SHORTAGES of PPE (personal protective equipment) during the early months of Covid-19 left doctors feeling ‘abandoned’ by the government, BMA council chair Chaand Nagpaul has warned MPs.
The failure to supply PPE to frontline doctors in March and April came as a bitter shock to the medical profession, Dr Nagpaul told members of the Parliamentary Public Accounts Committee, with doctors having previously been assured there were adequate stockpiles of PPE.
Addressing the committee’s hearing into government’s procurement processes and contracts for Covid-19 PPE via video link, Dr Nagpaul said doctors started to experience problems getting protective equipment as early as March.
He said many GPs had not even been able to buy PPE directly as supplies had already been directed towards the secondary care sector and had run out, adding the situation did not begin to improve until May.
He said: ‘The message to us (from the government) was, “don’t worry, we have enough”.
‘As the weeks went by in March, we were getting reports increasingly from doctors that they didn’t have access to the PPE they needed.
‘Even doctors in high-risk areas, half of them said there were shortages. In general practice, when this virus was really spreading within the community, we had received no supplies, by the middle of March, of any PPE.
‘We felt pretty abandoned in the middle of March.’
Dr Nagpaul further highlighted how guidance on PPE from Public Health England had been inconsistent, having failed to follow World Health Organisation guidance on the importance of issuing doctors with eye protection, prior to 2nd April.
Risk factors
When questioned by the committee about the government’s failure to investigate the deaths of healthcare staff who had contracted the virus, Dr Nagpaul expressed further dismay.
He said the BMA had written to NHS England chief executive Simon Stevens on 9th April calling for risk assessments of doctors to record metrics such as job role, exposure to the virus and concerns about PPE, so that it could be better understood whether certain doctors were at greater risk.
He said: ‘That data wasn’t collected. Had it been collected we would now be in a much better position to answer that question.’
When asked by committee chair Meg Hillier as to what the BMA and doctors felt they needed to make the vaccine roll out a success, Dr Nagpaul stressed the importance of supporting doctors and ensuring excellent public health messaging.
He added it was critical that no one let down their guard by failing to continue to adhere to social distancing and wearing face masks when in public, as these measures remained critical to controlling the spread of the virus.
He said: ‘This programme will take months to deliver. In the meantime, every day, there’s the risk of people becoming infected and becoming seriously ill.
‘We really must make sure that those members of the public who are most vulnerable, and that includes many in communities who may not be as trusting about the vaccine, we need to have proper public education messaging were people can trust the reasons why they should be vaccinated because this is a public measure to serve the nation and improve the health of the nation.’
Staffing concerns
Dr Nagpaul was among a number of health leaders giving evidence at the hearing on 10 December.
Other speakers included Royal Hospital for Neuro-disability director of nursing Emily McWhirter who was representing the Royal College of Nursing, and Care England CEO Professor Martin Green.
When asked by Meg Hillier about what effects a potential no-deal Brexit could have on the UK’s ability to supply initial doses of the vaccine to care homes, Professor Green said his two main concerns were keeping supply chains open and staffing.
He said: ‘We have relied heavily in our sector on EU staff, and if we’re not able to bring them in because of the new requirements, that’s going to cause major problems.
‘The Department (of Health and Social Care) needs to give some thought as to how there’s going to be enough staff to be able to staff social care effectively.’
Meanwhile, years of Tory cuts to GP funding, the mass closure of surgeries and a shortage of staff have created a perfect storm where some GP surgeries are struggling to cope with delivering the Covid vaccine. The first vaccinations at GP surgeries began yesterday morning.
The government body NHS England has said that GPs’ networks that are struggling to go ahead with plans to begin Covid vaccinations this week should ‘reach out’ to their commissioner for help.
But some NHS primary care networks (PCNs) have had to pull out of delivering the Covid vaccine this week because of the MHRA’s (Medicines and Healthcare products Regulatory Agency) new anaphylaxis safety guidance – with other PCNs left to urgently reconsider plans.
However, it was not clear what sort of help NHS England is offering to PCNs which will struggle with the reinstated requirement.
NHS England primary care director Dr Nikki Kanani said late last week that she was aware that practices ‘are reviewing their approaches to ensure they have the estate, staff and the resources in place to be able to comply’ with the new guidance.
She added: ‘Of course we know not every single practice will be able to do so. If the 15-minute observation is making it challenging to deliver your vaccination plans next week, please get in touch with your commissioner to see the support that can be found.’
Dr Kate Harvie, from East Cleveland PCN, told the medical magazine Pulse that the offer came after the PCN had informed its CCG last Thursday morning it ‘had to pull out’ of plans to deliver the Covid vaccine starting this week because ‘the logistical problems were just insurmountable’.
Dr Harvie said: ‘Having informed the CCG that we were reluctantly pulling out of wave one that morning, they have been back to us to say that NHS England wants to meet with us next week to see how this can be progressed.
‘It’s possible we might find a way through this which will be good. Hopefully a new site. I don’t think we are anything like alone in having this difficulty.’
Around 280 PCNs were due to join the vaccination programme this week (15 December), after around 50 hospital hubs began vaccinating over-80s and at-risk hospital staff last week.
Meanwhile GP teams delivering Covid vaccinations should visit care homes a ‘minimum’ of four times, NHS England has said.
New guidance also clarified that written consent is not required for each patient.
In new standard operating procedures for practices signed up to deliver the vaccine rollout programme, NHS England said that a ‘minimum four visit schedule is recommended’ to vaccinate care home residents and staff.
This is ‘subject to the vaccine being approved for deployment in care homes’, it added.
The guidance said: ‘As a principle, providers should seek to minimise the number of unnecessary visits to care homes to mitigate potential risk to residents. A minimum four visit schedule is recommended.’
- Simon Walsh, a consultant in emergency medicine and deputy chair of the BMA consultants committee, has voiced his concerns in a letter headed:
‘Is the roll-out of NHS 111 First the right “treatment” for the problem?’
‘The evidence that a phone service will help reduce pressure on emergency departments is scant
‘This initiative encourages those who have an urgent healthcare need, but not a true emergency, to call NHS 111 First rather than attend an emergency department. ‘Those who require an ambulance or who have a true emergency are encouraged to use the 999 service as before; makes sense perhaps?
‘Certainly, the efforts to reduce the pressure on EDs (emergency departments), which has been massively increased by the pandemic, have been welcomed by the RCEM (Royal College of Emergency Medicine) and indeed frontline emergency medicine clinicians.
‘But is there a risk in rolling out such a big change to the way the public accesses urgent and emergency care? And do we have evidence that these changes will achieve the desired effects?
‘Because of the pandemic, capacity in the UEC (urgent and emergency care) system has been drastically reduced, particularly by the need to maintain social distancing in waiting rooms (reducing capacity by 50-70% in many) and to comply with infection control measures in hospitals …
‘But reducing the demand on overstretched emergency departments sounds like a good idea; why not roll this out?
‘The BMA absolutely supports the aim of reducing the pressure on EDs. We have consistently called for the government to address the ever-worsening pressures on the urgent and emergency care system over many years, and specifically highlighted the need for thousands of additional hospital beds to address issue of ‘exit block’, which is caused largely by hospitals being run at excessive occupancy levels.
‘We are very interested in finding ways to reduce the additional pressure on EDs that the pandemic is driving. That’s why we have been meeting with NHSE/I regularly to hear about the progress of the pilot sites.
‘But as yet we have not seen evidence that this initiative actually achieves those aims. Without this evidence we do not know if there is a significant benefit to rolling it out. And there is a risk that increased pressure is being placed on other parts of the healthcare system as a consequence of this initiative.
‘For example, GPs are understandably concerned about where the GPs that are picking up the increased NHS 111 clinical validation work are coming from; are they doing this work instead of work in GP surgeries for instance?
‘And if the aim of NHS 111 First is for 1.5m patients to have their healthcare needs met somewhere other than an ED, then how many of these will need appointments with their GP?
‘Importantly, how many will need appointments in SDEC hospital clinics? How will already overstretched consultant staff from acute specialties accommodate additional clinical work in their packed job plans?
‘Where is the engagement with consultants who have shown incredible flexibility and resilience in the response to the pandemic? Where is the commissioning and funding for these patients to be managed in these settings?
‘Lots of important questions and very few clear answers.
‘We have put these questions to NHSE/I but we do not yet have the information that we need to make an assessment of whether any benefits of NHS 111 First outweigh the risks.
‘If this was a potential treatment that I was being offered, I would want to have those questions answered before I agreed to have it.
Simon Walsh.’
