On Sunday (12 December) the prime minister asked frontline NHS staff to make ‘another extraordinary effort’ in the bid to offer vaccines to every adult in England by the end of December, to meet the ‘tidal wave’ of infections of the Omicron variant of COVID-19 on the horizon. The target is unprecedented, with an estimated 1 million vaccinations needed per day – more than the peak of 844,000 achieved in the spring.

These measures are needed for a health service in a desperately precarious state, already facing a record backlog and waits for hospital treatments, failure to meet emergency ambulance response targets, and escalating pressures on general practice, with 3.1 million more patient contacts per month compared to pre-pandemic (October 2021 vs October 2019). The sudden exponential rise in the Omicron variant – likely to be the dominant variant within days – has added major challenges, given the evidence we have to date suggests reduced effectiveness of double vaccination, requiring a booster dose to improve protection.

One year into the vaccine programme, the new national mission to boost the country will require the entire NHS and social care system to yet again pull together to mount the biggest response possible. The lion’s share of the vaccine campaign to date has been shouldered by GPs and their teams; yet again they have been asked to step up. This additional responsibility comes while they continue to manage significant patient complexity, urgent and acute unmet need in their communities. In secondary care, doctors are likely not only to face a greater number of COVID hospitalisations but also winter pressures which our research found may be the worst on record. The secondary care workforce will face even more pressure with up to 5% of hospital staff shifted from supporting hospitals to the booster campaign.

I want to reassure you that the BMA is calling for you to have the support and protection you need as we face the coming weeks. 

Our priorities include:

• ensuring you are adequately protected: infection control measures to be reintroduced in healthcare settings, including the introduction of high-grade FFP3 masks where healthcare workers are seeing patients with suspected or confirmed cases of COVID, and for higher grade masks (FFP2) for all patient care, adequate ventilation and physical distancing of patients.
• doctors receiving proper rest and support. Doctors are physically and emotionally exhausted after 20 months of the pandemic, and we need proper rest and a manageable workload to cope with the daunting pressures ahead. You can access our guidance on working conditions during COVID and our expert support team is on hand to help and advise on any concerns you have. The guidance covers issues specific to branches of practice as well as broader advice on areas such as leave, risk assessments and if you are acting outside your usual role.
• our wellbeing services, which have already made an invaluable contribution during the pandemic, are open for doctors and medical students – members and non-members alike – plus their partners and dependants. These are available 24/7.

We must also ensure there are short- and long-term measures to address the punitive pension taxation system so that senior doctors can work extra hours to address the increasing patient demand without fear of a financial penalty. These measures are also vital to reduce early retirement in the profession, which further exacerbates the workforce crisis. We have written to secretary of state for health and social care Sajid Javid this week on these issues, seeking solutions.

I have absolutely no doubt that the effort made by every doctor and every one of our healthcare colleagues will be extraordinary, just as it has been throughout the pandemic.

But the Government needs to make its own efforts too. It says the current situation is an ‘emergency’; that there will be a ‘tidal wave’ of infections.

The vaccination programme is hugely important, but nearly a quarter of adults will not be eligible for a booster by the end of the year due to being unvaccinated, or not having had a second dose in time. It is therefore vital the Government urgently introduces robust infection control measures in the community, especially where people mix in indoor settings.

This includes:

• mandatory wearing of face masks in all indoor settings, including all hospitality settings, unless eating or drinking
• reintroducing two-metre social distancing rules in all indoor public settings
• much more widespread use of lateral flow tests before social mixing in all settings should be the norm and the expectation for entry to all hospitality venues, regardless of vaccination status
• limiting large indoor gatherings that risk accelerating the spread of the virus
• legal requirements on ventilation in indoor public and educational settings
• recommending the wearing of FFP2 masks (which provide protection for the wearer) in particular for those who are clinically vulnerable
• we must also see the Government ensure enforcement and adherence of these measures, including financial support where appropriate to businesses that would be adversely impacted.

In an already severely understaffed health service there is simply not the capacity for hospitals to cope with expected surges in COVID patients, and for GPs to deliver on the fastest rollout of vaccinations in history without an impact on non-COVID work in primary and secondary care, potentially adding further to the backlog of work.

The total waiting list stands at a record high of 5.98m and continues to grow, and other data points show the alarming pressure points in the system. We need the Government and NHS England to be vocal, honest and open about why priorities are having to change, instead of allowing individual doctors, hospitals and GP practices to face blame, scapegoating or abuse for the reduction in access to routine services.

The Government can be sure that doctors will continue to play their part in tackling the greatest crisis ever faced by the health service. What we need in return is for the Government to play its part, by bringing in reasonable public health measures to contain the spread of this exceptionally transmissible new variant.