LMC weekly update - 13 August, 2021

BMA survey reveals worrying levels of abuse against doctors and staff 

A BMA survey of doctors in England, Wales and Northern Ireland, published earlier this week, showed that more than half of GPs responding have faced recent verbal abuse from patients, or those close to them. The survey was widely reported in national and local media, including in this powerful piece in the Guardian, and key findings include: 

• 51% of GPs respondents had experienced verbal abuse first-hand in the most recent month and one in five GPs reported being threatened 
• 67% of GPs had witnessed violence or abuse against other staff and 96% of these said this was directed at reception staff 
• Two-thirds of GPs said their experience of abuse, threatening behaviour or violence had got worse in the last year 
• The most common place for abuse experienced by GPs was in their consulting rooms (53%) 
• While respondents reported a number of factors they felt were behind the incidents, 75% of GPs said the perpetrator was dissatisfied with the service or access. 
  
  The last year and a half has been an incredibly challenging time for doctors, the staff they work with and patients. Many doctors share the frustrations of their patients around unfamiliar ways of working and increasing waiting times. However, abuse, violence and threats are absolutely unacceptable and should never be tolerated. 
  
  GPs and their colleagues are doing their absolute best to provide care to their local communities, and these findings show an incredibly worrying trend, with GPs reporting rising levels of abuse against staff in general practice, who are already working under intense pressure. Facing such abuse can leave even the most resilient GP feeling alienated and undervalued, leaving them questioning their career when the NHS can ill afford to lose any more staff in general practice.  
  
  There is an urgent need for support for general practice and there must be an honest public conversation, led by the Government and NHS England, about the precarious state the NHS now finds itself in after 18 months of managing a pandemic, so that people have realistic expectations, and to prevent staff bearing the brunt of frustration and anger. Government must also do more to protect and defend frontline healthcare workers at risk of abuse, including not doing anything that makes the situation worse. Read my full statement here 
  
  Media 
  The survey received widespread media coverage including in the Guardian, the Telegraph, ITV, Pulse, GP Online,  LBC, the BMJ, Daily Mail (also in print), the i (print), Daily Telegraph (print), Daily Mirror (print), Telegraph, Metro, GB News, Yorkshire Post (print), Head Topics, Pulse, GP Online, Health Business, Management in Practice, Eastern Eye, Nursing Times, in two letters to The Guardian (also in the print edition, and replicated in Business Fast), in MDDUS, and in over a hundred regional and local media outlets, and dozens of radio stations across the country including Times Radio.  
  
  I appeared on Times Radio (2h6min), Sky News and GB News, GPC England executive team member Dr Farah Jameel was interviewed on Talk Radio (21min30s in) and (Talk Radio twitter), BMA council deputy chair Dr David Wrigley was on LBC News (from around 1hr23) and Channel 5 News, GPCE member Dr Rob Barnett was on BBC Radio Merseyside (from 1hr25), and Dr George Rae (BMA north east regional chair and GP) was on BBC Radio Tees (around 2hrs25). Dr Mary McCarthy, deputy chair of the West Midlands regional council, was interviewed on BBC Radio WM (item at 2h09).NIGPC chair Dr Alan Stout appeared on Q radio and said, in response to the findings, that the information is extremely concerning, particularly in what's already been a tough year for the health service.  GPC England deputy chair Dr Mark Sanford-Wood appeared on BBC Radio Somerset and Dr Brian McGregor appeared on ITV Calendar on Tuesday evening. Thank you to the BMA communications team and all those who helped highlight this important issue. 
  
  Meeting with Amanda Pritchard, new CEO of NHS England and NHS Improvement 
  This week I had a face to face meeting with the newly appointed NHSE/I chief executive, Amanda Pritchard.  We talked about the many issues impacting general practice, not least the significant workload pressures we are all experiencing as we deal with the impact of the pandemic and the NHS care backlog. I also discussed the importance of NHSE/I clearly supporting general practice in their words and actions, and that by strengthening our service it would not only help patients seeking care from us but would also benefit the wider NHS.  
  
  She stressed how important she felt it was to meet so soon after taking up this role and her wish to rebuild the relationship between GPC England and NHSE/I.  This was a constructive meeting and I hope will provide a strong supportive basis on which we can move forward.  

COVID vaccination programme data  

Three quarters of UK adults have now received both doses of a COVID-19 vaccine and the data shows that two doses provide over 90% protection against hospitalisation from the Delta variant, which is the dominant strain in the UK.  I commented about the amazing achievement of general practice teams and many others vaccinating so many so quickly here 

Self-isolation removed for close contacts of those who are fully vaccinated (England) 

From Monday 16 August, people who have had two COVID vaccinations or aged under 18 will no longer be legally required to self-isolate if they are identified as a close contact of a positive COVID-19 case. With 75% of people having received both doses of the vaccine, the majority of adults will no longer need to self-isolate if they are contacts. Read more here 

NHSE/I has distributed a system letter on how the government’s changes to the requirements to self-isolate following a positive COVID-19 contact will impact staff and students working in the NHS. 

The letter can be found here. 

The weekly BMA COVID-19 data analysis is attached.

Mandatory requirement for vaccinations to enter care homes (England) 

DHSC has published guidance on new regulations which make COVID-19 vaccination a requirement for NHS staff entering care homes in England. This includes all staff in NHS commissioned services going into care homes. The last date for a care home worker to get their first vaccination in time to be fully protected is 16 September as the regulations requiring two vaccinations will come into force on 11 November.  Booster doses are not currently covered by the regulations but may be added in the future. There are only a limited number of exemptions, and we are currently discussing this with DHSC.   

Becton Dickinson blood specimen collection supply disruption 

NHSE/I has issued urgent guidance on recommended actions following an alert by Becton Dickinson to a global shortage of products from their Blood Specimen Collection Portfolio, which is expected to last a significant period of time. They advise that, other than in exceptional circumstances, vitamin D testing should be stopped, retesting and monitoring intervals should be extended when clinically safe to do so and that routine screening for pre-diabetes and dyslipidaemia, allergy testing and routine infertility testing should be deferred until a resolution to the supply problem.  We have raised this issue with the NHSEI primary care team as it could have an impact on regular tests for NHS health checks, QOF and drug monitoring. It would be unreasonable for practices to delay tests and then be expected to catch-up later, so adding to the current care backlog. 

NHS Supply Chain has issued a Customer Notice which details the products impacted and the measures they have put in place. Practices that secure these products from Primary Care Support England (PCSE) should continue to order in this way. GP practices that do not usually order from PCSE can also order via their process. 

COVID-19 pandemic recovery workload prioritisation guidance 

As the COVID-19 restrictions are easing across the UK, and despite the success of the vaccination programme, the workload pressures caused by the pandemic remain at record levels. 

The UK is currently moving through a third wave of infections, driven by the delta variant, leading to large numbers of COVID-19 cases, albeit often less severe than in previous waves, many of whom are managed by GPs and their teams. General practice not only continues to deliver the vaccination programme, but also provides routine acute and long-term care to patients and supports large numbers of individuals who are awaiting specialist assessment or treatment. 

In light of these workload pressures, GPC England and RCGP have updated our joint COVID-19 Pandemic Recovery Workload Prioritisation Guidance for GP practices. 

We urge commissioners to understand that there is significant variation in local capacity in general practice - subject to local circumstances, COVID-19 prevalence, and staffing levels – and that it is for practices to determine how they meet the reasonable needs of their patients. 

Clinicians should continue to review and reprioritise workload, using clinical judgement and reflecting both patient need and local circumstances (e.g. staffing levels, local disease prevalence and patient demographics). Commissioners should also continue to limit or suspend additional expectations of practices, such as local enhanced services. However, with the withdrawal of the national Standard Operating Procedure (SOP) for general practice, following our intervention last month, the RCGP and GPC have amended our own national guidance. We will though be keeping the situation under close scrutiny and the winter approaches. 

Read more in our updated section on service provision in our COVID-19 toolkit for GP practices 

GPC Scotland update and blog 

Congratulations to Dr Andrew Buist who last week was confirmed as Chair of the BMA’s Scottish GP Committee for a further three-year term. Read his blog where he updates on the COVID-19 situation in Scotland, the implementation of the 2018 GMS contract, including their refreshed Memorandum of Understanding that describes the process for transfer of services from general practice to Health Board responsibility.   

BMA Annual Representative Meeting 2021 

The agenda for the 2021 ARM has been published.  The ARM takes place virtually on 13 and 14 September.  A dedicated ARM website had also been launched where you will find information on elections, events and a blog from Dr Latifa Patel, Acting representative body chair. 

BMA Infection control guidance 

The BMA has updated its guidance on reducing risk in healthcare settings following the easing of restrictions on 19 July, to reflect the fact that COVID-19 is still circulating in the community, and the need to continue to reduce the risk of infection in healthcare settings.  

The report sets out a number of measures that need to be taken by employers and government to reduce the risk of infection in all healthcare settings, including, adequate workplace and individual staff risk assessments; providing staff facilities that support infection control; a greater focus on ventilation in healthcare environments; the provision of safe and sufficient PPE; and reporting and investigation of COVID-19 cases suspected to have arisen from work.

The government’s infection control guidance for healthcare settings still applies following the lifting of the restrictions and as confirmed by the government, healthcare settings should maintain face coverings among other IPC measures. Download our poster for practices to display, about the continued use of face coverings for healthcare settings, here. 

Social Prescribing Link Worker Day Conference 

The National Association of Link Workers will be hosting a virtual Social Prescribing Link Worker Day Conference on 8 October 2021, with the theme of The Creative Disruptors Reducing Inequalities & Powering Up Integrated Care,  to celebrate and showcase Social Prescribing Link Workers’ impact and role in creatively disrupting inequalities and powering up integrated care.  

This event is open to GPs, social prescribing link workers, community health and social care industry leaders, Primary Care Networks and clinical directors across the UK.  Get the latest updates and best practices to power up your practice and patients through social prescribing – find out more here https://nalwevents.org/ 

There are 20 free tickets available for BMA members – first come first served - via this link 

Media 

England 

After the secretary of state for health and social care in England, Sajid Javid, confirmed that pending final advice from experts, the booster Covid vaccines would be given at the same time as flu jabs, my comments were played on dozens of local and national radio stations saying the booster campaign is added pressure on general practice, but one that is really important to deliver. 

Pulse reported on GPC England’s forthcoming supporting general practice campaign -materials and tools to help practices explain to their patients the pressures general practice is facing. I commented: “Even before the pandemic, surgeries were struggling with staff shortages, outdated and small premises and a lack of resources, and now they are facing spiralling demand and managing a record backlog of care, on top of delivering an historic vaccine rollout. The BMA regularly provides guidance, support and materials to practices to help them navigate these pressures – and helping the public understand the challenges faced by their local surgery, and the impact that this may have on their experience, as well as where the responsibility lies for addressing these issues, is one area in which we are committed to assist GPs and their teams – and we will provide members with more information in due course.” 

Dr George Rae, BMA North East regional chair, was interviewed on BBC Radio Tees (2h1m40s into replay) about reducing NHS pressures in the North East. He reminded listeners that the pandemic is not over and wearing a mask is not a big ask. 

Wales 

Dr Phil White, GPC Chair for BMA Cymru Wales contributed to a BBC Wales article regarding the change in access to GP services in Wales as a consequence of COVID-19. The story includes a balance of opinion from patients and GPs on how patients are accessing GP appointments, i.e. through telephone, video conference or face to face and the reasons behind this. Dr White said: "It is a complete misconception to suggest that surgeries have been closed. Appointments have always been honoured whether through video, telephone consultations or face-to-face where clinically necessary. Face-to-face consultations are gradually increasing but with Covid measures in place including PPE and room cleaning, each face-to-face consultation can take twice as long and so offering a range of consultations can help us to try to meet the growing need for our services whilst keeping the most vulnerable safe." The article is available to read in full at BBC Wales News. 

Northern Ireland 

NIGPC chair Dr Alan Stout discussed COVID vaccine hesitancy in an article in the Belfast Telegraph (behind paywall). 

Read the GP bulletin here.