The guilt of of burdening my colleagues and abandoning patients was overwhelming. But I was going to break if I didn’t stop and take time to heal away from the pressures of the current climate

“I first realised I was burnt out when I was reduced to tears at work, after being asked to “squeeze in” an extra patient in my already overflowing clinic. I ploughed on, but the tears told me that I had reached breaking point.

Burnout is the physical, mental and emotional exhaustion caused by extreme and prolonged periods of stress in the workplace. Even before the pandemic, GPs and emergency department doctors had higher burnout scores than any other group of doctors. Now things are even worse, with burnout rates 20 per cent higher and an average of three GPs leaving the profession every day.

The demand is unrelenting. GPs are routinely working 12-15 hour days, reporting 40 or more patient contacts – way above what is considered safe. In March last year as the pandemic hit our shores, NHS England mandated the move to “total triage” in primary care to limit the spread of Covid-19, protecting both patients and staff. Almost overnight, we moved to remote telephone, video and online consults, establishing hot hubs to enable ongoing face-to-face contact if the clinical need arose.

We delivered, at short notice, 75 per cent of a mass new vaccination programme. We dealt with the backlogs resulting from cancelled secondary care work. Data from NHS Digital confirms, contrary to the reports of being closed, general practice was and is busier than ever before. Despite this, we are being shouted at by patients frustrated with delays, and being vilified by large sections of the press. This all takes its toll and GP suicide rates are now four times the national average.

I didn’t go into medicine to defend myself against untruths that general practice has been closed for 18 months (we really haven’t). I’m trying my best and working my hardest to advocate for patients in a chronically underfunded system. If I was able to simply do my job and focus on practising medicine, I could do it. But we are bombarded with so much more than clinical care on a daily basis. Then after a 13-hour day, returning home to see social media comments about GPs refusing to see patients when you’ve just seen, spoken to, or messaged 80 in that one day alone.

Our leaders are unsupportive. NHS England has informed GPs about changes in their contract via the newspapers, and the government claims to provide more funding in general practice, but attach so many strings about when, where, and how it can be spent, when actually most practices just need an extra GP or practice nurse to help take the strain.

We’re constantly hearing that we need to be resilient. Resilience is being able to recover from setbacks without brooding on them; to bounce back from pressure to your starting position. It’s not about working harder with fewer resources, or being able to shrug off abuse. Elastic is very resilient – it stretches a long way, then bounces back to its original form. But even elastic will snap if too much pressure is applied. And this is what is happening to GPs right now. We stretched and now we are getting dangerously close to breaking. And as I found, it’s only going to take one more request, one more adjustment, one more hurdle, before we snap. Every GP who burns out is one less GP to see patients, to advocate, and to care for them. It has already started, and it will continue unless things change.

I didn’t want to have time off. The guilt of burdening my colleagues and abandoning the patients I was caring for was overwhelming – I would be letting them all down. But I was going to break if I didn’t stop and take time to heal away from the unrelenting pressures of the current climate.

Burnout can be eased with medication or time off, but ultimately, for someone to recover, there needs to be changes within the workplace that caused the condition to start with. The entire system needs to change. The workload of individual clinicians needs to be reduced to a safe level without adversely affecting patient care, and to do this we need more funding, alongside more vocal support from government and leaders. If we don’t make changes, there won’t be any GPs left to see patients.”

Dr Rosie Shire has resigned from her NHS GP job

full article by Alicia Clegg in the FT

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

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

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

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

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

Read the full piece by following the above link

Listen to the full interview here.

Thousands of doctors are calling for strike action over the Government’s 3 per cent pay rise offer for NHS staff in England which they have condemned as “shambolic and derisory”.

The Doctors’ Association UK (DAUK), a grassroots lobbying organisation, said it was dismayed at the award which it said represented a real-terms pay cut as inflation is estimated to be 3.7 per cent this year. The influential group said it was “an insult” to describe the offer as fair “at a time when doctors have given their lives and livelihoods” to the coronavirus pandemic, with no clear end in sight.

It said the Government’s decision to exclude junior doctors from the offer, who make up more than 50 per cent of doctors in the NHS, was “callous in view of the large number of doctors in training who have worked tirelessly” since Covid-19 struck.

The group said it consulted members on Wednesday night and an overwhelming majority supported industrial action. DAUK plan to hold an emergency meeting with members soon to formulate its next steps.

DAUK chair Dr Jenny Vaughan said: “Any improvement on the derisory 1 per cent previously offered to NHS workers is welcomed, but 3 per cent barely takes the edge off the erosion of doctors’ pay over two decades. Doctors in the NHS have suffered a 30 per cent pay cut in real terms, and after inflation this ‘pay rise’ will ultimately be a pay freeze.

“DAUK’s campaign ‘fair say for fair pay’ demonstrated the extremes staff have been put through during the pandemic – the effects of which are only starting to be realised. It is time to pay and we hope the [doctors’ unions] British Medical Association and the Hospital Consultants and Specialists Association as well as allied health professional unions will join us in voicing our discontent – including taking industrial action.”

Health unions are to consult their members regarding industrial action following the pay offer. Nurses, paramedics, consultants, dentists and salaried GPs come under the new pay deal, which is three times higher than the Government’s initial 1 per cent offer.

Read the full article here.

Thousands of doctors have condemned the government’s “shambolic and derisory” 3 per cent pay rise offer to NHS staff in England, threatening industrial action as Covid hospitalisations soar.

Lobbying organisation The Doctors’ Assocation (DAUK) said the 3 per cent offered “does not come close to what staff deserve” and was an “insult” from the government when the NHS has been immensely challenged by the pandemic.

DAUK also said the pay offer represents a pay cut in real terms, as inflation this year is estimated at 3.7 per cent.

The pay rise covers nurses, paramedics, consultants, dentists and salaried GPs. But crucially, it does not cover England’s 61,000 junior doctors – who make up more than 50 per cent of doctors in the NHS.

Junior doctors are three quarters of the way through a separate four-year deal that gives them 2 per cent pay rises each year, but their exclusion from the 3 per cent rise was “callous in view of the large number of doctors in training who have worked tirelessly through the pandemic,” the DAUK said in a statement.

Many have been called away from their area of expertise and had to cover rota gaps due to continuous under-staffing – especially during the ongoing “pingdemic”.

One junior doctor told City A.M that the pay rise “forgot everyone who’s had their training disrupted during the pandemic or been called up early from medical school.”

But asked if the pay row would risk a repeat of the junior doctor strikes in 2015 and 2016, they said: “It’s not like the last strike, as there’s an ongoing pandemic now.”

Read the full article here.

High levels of stress are severely harming the health of GPs and their ability to provide care for their patients, doctors have told MPs.

In a parliamentary briefing on 15 July representatives from the Doctors’ Association UK and the campaigning group GP Survival said there was a crisis of “unprecedented scale” in primary care that needed urgent attention.

John Hughes, a retired GP who now chairs GP Survival, said that the pressure on practices had intensified because GP numbers had not increased in line with surging demand, and ministers’ pledges to boost GP numbers had not been delivered. Constrained funding relative to the hospital sector, negative media coverage, and high levels of bureaucracy necessitated by the NHS and regulators had also contributed to GPs feeling burnt out, he added.

“GPs are leaving at a rate of three …

Read the full article here.

BORIS JOHNSON’s decision to ease remaining coronavirus restrictions in England is prompting growing fear and calls for caution, fueling worries that a surge in infections will strain hospitals and undermine Britain’s economic recovery.

Doctors are warning that the fresh toll of the pandemic will overburden an already beleaguered National Health Service (NHS) that’s struggling to clear a large backlog of other operations, while economists expect a dip in consumer confidence in the coming weeks due to the greater perceived threat to public safety.

With social distancing and the mandatory wearing of masks due to end on July 19, Mr. Johnson is pushing ahead with dropping virus measures even as a new wave of the pandemic takes hold. Daily hospital admissions are expected to hit 1,000-2,000 per day at a peak in August and there are expected to be as many as 200 daily deaths, according to modeling by the UK’s Scientific Advisory Group for Emergencies (SAGE).

Announcing the decision on Monday, Mr. Johnson urged caution, appealing to the public to wear masks in crowded indoor spaces and on buses and trains. He said that while the general instruction to work from home would end, “we don’t expect that the whole country will return to their desks as one from Monday.” He added that businesses should plan for a “gradual return to work over the summer.”

The question is whether Mr. Johnson’s move is too much of a gamble: Though the nation’s vaccination roll out has significantly weakened the connection between rising virus cases and hospitalizations and deaths, a resurgent pandemic would mean greater pressure on the NHS and added uncertainty for businesses.

Doctors’ Association UK (DAUK), a non-profit organization, said an increase in coronavirus cases would be a “disaster” for hospitals because the NHS is already facing an unprecedented workload, with many staff self-isolating. A surge in cases will mean more disruptions to services and delays to routine treatments, DAUK said.

“The unfolding disaster which awaits us in autumn and winter is the biggest public health experiment ever seen,” said Elizabeth Toberty, a general practitioner and spokesperson for DAUK. “The government’s strategy for opening up is completely lacking in logic and stands to put both patients and public services at risk.”

A survey of 2,500 doctors by the British Medical Association found that 90% wanted masks to continue to be mandatory on public transport, and 78% wanted them to continue to be worn in shops.

With social distancing and the mandatory wearing of masks due to end on July 19, Mr. Johnson is pushing ahead with dropping virus measures even as a new wave of the pandemic takes hold. Daily hospital admissions are expected to hit 1,000-2,000 per day at a peak in August and there are expected to be as many as 200 daily deaths, according to modeling by the UK’s Scientific Advisory Group for Emergencies (SAGE).

Announcing the decision on Monday, Mr. Johnson urged caution, appealing to the public to wear masks in crowded indoor spaces and on buses and trains. He said that while the general instruction to work from home would end, “we don’t expect that the whole country will return to their desks as one from Monday.” He added that businesses should plan for a “gradual return to work over the summer.”

The question is whether Mr. Johnson’s move is too much of a gamble: Though the nation’s vaccination roll out has significantly weakened the connection between rising virus cases and hospitalizations and deaths, a resurgent pandemic would mean greater pressure on the NHS and added uncertainty for businesses.

Doctors’ Association UK (DAUK), a non-profit organization, said an increase in coronavirus cases would be a “disaster” for hospitals because the NHS is already facing an unprecedented workload, with many staff self-isolating. A surge in cases will mean more disruptions to services and delays to routine treatments, DAUK said.

“The unfolding disaster which awaits us in autumn and winter is the biggest public health experiment ever seen,” said Elizabeth Toberty, a general practitioner and spokesperson for DAUK. “The government’s strategy for opening up is completely lacking in logic and stands to put both patients and public services at risk.”

A survey of 2,500 doctors by the British Medical Association found that 90% wanted masks to continue to be mandatory on public transport, and 78% wanted them to continue to be worn in shops.

Read the full article here.

Boris Johnson’s decision to ease remaining coronavirus restrictions in England is prompting growing fear and calls for caution, fueling worries that a surge in infections will strain hospitals and undermine Britain’s economic recovery.

Doctors are warning that the fresh toll of the pandemic will overburden an already beleaguered National Health Service that’s struggling to clear a large backlog of other operations, while economists expect a dip in consumer confidence in the coming weeks due to the greater perceived threat to public safety.

With social distancing and the mandatory wearing of masks due to end on July 19, Johnson is pushing ahead with dropping virus measures even as a new wave of the pandemic takes hold. Daily hospital admissions are expected to hit 1,000-2,000 per day at a peak in August and there are expected to be as many as 200 daily deaths, according to modeling by the U.K.’s Scientific Advisory Group for Emergencies (SAGE).

Announcing the decision on Monday, Johnson urged caution, appealing to the public to wear masks in crowded indoor spaces and on buses and trains. He said that while the general instruction to work from home would end, “we don’t expect that the whole country will return to their desks as one from Monday.” He added that businesses should plan for a “gradual return to work over the summer.”

‘Unfolding Disaster’

The question is whether Johnson’s move is too much of a gamble: Though the nation’s vaccination roll out has significantly weakened the connection between rising virus cases and hospitalizations and deaths, a resurgent pandemic would mean greater pressure on the NHS and added uncertainty for businesses.

Doctors’ Association U.K., a non-profit organization, said an increase in coronavirus cases would be a “disaster” for hospitals because the NHS is already facing an unprecedented workload, with many staff self-isolating. A surge in cases will mean more disruptions to services and delays to routine treatments, DAUK said.

“The unfolding disaster which awaits us in autumn and winter is the biggest public health experiment ever seen,” said Elizabeth Toberty, a general practitioner and spokesperson for DAUK. “The government’s strategy for opening up is completely lacking in logic and stands to put both patients and public services at risk.”

A survey of 2,500 doctors by the British Medical Association found that 90% wanted masks to continue to be mandatory on public transport, and 78% wanted them to continue to be worn in shops.

Not making masks mandatory will “see a sustained and even steeper rise in infection rates across the summer,” said Chaand Nagpaul, BMA council chair. Johnson’s easing of restrictions will “mean more patients on waiting lists will suffer and wait longer for treatment,” he said.

Read the full article here.

A new system for extracting patient records has been postponed until the autumn, but GP anxieties about privacy, data security and liability remain, find Nicola Merrifield and Awil Mohamoud

As a former home secretary, Sajid Javid may know more than most about sensitivities around the state and people’s right to privacy. And – while not top of his to-do list – the NHS’s new GP patient data-sharing scheme has stoked the public’s fears.

The latest NHS scheme will see patient records extracted from practices, pseudonymised by the GP IT system and sent to NHS Digital, which will pass the packaged data to interested third parties. And it has serious implications for GPs. 

Under the scheme – named ‘General Practice Data for Planning and Research’, or GPDPR – it is up to practices to notify all their patients about the plans. On 1 September, NHS Digital will extract all patient data from GP records, except for patients who have opted out and whose opt-outs have been processed by GPs. Future data will then be extracted routinely, until a patient opts out. 

This will, of course, be a significant burden for GPs at a time when they are already facing huge workload. But workload is only part of the problem. GPs are still unclear about their obligations, and a case led by campaigning organisation Doctors’ Association UK (DAUK) is currently going through the court to establish the scheme’s legal basis.

But perhaps the biggest effect of the scheme – or, more accurately, the publicity around it – will be on the GP-patient relationship.  There are even suggestions that patients will be less willing to come forward with health concerns due to worries about privacy.

All this is set to come in over the summer. But there has already been a level of drama not normally associated with the subject of data processing. 

Rocky start

The scheme started to pique the public interest in early June (after being reported in Pulse, of course). 

Media reports focused on campaigners’ warnings that it would potentially make sensitive patient data available to private firms.  

This includes patients’ full history, not just any future changes to their records. This means it goes further than the previous controversial scheme, care.data – which itself was completely ditched in 2016 after becoming too toxic due to accusations of the NHS selling off the data to private companies. 

Originally, GPs were given just over a month to inform patients about the scheme and warn them they had until 23 June to opt out.

As the protests grew, the BMA and RCGP called for a delay to implementation due to the tight deadline, alongside fears of the data being sold to private companies. Meanwhile a group of organisations, including DAUK, threatened legal action unless the deadline for opting out was extended and ‘meaningful patient consent’ obtained.

On 8 June, the Government duly announced a delay to the data extraction until September. Health minister Jo Churchill told the House of Commons the extra time would be used to ‘talk to patients, doctors, health charities and others to strengthen the plan, build a trusted research environment and ensure data is accessed securely’.

A few days later, it was announced that then health secretary Matt Hancock had roped in former RCGP chair Professor Helen Stokes-Lampard to advise on the rollout.  

Privacy concerns

The purpose of the scheme has been somewhat lost in the media outcry. NHS Digital says it is intended to extract patient data for ‘better planning of healthcare services and use in medical research’.

The system will be ‘more efficient’ at extracting data than the General Practice Extraction Service (GPES) process it replaces, NHS Digital insists. During the pandemic GPES has allowed regular patient data extraction to help plan treatments and monitor the effects of Covid-19, with data that can be shared with third parties. 

Under GPDPR, the data will be pseudonymised – meaning information that could directly identify a patient, such as NHS number or date of birth, is replaced with unique codes – but NHS Digital says it could reverse this and identify patients ‘in certain circumstances, and where there is a valid legal reason’.

However, it says the GPDPR data will only be shared with organisations that ‘meet strict criteria to use it for local, regional, and national planning, policy development, commissioning, public health, and research purposes’.

But Phil Booth, coordinator of data confidentiality advocacy group MedConfidential, warns NHS Digital’s privacy statement is too wide and that questions remain about who will have access to the information. Furthermore, he says GPDPR is ‘far bigger’ than care.data because it takes all a person’s primary care medical history.

‘Care.data was only prospective… it would have collected data going forward. This is people’s entire coded GP history on first upload and then daily thereafter for changes. It’s far bigger than care.data.’ 

Warrington GP  and GP adviser at DAUK Dr Rosie Shire agrees: ‘There will be some people who have heard vaguely that the Government is going to share this data with third parties.’

If the Government does not clearly explain the system to the public, patients could accuse GPs of betraying their trust by handing over their data. It may also make them wary of frank conversations about their health, warns Dr Shire.

‘The name “GP” is in the title of the new system and it implies we are complicit in this. I would worry it would affect the relationship.’

She adds: ‘We want this done in the right way so patients can trust us as GPs and don’t feel they’ve got to hide stuff from us in case in gets in their record and gets uploaded.’

Legal risks for GPs 

It seems unlikely that GPs, as the data controllers, would be held liable under data protection laws if a patient felt their record had been used illegally, or their privacy or confidentiality breached. 

Cori Crider, director of legal firm Foxglove, which is working with DAUK on the legal challenge against the secretary of state over the scheme, tells Pulse: ‘Everything turns on whether the secretary of state’s direction to GPs to hand off the data is lawful. If it’s [found to be] lawful, then suddenly NHS Digital will be the controller of the data, and if there is any downstream misuse they are going to be on the hook, rather than GPs.’ 

But that may not stop patients trying to sue practices if things go wrong.

Nathalie Moreno, a data protection and cyber security partner at law firm Addleshaw Goddard, warns: ‘It might be difficult to identify who made the mistake – was it the GP, a system failure? Is it clearly NHS Digital’s responsibility or the GP supplier’s responsibility?

‘In any case, the principle from [a data regulations] perspective means if anything goes wrong… the patient doesn’t need to know who caused the mistake. They are entitled to sue both the GP practice and NHS Digital.’

Despite the risks, unless the court finds the Government’s request for data to be unlawful in the DAUK case, GPs must comply. The BMA has confirmed GPs are contractually required to take part.

Opting out

GPs’ major role in this will be around opt-outs. They will have to opt patients out who request it. Patients can only opt out of having their historical health record data extracted on 1 September by filling in a Type-1 opt-out form and sending it to their GP practice.

They will be able to opt out after that, but this will only apply to future data – their historical data will already have been extracted and will be retained.

Before the recent delay, NHS Digital imposed a deadline for patients to opt out a week before the data were extracted, giving GPs a bit of time to process any opt-outs. However, following the delay, NHS Digital removed a deadline for patients, leaving GPs to determine the cut-off point to ensure opt-outs can be processed in time.

The BMA is not happy about this. GPC England executive team IT lead Dr Farah Jameel says: ‘The public needs a clear deadline for opting out, with clear instructions on how to do this if they wish. 

‘We have been urging the Government and NHS Digital to consider making the process of opting out simpler, and in effect remove any additional burden [that] large volumes of Type 1 opt-outs could place on already under-pressure general practice.  

‘NHS Digital must also make clear to patients what will happen to their data if they do not opt out before the deadline, and how long this data will be stored for, as well explaining why it cannot be retrospectively deleted should patients subsequently decide to opt out.’

Hampshire GP and data privacy campaigner Dr Neil Bhatia says: ‘There is always the risk that GPs are going to suddenly end up with a whole load of forms right at the last minute.’ 

As the deadline will now be in GPs’ hands, patients could be ‘very angry’ if their opt-out requests aren’t registered in time, as ‘there is no way back’, he says. ‘It is not good for the relationship with our patients if this happens.’

The Care Quality Commission (CQC) will not launch an inquiry into its process for inspecting GP practices, despite 145 GP practices calling for one in an open letter.

In March, the Doctor’s Association UK (DAUK) published an open letter to the Commission calling for a ‘full enquiry and overhaul of the CQC inspection process’, after some ‘aggressive and unreasonable’ inspections had taken place.

In a response dated 28 June, CQC’s chief inspector for primary care, Dr Rosie Benneyworth, said that ‘bullying and harassment is unacceptable in all circumstances’ and that her ‘expectation is that CQC inspectors act professionally at all times’.

However, the letter did not address the call for a full inquiry.

Dr Benneyworth instead said that the CQC’s new monitoring approach, which was developed during the pandemic and published earlier this month, reflects ‘the pressure providers are under’ and will remain in place.

She added that she is ‘keen to continue to develop’ the CQC’s regulatory approach for general practice – in line with the aims set out in its new strategy – so that it is ‘proportionate’ and ‘helps ensure people receive safe and effective care’.

Management in Practice reported earlier this month that the CQC’s new monitoring approach set out its plan to begin ‘sampling’ services and carrying out monthly risk reviews.

A CQC spokesperson told Management in Practice: ‘While we do not intend to launch an inquiry, work has already been carried out to review our approach across all sectors, which has changed from how things operated before the pandemic. 

‘We are committed to continuous improvement and review of our processes, involving people who work in and use services along the way.’

The CQC has invited DAUK representatives to ‘discuss their concerns in person’.

Inspections ‘aggressive and unreasonable’

In its March letter, the DAUK said the CQC’s decision to resume inspections was ‘unfortunate and unacceptable’, and that they had been conducted ‘in an aggressive and unreasonable manner that can no longer be tolerated’.

It called for a ‘simplified’ and ‘evidence-based’ approach to the inspections grounded in ‘mutual respect, understanding, collaboration’ and support.

It suggested CQC inspections be reduced in frequency unless there have been concerns within the previous three to five years, and for inspections to be suspended for the duration of the pandemic.

It also said that GP teams were aware of reports that the CQC has issued threats of practice closures and fines, which have heaped ‘undue pressure on colleagues’.

It added that many practices feel ‘unable to air their grievances’ over the CQC inspection process, which can take ‘days or weeks’ to prepare for.

The 145 signatories called for a ‘full investigation into such practices and behaviours’, adding that the NHS has a ‘zero tolerance policy’ to bullying and harassment, and that they ‘demand that CQC respect our position’.

CQC inspections of services that had previously breached regulations, as well as those rated as ‘requires improvement’ without any regulatory breaches, resumed in April 2021, after routine inspections were paused in March 2020.

Read the full article here.