Doctors Association UK (DAUK) has written to health secretary James Murray urging the introduction of clear national standards to ensure patients referred to hospital by a GP are assessed by a doctor.

DAUK GP co-leads Dr Sarah Jacques and Dr Steve Taylor wrote to Mr Murray following coroners’ reports into the deaths of nine-year-old Dylan Cope and eight-year-old Ethan Hanson.

They were both urgently referred to hospital by their GPs with suspected appendicitis but, according to the coroners’ findings, were not assessed by a doctor after arriving at hospital.

The letter has been featured by The BMJ, Pulse and Doctors.net.uk

In it, Dr Jacques and Dr Taylor called on the government to introduce national standards requiring patients urgently referred to hospital by a GP to be assessed by a doctor.

The letter also asks to ensure that no patient with undifferentiated symptoms is assessed or discharged without doctor oversight.

DAUK has invited Mr Murray and Department of Health officials to discuss the proposals.

Read the letter in full.

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Jess’s Rule is a safety initiative urging GPs to ‘think again’ if they see a patient three times with the same symptoms.

It was welcomed by DAUK when it was introduced last year.

Jess’s Rule

Speaking to Doctors.Net, Dr Taylor, DAUK’s GP co-lead, said the requirement in the new contract to expand the use of advice and guidance (A&G) could be at odds with the requirements of Jess’s Rule.

He said: “A&G changes will reduce patient choice and the ability of GPs to refer patients.

“GPs are generalist experts in patient care and when they refer it is always for good reasons.”

New GP contract

He added: “The new GP contract has a number of big issues which will affect patient care adversely and reduce the ability of practices to provide high quality care.”

Read the article in full on Doctors.Net.

Meanwhile, Dr Taylor has also commented in the medical media on new online access figures.

Pulse has reported on NHS England data showing GP practices received 9.2 million online requests in January, up from 7.8 million in December.

GP appointments

Dr Taylor said the increase in online requests did not mean there had been an increase in the available number of GP appointments.

He said: “Online forms are work for GPs and their teams, so the data means 2 million more bits of work without the resources to provide them.

“GPs want better access to care for patients but they recognise it’s not online forms that patients want, it’s GP appointments, and without the resources reality will not be met with the expectations raised by this Government.”

Read the article in full on the Pulse website.

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A hospital has sparked controversy by seeking to recruit an advanced clinical practitioner to fill a consultant’s job in emergency medicine, it has been revealed in Doctors.net

Blackpool Teaching Hospitals says the appointment will be a non-medical consultant, working on a tier 4 rota.

DAUK wrote to the Royal College of Emergency Medicine and received the following response:

The behaviour of senior managers at the West Suffolk NHS Foundation Trust was “intimidating, flawed and not fit for purpose,” according to an external review.

The Trust was forced to order a review after a whistleblower wrote to the family of a dead patient, revealing she was treated by an anaesthetist who was self-medicating.

Its first response to the anonymous letter was to order fingerprinting and handwriting analysis.

Adverse publicity then led it to commission Christine Outram, chair of the Christie Hospital, Manchester, to conduct a review. Yesterday the 200-page long review revealed that a female colleague of the self-medical anaesthetist had raised concerns some time before.

She was then accused of “divisive conduct”, undermining the executive of the trust and an “attempted coup” against the department’s clinical leadership.

Ms Outram says the concerns about the self-medicating doctor were well-founded, but the allegations lodged against the whistleblowing colleague were not.

She goes on to say that there was “inadequate” handling of the serious incident in 2018 that led to the anonymous letter, the death of a patient after receiving the wrong solution in an arterial line.

The medical director decided not to take action about the self-medicating anaesthetist after concluding the doctor was not responsible for the incident. Ms Outram says this showed insufficient regard for patient safety and the doctor’s wellbeing.

The review reveals several senior clinical staff raised concerns about the self-medicating anaesthetist and adds it was “extraordinary” this was ignored and rejected. The female colleague then wrote to the chair of the trust, who simply passed her letter to the chief executive, Steve Dunn, the review reveals.

The findings and an apology issued by the current management of the Trust were welcomed by the Doctors’ Association.

Chair Dr Jenny Vaughan said: “We hope that this long-awaited report provides some answers for the family of Susan Warby. It’s absolutely crucial that staff feel able to raise concerns without feeling bullied or intimidated as that’s much safer for patients. Unfortunately, what happened here was the opposite.

“There is no place for this in healthcare, and the Doctors’ Association looks forward to real cultural learning in future which means this does not happen again.”

Georgina Halford-Hall, chief executive of WhistleblowersUK, said: “This report must be a call to action by every member of the NHS from Board down, it sends a clear message that whistleblowers are essential to the NHS – their actions really can save lives.

“It is our experience that too many staff are forced to look the other way because they fear the consequences of retribution by colleagues – this culture must stop.”

Senior GPs have called for a national inquiry after new complaints that patients are heading to emergency departments because they cannot get appointments.

GPs say they have been working harder than ever before – but are now facing “unprecedented levels of burnout.”

The Doctors’ Association has written to health secretary Matt Hancock, senior NHS officials and HealthWatch chair Sir Robert Francis.

The concerns surfaced after the publication of the latest emergency department data, showing the largest numbers in a year using hospital emergency services in March.

Emergency specialists attribute the increase to the easing of lockdown – but have also warned it will be unsustainable.

In the letter, two GPs Dr Elizabeth Toberty and Dr Ellen Welch state: “General Practice has been consistently underfunded over the last 10 years. Currently 90% of NHS contacts happen within primary care for less than 10% of the total budget. We desperately need a huge funding increase to aid much needed innovation, improvements in IT and infrastructure, and to increase staffing levels. 

“We urgently call today for a reduction in bureaucracy, a focus on GP burnout and staff retention, and most importantly an analysis into why patients are struggling to access care so we can work towards finding a solution that involves the whole health service working together.”

They add: “GPs are working flat out, and it is incredibly demoralising to find that our best is not enough. It is clearly not acceptable for huge proportions of patients to attend emergency departments when GP would be more appropriate. However, practices are working at and beyond full capacity which has led to unprecedented levels of burnout, sick leave and tiredness amongst GPs.”

Read the story on doctors.net here

Doctors in a survey have unanimously rejected proposals to create an apprenticeship-style scheme as an alternative way of training doctors.

Members of the Doctors’ Association UK have voiced their opposition to the proposed new Health Education England doctor apprentice scheme in a survey, stating that the training is likely to be “inadequate.”

Health Education England (HEE) is creating an apprenticeship programme allowing candidates to receive an undergraduate medical degree without taking the traditional course.

During the programme, students could earn money alongside their studies, making entering the profession more financially accessible, HEE says.

HEE say the government-funded apprenticeship will “retain the same high standards of training”, and the British Medical Association say the proposals are “interesting and worthy of consideration”.

However, in a survey, Doctors’ Association UK members have voted unanimously to reject the proposals.

Chair of the association, Dr Jenny Vaughan, says: “Whilst we do not disagree with the general consensus of the scheme, which aims to diversify and widen participation in medicine, the question raised, is why it is necessary, considering there is a surplus of fully trained final year medical students unable to secure FY1 placements.”

She believes: “It is the background of several years of both theoretical learning and practical experience that doctors draw upon which enables them to deal with complexity.

“The current apprenticeship proposals are unclear about how standards will be achieved and maintained, meaning we are concerned apprentice trainees will lack this basic grounding and could be hazardous for patients.”

Dr Lizzie Toberty, of the Doctors’ Association UK, commented: “This apprenticeship scheme risks spending a lot of time and money to develop inadequately trained doctors. Without a thorough and rigorous grounding in the sciences we risk dumbing down our health system. If patients do not have access to doctors with adequate clinical knowledge their treatment will suffer.

“We strongly recommend HEE focus on making current medical school places more affordable and accessible to those from all backgrounds.”

Read the article here

The difficulties emerged as medical schools said that ensuring students graduate and become doctors is now a priority.
Some students have found the situational judgement tests prematurely terminated because of technical difficulties – or because of, alleged, minor infractions of rules, the Doctors’ Association revealed.

It said candidates had finally been offered resits – but that problems are continuing. Students are being told they must undertake their resits even when they have COVID-19 and some have been told they cannot use toilets at test centres, the association said.

The tests have been contracted to a large educational company Pearson Vue and the association said it was concerned the company has a “monopoly” on postgraduate exams for at least four medical colleges.

Anna Sigston, who sits on the association’s medical student committee, said: “Candidates are being failed for errors within Pearson Vue’s system, but instead of apologising, they, along with the UKFPO, have refused to take responsibility and subsequent action while ignoring serious concerns. Reports of candidates not being allowed to use the toilet and of those forced to sit the exam while suffering from COVID-19 is not only immoral but refuses to take into account the needs of individuals. “This is only the start, as more medical exams occur virtually, more issues and inequalities will arise.”

Fellow committee member Freya Rhodes added: “These re-sits have been offered with limited flexibility and extremely short notice, with some students being asked to take the examination whilst being unwell with COVID-19. We must continue to support our final year students who are also facing the challenges of graduating during a pandemic.”

Read the full article here.

Many practices feel unready for the second COVID-19 wave with concerns about protective equipment and premise management, according to a new survey of GPs.

The findings led one medical organisation to press MPs yesterday for an urgent review of PPE guidelines and stockpiles.

GPs also cited concerns about their own mental health and about access to flu vaccines in the survey conducted by the Doctors’ Association UK.

Nearly 900 doctors took part in the survey and 52% said their premises are not currently suitable for providing simultaneous care for non-COVID patients and those who might be infected.

55% said they lacked confidence in their future access to personal protective equipment.

Most GPs lacked confidence in the development of video consultations because of patients having poor access to Wifi and mobile data. According to NHS Digital, video consultation numbers have declined during the pandemic.

The Doctors’ Association also called for ring fenced funding for primary care and an urgent review of digital deprivation.

GP Dr Vinesh Patel, a committee member of the Doctors’ Association, said: “We spoke to MPs about the important issues those working on the ground in primary care are facing such as reduced capacity to see ‘hot’ patients in the run up to winter, the impact of digital deprivation on our patients, a rising workforce and its undeniable pressures on the mental health of primary care staff, as well as the disconnect between media messages and what is actually going on in primary care.

“We discussed issues such as the mental health of staff, rising workloads, the GP-bashing within the media and the importance of a primary care in this pandemic, and we are confident that we will be able to work together to tackle these issues going forward.”

Read the full article here: https://news.doctors.net.uk/news/32147

The Doctors’ Association said that some doctors are still waiting for biometric residency permits, which would allow them to start work.

In Leicester respiratory specialist Dr Ahmad Ussaid is sitting idle because of these delays, it said. Even an intervention by a local MP has failed to speed up the issuing of the permit.

Other doctors remain out of pocket because a promised refund of the health entry tax – the immigration health surcharge – has not arrived, the association said.

Neurosurgeon Dr Dolin Bhagawati said:

These prolonged and ongoing bureaucratic delays are simply unconscionable. We have trained doctors in this country who are ready and willing to help combat the pandemic but unable to work due to the Home Office not doing its job and supplying appropriate documentation.

Promises made by the Prime Minister and the cabinet regarding refunding the IHS to NHS staff continue to remain unfulfilled. How can the NHS attract the best and brightest to the UK if the world sees a government unable to fulfil straightforward promises?

Unfortunately, the immigration rhetoric and policies of the recent past has led to many of our valued colleagues feeling crestfallen, unappreciated, and exploited. This country must reward those that come to its aid in its time of greatest need.

We call on the government to do its job to allow the NHS to do its part in leading the country through this national emergency.

“Hundreds of NHS keyworkers have died of COVID-19 during this pandemic and yet staff continue to show up every day – despite healthcare workers being 12 times more likely to test positive for the virus compared to the general public.

“It is now vital that the government put measures in place to support staff to continue to do their jobs or else rising levels of burnout will are inevitable. NHS staff are routinely demoralised by defamatory articles in the press and poor communication from our leadership.

“Pressure has been placed on our GP workforce to deliver the new COVID-19 vaccine, but with no logistical guidance from the government on the roll out. Meanwhile in hospitals, the backlog of routine work due to the cancellation of elective procedures is overwhelming and investment in staff and resources is essential.

“Strategies need to be implemented to help those staff who are well enough to work to do so, such as child care arrangements, working from home initiatives and access to rapid testing where appropriate to ensure a rapid return to the workforce.”

More than 4,000 doctors are currently off suck from the NHS in England, nearly half of them because of COVID-19, it has been revealed.

In total more than 82,000 NHS staff are off sick with 42% of them out of work directly because of the virus, according to NHS England data reported by The Independent.

Last week the government was celebrating record numbers of doctors in employment – but medical campaigners said the truth was that the NHS workforce is “on its knees.”

The Doctors Association called for more support for staff to help them through the coming months.

It warned of staff leaving “in their droves” because exhaustion, burnout and morale affected by media claims that they were avoiding patients.

Spokesperson Dr Ellen Welch said: “Hundreds of NHS keyworkers have died of COVID-19 during this pandemic and yet staff continue to show up every day – despite healthcare workers being 12 times more likely to test positive for the virus compared to the general public.

“It is now vital that the government put measures in place to support staff to continue to do their jobs or else rising levels of burnout will are inevitable. NHS staff are routinely demoralised by defamatory articles in the press and poor communication from our leadership.

“Pressure has been placed on our GP workforce to deliver the new COVID-19 vaccine, but with no logistical guidance from the government on the roll out. Meanwhile in hospitals, the backlog of routine work due to the cancellation of elective procedures is overwhelming and investment in staff and resources is essential.

“Strategies need to be implemented to help those staff who are well enough to work to do so, such as child care arrangements, working from home initiatives and access to rapid testing where appropriate to ensure a rapid return to the workforce.”

NHS Providers chief executive Chris Hopson said: “National statistics tell only part of the story. In reality the situation for trusts is much more difficult. Trust leaders understand only too well the impact of these restrictions on people’s livelihoods and liberties and on their mental health.

“Vaccines, therapeutic drugs and mass scale rapid turnaround testing offer a clear way out of this next spring.

“But there is an immediate need to get through winter, avoiding a damaging third surge in infections with the virus, and ensuring the NHS is able to provide appropriate high quality care for all patients, COVID and non-COVID.”