Vital actions to minimise pressure on the NHS this winter

What is set to be the worst winter on record will increase strain on an already exhausted NHS. Our 'Weathering the storm' report calls on governments and health leaders to take urgent action now.

Location: UK
Audience: All doctors
Updated: Thursday 6 January 2022
NHS Structure Article Illustration

Health, care, and public health services across the UK are bracing for the worst winter in their history. There are record numbers of patients waiting for care and treatment. Flu season and the high burden of COVID-19 cases across the UK is causing strain on health services and leading to the devastating reality of crippled emergency departments.

This report outlines reasonable and practical interventions that should be implemented immediately to minimise pressure on services over the winter period and protect patients and staff.

This page is an overview of the 'Weathering the storm' report. You can download the full report below.

What is the situation this winter?

The hallmarks of winter pressures are being seen far earlier than expected this year, with doctors reporting that health services are already beginning to buckle under intense pressure.

GP practices

GP practices are fighting to overcome their own backlogs of care, while battling to care for an ever-growing number of patients with an ever-decreasing pool of GPs. All in the face of unfair and unfounded attacks in the media.

Hospitals

In hospitals, reports suggest that ambulances are once again queuing outside emergency departments. Staff are being forced to see patients in corridors due to a lack of beds, all while waiting lists continue to rise.

One trust chief has recently warned their hospital is ceasing to function, while a survey of NHS leaders in England has found that nine in 10 chief executives, chairs, and directors believe the pressures on their organisation have become unsustainable.

Waiting lists and increased demand

Health services across the UK have faced successive months of growing demand and a rising backlog of care. There is declining performance against key targets and catastrophically high waiting lists compared to pre-pandemic levels.

In England, the waiting list reached an alarming, record high of 5.8 million people in September 2021. A&E attendances have reached pre-pandemic levels but with over 7,000 attendees waiting over 12 hours.

Yet there were more than 3 million more GP appointments booked, including appointments for COVID vaccinations, in October 2021 compared to October 2019. In secondary care there were almost 100,000 current vacancies in September.

Health services will not be able to ensure patient safety this winter or protect the fragile recovery of elective services without a well-supported, healthy, and safe workforce.

Many doctors now feel not only exhausted, but also undervalued and demoralised. It is therefore imperative that governments, health service leaders, and employers take urgent action.

Find the most recent backlog data in our NHS pressures data analysis.

 

The BMA calls to action

Urgent and comprehensive action must be taken to support doctors and NHS staff through this winter and help ease demand on services. This is in the interest of patient safety, staff wellbeing, and protecting the NHS’s recovery of elective care.

Therefore, we call on all governments, system leaders, and employers across the UK to  take action on the following priorities in the next three months.

 

1. Communicate honestly with patients about pressures

Clearly give the public advice on how to access care

Patients and the public deserve complete honesty about the state of health services and what is being done to address pressures.

They must have access to advice on making the best decisions about if, when, and how they seek care in the interest of their own safety and of those providing services to them.

Don't blame staff for NHS performance

The NHS workforce, which is still keeping health services across the UK going under immense pressure, is facing increasing and undue criticism due to delays in care.

The present situation is due to system-wide pressures and not individual services or professions. Any attempt to imply otherwise should be firmly rebuked.

In particular, GPs have given outstanding levels of care throughout the pandemic while delivering an incredibly successful vaccination programme. The recent spate of negative rhetoric targeting GPs and practice staff must end.

Use targeted patient information campaigns

Information programmes are needed to support people to make the best decisions about if, when, and how they should access care this winter.

This should have a clear focus on providing resources to patients on self-care, plus guidance on which services are the most appropriate for specific conditions.

UK governments have launched nationwide advertising campaigns (notably 'hands, face, space' and 'together we'll keep Wales safe') throughout the pandemic and this capability should be used again.

2. Retain staff and maximise workforce capacity

Protect the health and wellbeing of staff

Take a zero-tolerance approach to violence

Staff must be protected from any forms of abuse or violence, including via email and online. Steps must be taken to provide or enhance security measures where appropriate, and to swift action taken against instances of verbal or physical attacks on staff.

This should include assessments of staff security in hospitals and direct assistance to GP practices wishing to improve security.

Likewise, a zero-tolerance approach to bullying in the workplace must be taken by employers.

Protect staff from infection

Employers must take steps to reduce infection risk in healthcare settings, in line with BMA recommendations.

All frontline staff must have access to appropriate PPE, including respiratory protective equipment when treating confirmed or suspected COVID-19 patients.

Newly published infection prevention and control guidance still does not adequately reflect the need for protection from airborne transmission of COVID-19, continuing to leave staff at risk as we head into winter.

Cater for the physical needs of staff

All staff must have:

  • sufficient rest breaks and time off between shifts
  • access to safe changing and rest areas
  • access to nutritious food and water to allow them to recharge
  • ability to have restorative sleep.

We encourage all employers to adopt the BMA’s fatigue and facilities charter.

Challenge political and media rhetoric on the dedication of NHS staff

Their efforts deserve to be duly recognised.

Failing to do so risks both further undermining staff morale which in turn can affect patient safety and also presents a false picture to the public.

Give staff access to occupational health services

NHS staff must be able to:

  • access consultant occupational physician-led occupational health services
  • receive up to date physical and psychological health risk assessments
  • be provided with reasonable adjustments where necessary
  • raise concerns if they feel their health, safety or wellbeing – or that of their patients – is at risk.

Scotland’s winter planning includes funding earmarked for staff wellbeing, focussing on physical and emotional needs. This approach should be adopted across the UK.

Provide staff with rapid access to psychological support services

Guidance and access to mental health support services for staff have to be offered readily, either through an occupational health team or on a self-referral and confidential basis.

We encourage all employers to adopt the BMA’s mental wellbeing charter.

Ensure safe and affordable transport to and from work

Many doctors have reported longstanding issues with transport to and from their places of work, particularly at night.

In winter, with staff arriving and leaving work in darkness, steps must be taken by employers to ensure the entire workforce is enabled to do so safely.

This should include:

  • discounted or free access to public transport to and from work
  • proper lighting of all car parks and bus stops
  • assistance in leaving work where needed
  • ensuring free parking is available for all staff where it is not already.
Permission to take leave where practical

All healthcare workers need the opportunity to take time to properly rest and recover so they and the service can get through this winter. They must be permitted to take leave as far as is possible and practical.

Cut red tape, stop unhelpful targets and barriers and reduce unnecessary bureaucratic workload

Pause any new initiatives that don't aid winter pressures

Health services need to be concentrating as much of their energy and resources on frontline care as they possibly can. Any non-essential initiatives or programmes should be paused or scrapped this winter.

Similarly, the promise of any additional funding to better manage demand cannot depend on burdensome measures with no short-term impact.

Balance recovery of the backlog with the need to manage immediate pressures

Ambitious targets have been set for elective activity across the NHS in England. The Government have an aim of 30 percent more elective activity by 2024-25 compared to before the pandemic, with the aim of tackling waiting lists and backlogs in care.

However, unless frontline services are protected, elective care may be paused yet again – wasting the valiant efforts made to increase elective activity.

Trust GPs to act in the best interests of their patients

This includes:

  • reducing the burden of regulation within the system
  • significantly reducing bureaucracy and duplication
  • empowering GPs with resource and decision-making capacity locally.

Practices must equally be supported to care for all patients by allowing GPs to prioritise those who need care the most. This is rather than through 'improvement' initiatives, performance management targets and oversight meetings.

For example, QOF (quality outcomes framework) should be suspended in England as it has been in Scotland since 2016 and in Northern Ireland.

Employ dedicated staff to take on administrative duties

To avoid doctors being diverted away from direct patient care, steps should be taken to employ appropriate staff on a seasonal basis to ease the workload of doctors and clinical staff. This will allow them to focus on their clinical practice.

A 2018 BMA survey found that one in three doctors felt that a lack of administrative support affected their ability to deliver safe patient care. Four in ten doctors said that they spend over an hour a day on work that could be carried out by non-clinical staff.

A 2020 BMA survey found that nearly nine in 10 consultants felt that some of the administrative or clerical tasks they undertook could be carried out by a non-clinical member of staff. Yet, around two in three stated that their department had reduced the availability of administrative or clerical staff to consultants in the last two years.

Pause all unnecessary mandatory checks and training

Maintain only those strictly and demonstrably necessary for ensuring safe patient care.

Minimise the burden of appraisal and revalidation which can take a significant amount of time away from providing direct patient care.

The revised streamlined and less bureaucratic approach to appraisal introduced in 2020 should be maintained.

Taking additional measures to maximising workforce capacity

Support staff to control unmanageable workload

According to a September 2021 BMA survey, two thirds of doctors said that they work additional hours over and above their contractual or agreed requirement within the last month.

One in five said they were never able to take their breaks in full in the last two weeks. Another recent BMA survey found that 44% of consultants find their workload unmanageable.

There is a workload crisis in general practice with 70% of GPs reporting a higher workload than before the pandemic, with family doctors on average working 11 hours each day.

Controlling workload and preventing burnout is crucial for staff retention and to ensure doctors and other clinical staff are practicing safely.

Act to address punitive pension tax rules

A tax unregistered scheme, as used for the judiciary in response to the McCloud judgement, is needed within the NHS to ensure that doctors are able to work as many hours as possible this winter, without paying for it. Read more in our pensions campaign - end the pension tax trap.

Existing tax and pensions rules – including the annual and lifetime allowance – have been a major factor in doctors choosing to either retire early or to reduce the number of hours they work.

A 2019 survey by the Royal College of Physicians found that almost half (45%) were intending to retire earlier than planned, with 86% citing pensions as one of the reasons for their decisions.

At a time when waiting lists are at their highest, health services need as many doctors working as many hours as possible.

Retired doctors looking to return to clinical practice must also be given guarantees that they will not be penalised with large tax bills if they return to work.

Better processes for staff to join, remain, or return

We need to ensure as many staff as possible are available to the NHS this winter. This includes retired doctors, refugee doctors, international medical graduates, and those coming back from parental leave. 

It is imperative that lessons are learned from previous attempts to recruit staff back into roles to support the pandemic response. For example, by ensuring flexible and remote working wherever possible, increasing HR capacity to hasten the return-to-work process. Any mandatory training that is not necessary to ensure patient safety should also be dropped.

International doctors must be supported to concentrate on patient care without having to worry about their immigration status. Those who are already on a path to settlement should be granted automatic indefinite leave to remain.

Provide support for childcare

The UK’s costly and inflexible childcare system has led to many parents leaving the workforce and the many problems with the system have been compounded by the pandemic.

In 2020, parents in the UK faced the highest net childcare costs across the OECD.

Finding childcare that works around changing shift patterns is difficult to start with. Winter bugs, Brexit leading to an end to the au-pair scheme and the pandemic have led to fewer nannies from abroad entering the UK.

Funding should be provided to employers to provide emergency access to childcare for staff, as well as to expand NHS nursery spaces where this is possible quickly.

Protect training time

Junior doctors and medical students must be assured that their efforts to support the delivery of care this winter will not impact on their future careers due to time away from formal training and education.

Trainees who have already had their progression impaired by the pandemic must be protected from further detriment.

HEE’s (Health Education England) COVID-19 Training Recovery Programme Interim Report includes a number of commitments that should be used now to protect trainees and against further disruption to training programmes.

3. Promote responsible public health policies

Promote vaccine uptake

Improving vaccination uptake, especially among groups or in areas where uptake is lower remains crucial to reducing morbidity and mortality from COVID-19, and therefore pressure on health services.

Improve ventilation

Proper ventilation of enclosed spaces is vital in reducing infection risk and potential hospitalisation with COVID-19.

All practical steps should be taken to improve ventilation across the entire NHS estate. Each UK government should act to improve ventilation in public transport and public buildings. They should encourage the private sector to do the same in workplaces, entertainment venues, and restaurants and citizens in their own homes.

Require mask wearing in enclosed public places

Mask wearing has been shown to help reduce the spread of COVID-19 in enclosed spaces such as:

  • public transport
  • shops
  • healthcare settings
  • communal areas in educational settings
  • where adequate ventilation and distancing are often not possible.

Therefore, public health messaging and guidance should stress the importance of mask-wearing this winter including the additional protection to the wearer of an FFP2 mask or equivalent.

Improve public messaging on the ongoing risk of COVID-19

It is imperative that public messaging emphasises that the virus continues to circulate. Practising social distancing and meeting outdoors or in well-ventilated spaces – and wearing masks when this is not possible – remains the best way to reduce risk of infection and keep people safe.

Enforce COVID-secure standards

Greater guidance and support for businesses and educational settings to create sustainable, COVID-secure environments, as well as enforcement of standards is needed.

Improved support for those self-isolating

No one should be forced to make unacceptable choices between paying for essentials like food and housing, or risking further spread of the virus. Those needing to self-isolate must be supported according to their need.

Additional resources for local public health teams

Local public health teams are vital to managing the COVID-19 pandemic.

They need proper financial support and staff to enable them to continue to play a central role in testing and contact tracing. They also need capacity to deliver surge testing and other activities needed to rapidly bring local outbreaks under control.

4. Direct resources to where they are needed most

Prioritise workforce in all winter funding decisions

Supporting the wellbeing and retention of the NHS workforce must be an ultimate priority this winter.

While expansion of the workforce remains a key medium- and long-term priority, it is impossible to recruit or train enough doctors to help the NHS through this winter. Every effort must be made to keep those we have.

Provide funding for short-term staffing

Health, public health and care systems will need to support employers and GP practices to secure temporary locum support, particularly where there are acute workforce shortages.

Provide dedicated winter funding

Health services in all four UK nations must be given specific extra resources to tackle the additional challenges posed by winter pressures, alongside support for elective recovery.

Make capital funding available for urgent repairs to estates

So that patients and staff can safely use them, resources must be made available to ensure rapid repairs and remedial works can be done across the NHS estate.

The maintenance backlog across the NHS remains enormous and now sits at more than £9 billion in England alone. As this grows, so does the risk to those who use and work in them.

Adequately support social care

All UK governments must ensure social care is properly supported financially to ensure it is able to provide safe care to those who need it. This will also help to reduce pressure on hospital and GP services, as well as ensure timely discharge from hospital.

Scotland’s winter plan has, for example, proposed a number of welcome ideas to support social care, including increasing pay for social care staff to improve retention, and to enhance joint working between health and social care.

In England, the UK Government should also continuously monitor the impact of mandatory vaccination on the social care and healthcare workforce. If necessary, they should consider whether alternative measures to this policy – such as enhanced PPE and regular testing – are necessary to ensure safe staffing levels.

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