Grassroots lobbying group Doctors’ Association UK (DAUK) argues the current system is unsustainable and does not give GPs enough flexibility on how and where they spend allocated budgets.

It said their hands are tied, as their funding is directed by NHS England though primary care networks (PCNs) – GP practices working together with community, mental health, social care, pharmacy, hospital and voluntary services in their local area – with strict budget criteria.

The association is concerned that GP practices are not able to spend the money on extra doctors where they are needed. Its warning comes as a report published this week warned that up to half of GP posts could be vacant by the end of the decade.

Dr Lizzie Toberty, GP lead at DAUK, said: “Money that comes down from NHS England via the PCNs is very tightly controlled. It is not for GPs, nurses or new buildings, but only for other allied healthcare professionals. We’re told how much we can spend on a social prescriber or a pharmacist, but that might not be what your area needs.

“Areas within a one mile radius, never mind the whole of England, can have extremely different health population needs. Trying to stipulate from NHSE head office which type of staff can be employed in rural Lincolnshire or inner city Sunderland is ridiculous, yet it is what is happening. It’s extremely problematic.

“I’m concerned that non-doctor staff may not be able to perform GP roles to the same level of quality and effectiveness. Yes physician associates can have their role, and they are welcome additions to our over stretched teams, but as our patients are becoming more complex, you need doctors with breadth of training and experience in order to manage multiple conditions simultaneously.”

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A spate of attacks in recent months has led to calls from health professionals for trust leaders and the Care Quality Commission to do more.

A major report on racism in the NHS by the British Medical Association (BMA), to be published this month, is expected to confirm ethnic minority staff facing “debilitating” levels of racism.

Now the Doctors’ Association UK, is warning of a rise in racist attacks “in accordance with what is happening nationally”.

Dr Yasotha Browne, diversity lead at the grassroots lobbying organisation, said: “The reasons will be multi-fold, but certainly in environments where racism is not taken seriously it will be very difficult for staff to feel that they will be supported when they have concerns or are a target.”

Last week, Dr Aman Amir spoke out about “heartbreaking” arson and racist graffiti attacks suffered by his practice in Knowsley, Merseyside.

The GP, who recently took over Roby Medical Centre, said “everything we’ve invested is undone” after a fire in the early hours of the morning caused extensive damage.

Just days before the arson attack, racist graffiti was sprayed on the front and side of the practice with the words “P***” and “paedo” scrawled on the white walls, Dr Amir said. “It’s very difficult because I’m the only person of colour in my organisation. Of course, I’ve grown up in the UK and unfortunately, I have at times faced racial stuff, but very rarely in my professional life,” he said.

Dr Browne, from Doctors’ Association UK, went further – telling ithat a white doctor in the same position would never have been treated the same way.

She said: “Dr Arora’s case has alarmed the profession. Many are conveying a feeling that this would not happen to a rich well connected – in other words ‘respected’ – white male doctor. Cases like this and disparities in treatment and fairness can be a damaging deterrent to those who may otherwise speak up or ally.”

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A doctor and mother has made a personal plea to parents urging them to make sure their children get their measles, mumps and rubella (MMR) vaccines as uptake falls to a 10-year low.

Dr Ellen Welch, a GP and editorial lead at grassroots lobbying group Doctors’ Association UK, said anti-vax conspiracy theories aimed at the Covid-19 jab are likely to have played a role in numbers falling since the pandemic began.

Figures covering July to September last year, published on Monday, show that just 88.6 per cent of children have had their first MMR dose by the age of two while just 85.5 per cent have had both doses aged five. The World Health Organisation (WHO) says 95 per cent of children need to be vaccinated to keep measles away.

The NHS has launched a new campaign in response as officials stress the importance of children having keeping up to date with their routine vaccines. All children are invited for their first MMR vaccine on the NHS aged one, with the second dose given when they are three years and four months.

Dr Welch told i: “It’s a huge concern that MMR vaccination rates are down. The impacts of the pandemic are starting to now show themselves and the anti-vax conspiracies around the Covid vaccine are very likely to have played a part in this figure. I will be taking my 10-month-old to be vaccinated next month, and appreciate the anxieties parents can have around vaccination.

“However, vaccination provides protection against diseases that can be fatal or life altering. At 7 months my son spent a fraught weekend admitted to hospital with bronchiolitis – caused by a virus there is no current vaccine for. If I could have prevented his suffering with a vaccine then I would have done so in an instance.”

Dr Welch said any parent with concerns should read information from “reliable websites”, such as the Vaccine Knowledge Project run by Oxford University scientists.

“Those who missed vaccinations can catch up – and it is so important to do so to give our communities protection from these preventable diseases,” she said.

Professor Martin Marshall, chair of the Royal College of GPs, also spoke of his concern at the drop in MMR vaccine uptake.

He said: “The NHS childhood vaccination programme, which includes the MMR vaccination, is critical to protect children – and wider society – against serious and potentially fatal diseases. It’s very concerning to see this drop in MMR vaccination rates. The MMR vaccine offers safe and effective protection from serious, sometimes fatal, illnesses.

“It is one of the most effective health interventions we have and we would urge all parents to ensure their children have the MMR vaccination, and that their vaccinations are kept up-to-date.

“GPs and our teams have worked incredibly hard to ensure childhood vaccinations have continued to be available throughout the pandemic. If any parents did not come forward during the crisis, for whatever reason, we would encourage them to make an appointment for their child to have the MMR vaccination as soon as possible.”

Healthcare workers have backed union calls for an inflation-proof pay rise for NHS staff, warning the health service is at “breaking point”.

Fourteen unions, representing 1.2 million health staff in England, have called on the Government to raise NHS pay and raised fears of a “growing exodus of exhausted staff”.

In a submission to the independent NHS pay review body, the unions urged action on pay to stem an “alarming” loss of medics. Inflation rose to 5.4 per cent last month, the highest for nearly 30 years, and as the cost of living crisis has deepened frontline workers have demanded a boost to pay.

Dr Yaso Browne, a Hampshire-based GP speaking on behalf of the Doctors’ Association UK (DAUK), told i: “People were encouraged to ‘protect the NHS’, but the people of the NHS need protecting from unfair freezes on their pay. 

“For years NHS staff have been offered wage increases below or barely meeting the cost of living, in real terms. They have gone and are still going above and beyond to keep the NHS running. Their pay needs to reflect the value the Government proclaimed it held for the NHS throughout the pandemic, and still claims it holds.

“Paying people a fair wage is a much-needed reality if we have any chance of retaining highly trained staff.”

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Dr Jenny Vaughan, chair of the grassroots lobbying Doctors’ Association UK, said: “Any extra funding for the NHS is clearly necessary given its current parlous state and the number of patients facing increasing uncertainty and suffering as a direct result.

Frontline staff are facing impossible demands on their departments and on their own lives to try to cope with this. But we would like to see an assurance that this is the start of something better and bigger for the NHS, not a scramble to buy the PM out of his current troubles.”

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Better safety and protection

Frontline doctors want the Government and/or the NHS to provide a physically safer working environment, with more air purifiers in hospitals, better ventilation, and FFP3 masks (which provide the highest level of respiratory protection) across all areas while Covid-19 rates are high in the general population.

Improve health and well-being

The grassroots lobbying organisation Doctors’ Association UK said the NHS should ensure staff have access to food and drink at all times. “If too busy for breaks, get a tea-lady (or man) to go round,” Dr Louise Hyde, a GP with the association, said.

“The NHS could provide emotionally safer workplaces by ensuring shifts had realistic arrangements for handovers and time for debriefing;, by tackling any culture of bullying or toxic HR culture; by ensuring all staff have protected holiday time, time off for weddings and funerals, and are not made responsible for making swaps or finding locums to replace them.

“Ultimately, treat health care workers as the valued, skilled professional workforce that they are, with human needs and lives which cannot be sacrificed indefinitely for their job.”

Visas for elderly relatives of overseas-born NHS staff

Over the last 12 months i has highlighted numerous cases of NHS staff – born overseas and now British citizens – forced to choose between their job and returning to their country of birth to look after ailing parents, as tighter immigrations rules reduced the chance of obtaining an adult dependent relative (ADR) visa to almost zero.

It is a ripple effect of th “hostile environment” policy introduced when Theresa May was Home Secretary.

With about 170,000 non-British NHS staff, the restrictive immigration rules are disproportionately affecting healthcare workers. The British Medical Association, along with other organisations such as the BAPIO (the British Association of Physicians of Indian Origin) and APPNE (Association of Pakistani Physicians of Northern Europe), have campaigned for rules on ADR to be relaxed.

Just 70 ADR visas were issued by the Home Office last year – in contrast 2,325 ADR visas granted between April 2010 and March 2011.

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“We are seeing huge staff shortages. The question really on my mind, and I think on the minds of a lot of NHS staff, is what’s the plan here?

“How are we going to staff these beds and make sure people get the care they need?”

nhs staff
She added: “My worry for my patients is what if they get something that is not Covid related but still needs urgent treatment and the staff that are needed to treat them are off with Covid?”

Dr Lizzie Toberty

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NHS and care staff should be moved to the front of the queue for lateral flow and PCR tests amid a shortage of the devices, senior health figures say.

Dr David Nicholl, spokesperson for grassroots lobbying group Doctors’ Association UK, said: “It is imperative that all members of the public have reliable and timely access to vital lateral flow tests and healthcare workers are no exception. In their line to duty they are regularly exposed to the virus and often with inadequate PPE. 

“In order to minimise the risk of spreading the virus to those who are most vulnerable in hospitals and other clinical settings, it stands to reason that healthcare workers need lateral flow tests as a priority if demand cannot reach everyone.

“Without this we will see further isolation and staff absences at a time when hospitals and GP surgeries are critically understaffed due to the pandemic.”

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Health professionals said frontline NHS and social care staff were left “woefully unprotected” by a lack of personal protective equipment (PPE) in the early months of the pandemic.

They pleaded with the Government not to ignore the recommendations made in today’s “lessons learned” report by MPs on the Science and Technology and Health and Social Care committees.

The following insight from two health professionals reveals the extent of that failure.

Dr Ellen Welch, GP, Editorial Lead, Doctors’ Association UK, and author of How the NHS Coped with Covid, due for release by Pen and Sword soon

Today’s “lessons learned” report held no great surprises for NHS staff. It is released as the UK records the highest number of deaths from coronavirus in Western Europe (136,986 deaths or 2,029 deaths per million people), along with over 7 million confirmed cases. 

The economy is recovering from a recession, while unemployment and national debt soars. Masks have been discarded; employees are returning to their workplaces and travel restrictions lifting as the country wills itself to return to ‘normal’.

Normality for the staff of the NHS however, is that this virus is not going away. Younger, unvaccinated people are being admitted to hospitals ; GPs are delivering almost 2 million more appointments per month than they were pre-pandemic, while still being accused of being closed by some sections of the media; and more than 5.45 million people are waiting for hospital treatment in England. Much of this was preventable.

Looking back on the events of the pandemic response in the UK shows how this crisis unfolded. When other countries closed borders and locked down, the UK dallied and debated herd immunity. 

Contact tracing was abandoned in early March 2020, while large gatherings continued to take place up until the end of that same month. 

As a GP working within the 111 service, I spoke with multiple patients at this time, all reporting classic symptoms of covid. At this point, widespread testing was not available, and quarantine only mandatory for people who had travelled to very specific countries. 

We all knew this was outrageous and often I counselled people to stay home regardless. The government allowed this virus to creep into the country unchecked, and much, much more should have been done to control spread.

Frontline NHS and social care staff were left woefully unprotected by a lack of PPE. Doctors’ Association UK raised concerns at the outset of the pandemic, reporting the shortages were putting them at risk. GPs fashioned their own PPE to enable them to see patients safely, while care homes were left unprotected. As a result – hundreds of frontline staff died.

We’ve seen the government ignore advice in the past – pandemic simulation exercise  ‘Cygnus’ conducted in 2016 showed that the UK was short of critical care beds, ventilators and PPE and could not cope with a pandemic – but stockpiling PPE was not done due to the expense. 

Last year we saw the events of March 2020 repeated in December in efforts to ‘save Christmas’ We can only hope that as another winter approaches, lessons really have been learned and the government takes decisive action if we approach crisis point again.

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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.

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