

In Australia, the Nobel prize-winning immunologist, Peter Doherty, said on Sunday: “Young people are at considerable risk and at higher risk than with the earlier variants of Covid. Young people shouldn’t think they’re at no risk or even minimal risks. Because it’s going to kill.”

The government’s proposed introduction of vaccine passports has caused significant backlash among Conservative MPs and it is unclear whether the government will be able to assemble a majority behind it.

Ministers are currently considering whether to make them mandatory for Premier League football matches and other events with more than 20,0000 attenders, having already announced their introduction for nightclub entry and “other venues where large crowds gather”.

Finn suggested the move could backfire and a more gentle approach was needed.

“If people begin to feel they are being kind of forced against their will to do something, then in a sense that’s quite a damaging thing to do because it gives people the impression [that] vaccination is something being imposed on them from outside,” he said.

A Department of Health and Social Care spokesperson said:“We have one of the highest Covid-19 vaccine uptake rates in the world. The latest ONS (Office for National Statistics) data shows 90% of adults under 30 have said they would come forward for a vaccine and three in five adults aged 18-24 have already received one dose in England.

“We have worked closely with the NHS to provide information at every opportunity on how to get a vaccine and its benefits – including partnerships with high-profile celebrities, social media platforms, and dating apps to encourage uptake among younger age groups.

“We are continuing to do everything we can to boost uptake for younger people and urge all those who have yet to book their appointment to do so as quickly as possible to help protect themselves and their loved ones.”

Read the full article here.

Unions demand fair compensation for dozens of doctors now unable to work because of debilitating symptoms, as DAUK’s Co-Vice Chair, Dr Kaveri Jalundhwala comments.

Read the full article here.

The Prime Minister has previously told NHS staff “We owe you more than words can say” Now he must back up his rhetoric with action

Dr Kaveri Jalundhwala-Vice Chair DAUK

Read the article online here

6th March 2021 FOR IMMEDIATE RELEASE

Many NHS staff finished another exhausting hospital shift this week to devastating news regarding the government’s recommendations for NHS staff pay. This represents an unconscionable affront to frontline NHS staff in all roles who have endured a year of torment working without adequate PPE, worrying about risks to their own health and mourning the death of colleagues.

It should be noted that higher pay rises (2.1%) were previously promised by the NHS Long Term Plan prior to COVID. The Chancellor vowed to give the NHS “whatever it needs” to tackle the coronavirus crisis (March 8th 2020). The latest recommendation of a pay rise of 1% therefore represents a conscious policy choice to insult NHS staff rather than that of economic reality and ignores a decade of real terms pay cuts (see figures at end of document from independent research from The Nuffield Trust and The Health Foundation) which has seen pay cut by £600 per employee over the last decade.

Dr Kaveri Jalundhwala, Vice-Chair Doctors’ Association UK said: The Prime Minister has previously told NHS staff that, “We owe you more than words can say” for their work during the COVID-19 pandemic. Now he must back up his rhetoric with action and act to pay NHS staff what they deserve after the last year of hell. If he fails to do so, it will be clear to the public that his priority is not the NHS.

A newly qualified nurse starting in 2020-21 would be earning about 3% less than one who started in 2010-11, once we account for inflation and the impact of pay freezes and caps. This is simply unacceptable. This isn’t a media story for the government to spin. This isn’t an election to score political points. These are livelihoods of exhausted NHS staff who have risked their lives to protect, treat and vaccinate the country in the midst of an unprecedented pandemic.

The Doctors’ Association challenges the government to explain to the country how it is morally or economically justifiable to cut the real-terms pay of staff that saved the life of the Prime Minister in the last year, while paying £7000 a day to management consultants for the outsourced test and trace program. Frontline staff are already shell shocked and considering if they want to keep working in the NHS after the betrayals they have experienced in the last year and previously.

This latest knife in the back may represent an insurmountable barrier to staff retainment and worsening NHS staff vacancies which already stand at over 100,000. The NHS is facing a retention crisis, and this recommendation of 1% maybe the final nail in the coffin.

Doctors’ Association UK 1-2-1 The Barracks Lancashire, LA1 4XQ press@dauk.org www.dauk.org 6th March 2021 FOR IMMEDIATE RELEASE DOCTORS’ ASSOCIATION UK condemns Govt recommendations regarding pay for NHS staff Many NHS staff finished another exhausting hospital shift this week to devastating news regarding the government’s recommendations for NHS staff pay. This represents an unconscionable affront to frontline NHS staff in all roles who have endured a year of torment working without adequate PPE, worrying about risks to their own health and mourning the death of colleagues. It should be noted that higher pay rises (2.1%) were previously promised by the NHS Long Term Plan prior to COVID. The Chancellor vowed to give the NHS “whatever it needs” to tackle the coronavirus crisis (March 8th 2020). The latest recommendation of a pay rise of 1% therefore represents a conscious policy choice to insult NHS staff rather than that of economic reality and ignores a decade of real terms pay cuts (see figures at end of document from independent research from The Nuffield Trust and The Health Foundation) which has seen pay cut by £600 per employee over the last decade. Dr Kaveri Jalundhwala, Vice-Chair Doctors’ Association UK said: The Prime Minister has previously told NHS staff that, “We owe you more than words can say” for their work during the COVID-19 pandemic. Now he must back up his rhetoric with action and act to pay NHS staff what they deserve after the last year of hell. If he fails to do so, it will be clear to the public that his priority is not the NHS. A newly qualified nurse starting in 2020-21 would be earning about 3% less than one who started in 2010-11, once we account for inflation and the impact of pay freezes and caps. This is simply unacceptable. This isn’t a media story for the government to spin. This isn’t an election to score political points. These are livelihoods of exhausted NHS staff who have risked their lives to protect, treat and vaccinate the country in the midst of an unprecedented pandemic. The Doctors’ Association challenges the government to explain to the country how it is morally or economically justifiable to cut the real-terms pay of staff that saved the life of the Prime Registered office: The Doctors’ Association UK, 1-2-1 The Barracks, Lancashire, LA1 4XQ. Company no.: 11562124, Registered in England & Wales Minister in the last year, while paying £7000 a day to management consultants for the outsourced test and trace program. Frontline staff are already shell shocked and considering if they want to keep working in the NHS after the betrayals they have experienced in the last year and previously. This latest knife in the back may represent an insurmountable barrier to staff retainment and worsening NHS staff vacancies which already stand at over 100,000. The NHS is facing a retention crisis, and this recommendation of 1% maybe the final inail in the coffin. Registered office: The Doctors’ Association UK, 1-2-1 The Barracks, Lancashire, LA1 4XQ. Company no.: 11562124, Registered in England & Wales CONTACT Press@dauk.org 1The Doctors’ Association UK (DAUK) is a professional association for UK doctors. Run by frontline NHS doctors, DAUK campaigns for patients and the NHS as well as advocating for the medical profession.

Kaveri Jalundhwala is losing income and faces an extension of her GP training after contracting COVID-19 at work while on a hospital placement.

The uncertainty, on top of debilitating ongoing symptoms, has been very difficult.

‘I became ill on 30 March and had all the usual symptoms, and after a week I felt better and went back to work. I was sent to a COVID ward and worked there for three days while I was still coughing, but I didn’t have fever.

‘Then I got another fever, so I isolated again and then I started really struggling with shortness of breath and that’s been my primary symptom for three months. After that my main symptom was fatigue, which I’m still struggling with now.’

Dr Jalundhwala, 28, is doing an extended phased return on a GP placement in the Thames Valley.

She had three months sick pay, followed by two months working 60 per cent, and is now working 80 per cent, all remote.

‘I got the full pay while I was on sick leave but then they put me on less than full time pay, so I was paid 60 per cent for two months and now I’m paid 80 per cent.

‘Someone on the Facebook group highlighted to me that I shouldn’t have had my pay cut at all, so I’m following that up with my employers,’ she says.

Losing 40 per cent of income is always hard – especially when you still have around £26,000 in student loans still to pay off.

‘I’m lucky, I’ve got savings and my husband has a good job so we’re managing OK at the moment. But I’ve heard of people who have lost their jobs, which is just terrible.’

She is also concerned about what will happen when she rotates to her next hospital placement, which is due to be emergency medicine – something she won’t be able to do from home.

‘Hopefully I’ll be better, but there are still days when I just can’t do it, no matter how much I push myself. I think I’ll be working eight-hour shifts but I’m struggling to get in contact with anybody to find out if there’s any flexibility in this. I’ll be going to 60 per cent, so that will be a big cut in pay again.

‘It will also mean more months of working as a trainee, which is fine for me, because that’s just how it is, but it wouldn’t be fine for everybody.’

She is finding it difficult to deal with the situation, particularly as she has problems concentrating because of her long COVID. 

‘I think it would help if employers were more proactive and when people are sick for a long time, I think they should be reaching out to find out what is happening. It’s also difficult to find out information, for example what is the situation with sick pay. Some days I’ve felt I don’t have the energy to do this as well as my work, so obviously I prioritise my work. It’s very difficult all round.’

Read the full article here: https://www.bma.org.uk/news-and-opinion/living-with-covid

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

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

Background

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

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

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

Issues and recommendations

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

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

Flexibility and further information

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

Funding

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

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

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

Working hours and logistics

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

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

Reduction in workload

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

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

Information around COVID Vaccine

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

Recommendations

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

Summary

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

Dr Vinesh Patel
GP Partner, Sutton

Dr Lizzie Toberty
Salaried GP, Sunderland

Dr Kaveri Jalundhwala
GP Trainee, Thames Valley

Dr Zainab Najim
GP Trainee, Norfolk

DAUK GP Committee

NHSE agreed information being released to the public at the same time as doctors is not acceptable and will make every effort to ensure this does not repeat. As part of their media campaign, they have advised patients to wait to be contacted about the vaccine and not to contact their surgery. We welcome this move.

DAUK raised a few further concerns:

1. Practices are worrying about financial liability. We have requested more vocal and contractual support financially for PCNs taking this risk, as well as appropriate media coverage to ensure those unable to will not suffer a backlash.
2. GPs are worried that routine work will suffer at the expense of the vaccine due to staffing issues. We have asked to know what the long term strategy for this is.
3. CCGs are pressurising practices in some area. We have asked NHSE to contact CCGs and remind them to be supportive.
4. DAUK asked for reassurance that no changes will be made unilaterally to the DES without prior discussion

Download and read our full Statement here: