DAUK are supporting Oxfam’s campaign to cancel the debt.

We wholeheartedly agree with the principles of universal access to healthcare. No DAUK membership fees or crowdfunding funds have been used in this campaign, which has been led by Oxfam. We have simply offered guidance and support. We hope that you can support these calls to help the poorest countries in the world

Parts of the UK have entered a third lockdown due to the pandemic, with London’s NHS frontline staff preparing for an “inevitable” coronavirus case surge following Christmas and New Year’s Eve gatherings. DW reports.

As England goes into its third national lockdown, National Health Service (NHS) workers are scrambling to accommodate COVID-19 patients in critical condition, warning that the worst is likely still to come as a new variant of the coronavirus spreads across the country.

“Even before Christmas we had to expand and send patients elsewhere because we didn’t have enough beds,” says Beth Walmsley, a pediatric nurse. The 33-year-old has recently been treating adult patients as well as children, to alleviate the burden from colleagues caring for the influx of COVID patients in critical condition.

Walmsley’s hospital is one of the dozens across the country that declared a “major incident” ahead of the holidays — requesting that staff cancel annual leave and holiday plans to work until further notice. Now they’re bracing themselves for an unknown number of people who were infected over the holiday season.

1 in 50 households infected

“We are already at such a breaking point and we still have yet to reach the predicted peak from Christmas and New Year’s Eve,” says Secretary of the Doctor’s Association of the United Kingdom Dr. Zainab Najim.

Figures from the Office of National Statistics suggest that as many as 1 million people were infected with the coronavirus last week. That is one in every 50 households in the country, and one in every 30 households in London.

UK Prime Minister Boris Johnson had encouraged people across the country to limit their holiday plans — and urged those in London and the hard-hit southeast to cancel them altogether — with a last-minute lockdown order. But NHS workers are nonetheless anticipating a spike from those who defied the orders.

Given the fact that the virus takes several days to incubate, anyone who was infected over the holiday period likely has yet to develop symptoms.

Strain on the NHS

“I think there is a feeling of ‘here we go again,’ and that it is going to be worse than the first time,” says Walmsley, describing the mood among healthcare workers who have been responding to the pandemic since March of last year.

“That is hard to wrap your head around,” she continues. “The public has no idea how bad it is.”

On top of learning new skills, adapting to the changing circumstances and canceling annual leave, healthcare workers are still one of the most at-risk groups for contracting the virus, particularly as the new, more infectious variant makes the rounds.

“Many of the (NHS) trusts have done an incredible job to increase capacity,” Dr. Najim says, giving a nod to frontline staff, like Walmsley, who have taken on additional duties as hospitals come under increased pressure.

“Unfortunately, we do not have enough staff,” she adds, pointing out that many healthcare workers are getting sick, and having to self-isolate themselves. While the UK is rolling out the vaccine amongst the public, there is yet to be a campaign that aggressively targets and prioritizes healthcare workers.

Dr. Najim fears that the strain on healthcare workers could lead to burnout — and a longer-term mental health crisis. “It is difficult for staff to take a break from everything,” she says. “Patients are much sicker, and there is going to be a big mental health burden once this is all over.”

Read the full article here: https://m.dw.com/en/covid-london-nhs-frontline-workers-brace-for-post-holiday-case-surge/a-56140367

Visiting a north London hospital as some of the first patients received doses of the Oxford/Astra Zeneca vaccine, prime minister Boris Johnson said tougher restrictions were inevitable.

‘If you look at the numbers there is no question that we are going to have to take tougher measures and we will be announcing those in due course,’ Mr Johnson said.

Scottish first minister Nicola Sturgeon, meanwhile, has announced a lockdown from midnight – with schools across Scotland to remain closed until February at the earliest.

Labour leader Sir Keir Starmer on Sunday called for a full national lockdown in England within 24 hours, and groups including the Doctors Association UK have joined calls for an emergency national lockdown.

COVID-19 lockdown

Former health secretary Jeremy Hunt – now chair of the influential House of Commons health select committee – warned that although during his record tenure in the role the NHS had faced four ‘serious winter crises’, soaring rates of COVID-19 infection in the second wave of the pandemic meant pressure on the health service was now ‘off-the-scale worse than any of those’.

Mr Hunt called for immediate closure of schools, borders and a ban on all household mixing.

Calls for rapid action to contain the COVID-19 pandemic came after the UK recorded more than 50,000 new infections per day for six days in a row.

COVID-19 cases rising

More than 75,000 people in the UK have died within 28 days of a positive COVID-19 test, and on 28 December 23,823 were in hospital with the virus – more than the number at the peak of the first wave.

DAUK vice chair Dr Natalie Ashburner said: ‘We acknowledge that these decisions are far from easy to make but the rapid of acceleration of the virus is deeply concerning and the current measures don’t appear to be containing transmission of the virus.

‘For the sixth day in a row over 50,000 transmissions have been recorded and the death toll is climbing inexorably. DAUK is particularly worried that things will get even worse as the effects of Christmas and New Year are fully realised.’

Dr Zainab Najim of the DAUK GP committee said: ‘We are in the midst of the toughest winter the NHS has ever seen, exacerbated by the new highly transmissible strain of COVID-19.

‘Sickness rates among NHS staff have doubled to trebled compared to last winter and there are real worries that safe patient care could be compromised by the sheer number of patients needing care and staffing ratios not seen in peacetime.’

Read the full article here: https://www.gponline.com/tougher-measures-imminent-hunt-warns-covid-19-crisis-off-scale/article/1703589

GPs have expressed frustration that non-frontline hospital staff were being given access to the Pfizer/BioNTech Covid-19 vaccine ahead of primary care.

The Doctors’ Association UK have written to health secretary Matt Hancock over concerns that many frontline staff, including GPs, have not heard anything about when they would be vaccinated.

NHS England had advised GP sites administering the jabs to give spare leftover jabs to staff members identified as being most at risk.

But other frontline GPs have been told by their CCGs that they were not yet a priority.

GPs in Surrey, Nottinghamshire and Cardiff were among those told they could not yet book a Covid-19 vaccine appointment despite it being freely offered to hospital staff.

In response to complaints about CCGs taking differing approaches on vaccination of primary care staff, NHS England director of primary care Dr Nikki Kanani said on Twitter: ‘Primary care staff absolutely can and should be vaccinated according to risk assessment.’

Guidance from the Joint Committee on Vaccination and Immunisation is that frontline health and social care workers are of top priority alongside care homes and those aged over 80 years old.

The advice is that ‘frontline health and social care workers at high risk of acquiring infection, at high individual risk of developing serious disease, or at risk of transmitting infection to multiple vulnerable persons or other staff in a healthcare environment, are considered of higher priority for vaccination than those at lower risk’.

Dr Prakash Kachhala, a GP in Nottingham, said there had been lots of confusion over risk assessment of healthcare staff.

‘Our CCG have told us that primary care staff should not book vaccination slots at our local hospital hub, despite some ringing the hub and being offered the vaccine and getting it done.

‘No risk assessments are being done to ensure the higher risk get it. It’s very worrying for primary care staff.’

Another GP in Nottinghamshire, Dr Shan Hussain, told Pulse he had written to the CCG expressing concern about the delay in primary care staff accessing the vaccine. 

‘As GPs, we are front-facing and have been seeing patients throughout the lockdown (despite media reports to the contrary). And as you will know, over 90% of all NHS consultations occur within primary care.

‘Many of us are high risk, BAME, and have pre-existing medical conditions. The decision to delay our vaccination has not only placed our staff at risk compared to secondary care workers, but is also damaging to morale within the workplace,’ he said.

He received a response from the accountable officer agreeing that there was a need to prioritise the highest risk staff and teams were revising plans to ensure JCVI recommendations were met.

‘As the vaccine becomes more widely available, I think access to the vaccine will improve significantly. Thank you for everything you are doing to support our local health services,’ the response said.

Dr Lis Galloway, a GP in Surrey, said the CCG had told them there was no provision for GPs to be vaccinated yet.

‘It’s care home staff, hospital staff and over 80’s only. It’s terrifying given we are in the South East.

‘We are still tier 2 officially, but it’s only a matter of time before we move into tier 4 as in the rest of Surrey considering the number of positive swab results I’ve seen from the weekend.’

She said some GP colleagues had been vaccinated after walking into the hospital hub but others were turned away.

‘There is no consistency and as someone who is seeing Covid cases and with additional risks, it extremely disheartening to see hospital admin staff being prioritised over frontline health workers.’

A letter to general practice from Surrey Heartlands CCG apologised for any confusion but said the hospital hub had not been commissioned to deliver vaccines to primary care or community staff.

It said that when community vaccine sites had empty appointments they had been proactively phoning neighbouring GP practices and inviting staff in for the vaccine.

‘Unfortunately we are not yet in a position to offer a system wide vaccination service to primary care staff until the initial cohort of priority patients have been vaccinated.

‘However, as vaccine supplies increase in the New Year and as we open up the mass vaccination site/s we will ensure that GPs and patient facing primary care staff are contacted and offered an appt,’ the letter said.

Dr Zainab Najim, Secretary of the Doctors’ Association UK and a GP registrar criticised the lack of top down communication from the Department of Health over vaccination of front-line staff amidst news of a more transmissible strain of Covid-19.

‘Without a universal policy to vaccinate frontline patient-facing staff as a priority, and no review of current PPE guidance, we could be facing avoidable staff sickness and absence over the already difficult winter months.’

The full article is available here: https://www.pulsetoday.co.uk/news/clinical-areas/immunology-and-vaccines/gps-express-frustration-at-not-being-prioritised-for-covid-19-vaccination/

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

“It’s very difficult to ask doctors to say to their patients, the elderly and vulnerable, sat in front of them, ‘Well, actually, we’ve chosen to delay this.’ And don’t get me wrong, GPs are desperate for this vaccination rollout to be a success. It’s the only way to get us out of the pandemic. But it has to be done with frontline clinicians aware of the evidence, with access to up to date knowledge that’s led to this decision.”

Dr Zainab Najim, DAUK

In the face of rising demand, medical leaders have told The BMJ that some hospitals are having to ration oxygen, staff are being asked to work extra shifts, and patients are being treated in the back of ambulances because hospitals have no space.

As at 30 December 22 713 people in England were in hospital with covid-19, 1854 of whom were being ventilated.1This is higher than the previous peak of 19 000 patients in April. As a result, most of England has now been moved into the highest tier of restrictions, similar to lockdown.2

Saffron Cordery, deputy chief executive of NHS Providers, said that in the past seven days the number of patients in hospitals in England had risen by 27%, with an increase of 35% in critical care beds. “We are in for a very difficult new year,” she said.

Alison Pittard, dean of the Faculty of Intensive Care Medicine, said, “It is really bad. London, the East of England, and the South East of England are under immense pressure. Critical care units are overcapacity: there are some units that are at 140% capacity, so they have patients outside the critical care units. Departments have exhausted their mutual aid in terms of transferring locally because local units are full, so they are looking at transferring patients further afield to make sure they get the care that they need.”

She added, “Emergency departments are jam packed because they can’t get patients out onto a ward in the hospital, because the ward beds are all full. That has a knock-on effect on ambulances, which are then queuing up outside hospitals because there is no cubical for the patient to go to in the A&E. It has a huge knock-on effect.”

Pittard said that if the public could just see what was happening they “might think twice about partying at New Year and might be encouraged to continue with the ‘hands, space, face,’ knowing that if they do their bit it will help us get through these next few months.”

Meanwhile, the Doctors’ Association UK said it was growing “increasingly worried about the current crisis going on in hospitals in the UK.”

In a statement the association said,

“We are hearing stories of several trusts across London and the South East having to ration oxygen, with target saturations for normal oxygenation having to be dropped as a result of fears of running out. Emails from trusts are being circulated asking already exhausted staff who have worked non-stop during the pandemic to cancel their annual leave, and consider taking on extra shifts.”

“The situation has been compared to field hospitals in active war zones, with several patients being seen and treated whilst still in the backs of ambulances, sharing cubicles in the emergency department, or lining up the corridors due to a lack of space.”

Zainab Najim, secretary of the Doctors’ Association UK and a member of its GP committee, said the government needed to provide urgent guidance and support for the NHS, as it was “crumbling.”

Read the full article here.

The article points out that this delay in vaccinating frontline staff echoes the “shambles” of PPE provision during the first wave, which proved devastating to staff safety.

“My personal experience would be that a nearby trust have patchily offered vaccines out to hospital staff. GP staff haven’t been told at all what’s going on. We may or may not be being sent slots in the new year.”

Dr Zainab Najim, DAUK

“At present there is no central government guidance on this issue and the vaccination of staff has been carried out sporadically, often on an ad hoc basis, without appropriate prioritisation.”

“Frontline staff are the greatest asset the NHS has and we should ensure we are protecting them. The impact of staff sickness is already taking its toll across the country. We can prevent further staff shortages by vaccinating our front line.”

Dr Ellen Welch, DAUK

Read the full article here.

Without a universal policy to vaccinate frontline patient-facing staff as a priority, we could be facing avoidable staff sickness and absence over the already difficult winter months. We call on Matt Hancock to act on this immediately and prevent what will be a potential disaster this winter.

Hospitals have been ordered to mobilise their “surge capacity” over new year as they face a triple whammy of soaring infections, rising staff sickness and longer patient stays.

Doctors are bracing themselves for a spike in admissions — already at their highest level since mid-April — over the next fortnight after cases increased by 57% last week.

The threat was underlined in a leaked letter to hundreds of local NHS bosses on Wednesday from the service’s chief operating officer, Amanda Pritchard. In the six-page memo on NHS winter priorities, she ordered trusts “to safely mobilise all of their available surge capacity over the coming weeks”.

She added: “This should include maximising use of the independent sector, providing mutual aid, making use of specialist hospitals and hubs to protect urgent cancer and elective activity, and planning for use of funded additional facilities such as the Nightingale hospitals, Seacole services and other community capacity.”

Hospital capacity was a problem before the coronavirus hit. The NHS has among the lowest per capita numbers of doctors, nurses and hospital beds in the western world.

A King’s Fund analysis of data from 21 countries, collected by the Organisation for Economic Co-operation and Development (OECD), found the UK had the third-fewest doctors among the 21 nations, with just 2.8 per 1,000 people, barely half the number in Austria, which has 5.1 doctors per 1,000.The UK also had the sixth-fewest nurses for its population: 7.9 per 1,000 people — way behind Switzerland, which has the most, at 18 nurses.

As for hospital beds, the UK has just 2.6 for every 1,000 people, less than a third of the number in Germany, which has the most — 8.1 beds — and leaves the UK 18th overall out of the 21 countries for which the OECD gathered figures.

“Without a universal policy to vaccinate frontline patient-facing staff as a priority, we could be facing avoidable staff sickness and absence over the already difficult winter months,” said Dr Zainab Najim, of the Doctors’ Association UK. “We call on Matt Hancock to act on this immediately and prevent what will be a potential disaster this winter.”

Read the full article here.

“I think January is going to be a very difficult time. If we’ve not vaccinated staff and we’ve got sickness going on due to self-isolation and possible Covid infection then we’re going to be in big trouble, more than we already are.”

NHS workers and police are asking to be at the front of the vaccine queue, as they plead for priority over the elderly in order to tackle a winter surge in infections.  

Medics warned of a January crisis in care if swathes of NHS staff are struck down by the virus or forced to isolate due to exposure.

The new Covid-19 strain, which the Prime Minister said on Saturday was up to 70 per cent more transmissible, has led to increased worry about the risk to staff.

Dr Zainab Najim, a junior doctor and Doctors Association UK spokeswoman, said the new strain meant the virus was more likely to get “out of control” as medical staff vaccinated vulnerable people.

She said the arrangement was affecting morale among staff, who felt “forgotten” after months of putting themselves at risk.

“I think January is going to be a very difficult time. If we’ve not vaccinated staff and we’ve got sickness going on due to self-isolation and possible Covid infection then we’re going to be in big trouble, more than we already are,” she said.

A poll carried out by the association, of 1,000 frontline doctors, found that 70 per cent had not yet received or been offered the vaccine. 

The rest of the article can be read here.