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Testing for coronavirus: what is being done in the UK?

Who is being tested for coronavirus in the UK? 

As of last week, when the Prime Minister announced Britain was no longer in the “contain” phase of the pandemic, most testing outside of hospitals stopped. People with symptoms are expected to self-isolate but will not know whether they have COVID-19. That means they will not know if they are immune or still at risk – and a risk to other people.

Testing now mostly takes place in hospital. People in intensive care units and those with respiratory illness, especially if it is pneumonia, will get tested for COVID-19. When there is a cluster of infections, such as an outbreak in a care home, those people will also be tested.

But the World Health Organization has criticised the approach of countries that are not prioritising testing, with its director general saying “you cannot fight a fire blindfolded … test, test, test”.

So why are people with symptoms not being tested?

It appears to be a capacity issue, although the Department of Health and Social Care failed to respond to repeated requests for explanation. So far there have been about 44,000 tests in England, which the government’s chief scientific adviser, Sir Patrick Vallance, told the health select committee put it in “the top three or four countries in terms of testing”.

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Source: BBC News, 17 March 2020

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Coronavirus: Australian scientists map how immune system fights virus

Scientists in Australia say they have identified how the body's immune system fights the Covid-19 virus.

Their research, published in Nature Medicine journal on Tuesday, shows people are recovering from the new virus like they would from the flu.

Determining which immune cells are appearing should also help with vaccine development, experts say.

"This [discovery] is important because it is the first time where we are really understanding how our immune system fights novel coronavirus," said study co-author Prof Katherine Kedzierska.

The research by Melbourne's Peter Doherty Institute for Infection and Immunity has been praised by other experts, with one calling it "a breakthrough".

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Source: BBC News, 17 March 2020

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Coronavirus: UK changes course amid death toll fears

Change course or a quarter of a million people will die in a "catastrophic epidemic" of coronavirus – warnings do not come much starker than that.

The message came from researchers modelling how the disease will spread, how the NHS would be overwhelmed and how many would die. The situation has shifted dramatically and as a result we are now facing the most profound changes to our daily lives in peacetime.

This realisation has happened only in the past few days.

However, it is long after other scientists and the World Health Organization had warned of the risks of not going all-out to stop the virus.

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Source: BBC News, 18 March 2020

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NHS staff ‘can access covid-19 testing’, government insists

NHS staff are to be given access to testing for covid-19, the government said this morning, but it remains unclear how the policy will be applied.

A Department of Health and Social Care spokesman said at lunchtime: “Our testing regime is set up to provide for those who need tests the most. This includes key workers, such as NHS staff. We will set out more details shortly.”

It remains unclear how this will be applied.

The announcement follows concerns from healthcare professionals they are not being tested for the virus, even if they had been exposed to infected patients.

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Source: HSJ, 17 March 2020

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Coronavirus: Routine NHS operations cancelled in effort to free up 30,000 hospital beds

NHS hospitals have been told to cancel operations in an effort to free up 30,000 beds to create space for an expected surge in coronavirus patients.

In a letter to NHS bosses today, NHS England said hospitals should look to cancel all non-urgent surgeries for at least three months starting from 15 April. 

Hospitals were given discretion to begin winding down activity immediately to help train staff and begin work setting up makeshift intensive care wards. Any cancer operations and patients needing emergency treatment will not be affected.

The letter from NHS England Chief Executive Simon Stevens said: “The operational aim is to expand critical care capacity to the maximum; free up 30,000 (or more) of the English NHS’s 100,000 general and acute beds."

In the meantime hospitals were told to do as much elective surgery, such as hip operations and knee replacements, as possible and to use private sector hospitals which it said could free up 12 to 15,000 beds across England.

Sir Simon also said patients who did not need to be in hospital should be discharged as quickly as possible adding: “Community health providers must take immediate full responsibility for urgent discharge of all eligible patients identified by acute providers on a discharge list. For those needing social care, emergency legislation before Parliament this week will ensure that eligibility assessments do not delay discharge.

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Source: The Independent, 17 March 2020

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Child deaths 'not properly investigated' at top hospital

Great Ormond Street Hospital (GOSH) failed to properly investigate child deaths, suggests evidence uncovered by the BBC.

The source of one fatal infection was never examined and in another case GOSH concealed internal doubts over care. Amid claims GOSH put reputation above patient care, former Health Secretary Jeremy Hunt urged it to consider a possible "profound cultural problem".

Responding, the central London hospital said it rejected all suggestions that it treated any child's death lightly.

BBC Radio 4's File on 4 programme has spoken to several families whose children were treated at the world-famous hospital. All said that while care at one point had been excellent, when things went wrong GOSH appeared to have little interest in fully understanding what had happened.

The concerns over how Great Ormond Street is run are shared by staff. A staff survey, published last month, made grim reading for management.

On two aspects, including whether there is a safety culture, it received the lowest score of all trusts in its category, while on three other questions, including how bad bullying and harassment were, and how good the quality of care was, its own staff rated it as among the worst.

"If we want the NHS to offer the highest quality care in the world, then we have to change a blame culture and sometimes a bullying culture, for a learning and an improvement culture," the former Health Secretary Jeremy Hunt told File on 4.

"That staff survey would indicate they don't have that culture at Great Ormond Street."

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Source: BBC News, 17 March 2020

Read Joanne Hughes' response to this news in her blog shared on the hub.

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'Not fit for purpose': UK medics condemn Covid-19 protection

Frontline NHS staff are at risk of dying from Covid-19 after the protective gear requirements for health workers treating those infected were downgraded last week, doctors and nurses have warned.

Hospital staff caring for the growing number of those seriously ill with the disease also fear that they could pass the infection on to other patients after catching it at work because of poor protection.

Doctors who are dealing most closely with Covid-19 patients – A&E medics, anaesthetists and specialists in acute medicine and intensive care – are most worried.

A doctor in an infectious diseases ward of a major UK hospital, who is treating patients with Covid-19, said: “I am terrified. I am seriously considering whether I can keep working as a doctor.”

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Source: The Guardian, 16 March 2020

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On the front lines of coronavirus: the Italian response to covid-19

Italy has rapidly become the country hit second hardest in the world by the coronavirus pandemic. Marta Paterlini reports in the BMJ on the front lines of a country in total lockdown.

The resulting government imposed state of emergency lockdown, which started in northern Italy and has expanded to the whole country, will last until at least 3 April in an attempt to contain a contagion that has, at the time of writing, infected over 24 747 people (including at least 2026 healthcare staff) and killed 1809. The fatality rate of 7.2 is now higher than in China (3.8).

Italian doctors describe a warlike scenario in hospitals, with fewer places available than there are patients in critical condition. Lombardy, the region around Milan and the most affected in the country, has around 1000 beds available for patients in need of intensive care, but they are near to saturation.

Italy is experiencing a chronic shortage of healthcare workers. On 9 March the government announced a plan to add 20 000 new doctors, nurses, and hospital employees to meet demand.567 Retired doctors may be called on, as well as students who have completed their medical degree and are in the final year of specialist training.

Meanwhile, medical authorities are trying to avoid quarantining doctors who have come into contact with coronavirus patients. They are encouraged to work unless they show symptoms of the infection or test positive. Specialist physicians such as gastroenterologists and cardiologists have been asked to work outside of their fields.

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Source: BMJ, 16 March 2020

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Coronavirus: PM says everyone should avoid office, pubs and travelling

The Prime Minister has said everyone in the UK should avoid "non-essential" travel and contact with others to curb coronavirus as the country's death toll hit 55.

Boris Johnson said people should work from home where possible as part of a range of stringent new measures, which include:

1. Everyone of every age should avoid any non-essential social contact and travel.

2. Everyone to avoid pubs, clubs, cinemas, theatres and restaurants etc.

3. Everyone to avoid large gatherings - including sports events.

4. Everyone should work from home where possible.

5. If anyone in a house has CV19 symptoms, everyone in that house has to isolate for at least 14 days

6. Over 70s and those at risk (including pregnant women) to stay home for 12 weeks, which means no going out to shops or collect anything etc., unless there is no other option.

Schools will not close for the moment. 

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Source: BBC News, 16 March 2020

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Health experts criticise NHS advice to take ibuprofen for Covid-19

Experts have criticised NHS advice that people self-isolating with Covid-19 should take ibuprofen, saying there is plausible evidence this could aggravate the condition.

The comments came after French authorities warned against taking widely used over the counter anti-inflammatory drugs. The country’s health minister, Olivier Véran, a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

NHS guidance states that people managing Covid-19 symptoms at home should take paracetamol or ibuprofen.

“I would advise against that,” said Prof Ian Jones, a virologist at the University of Reading. “There’s good scientific evidence for ibuprofen aggravating the condition or prolonging it. That recommendation needs to be updated.”

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Source: The Guardian, 16 March 2020

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Why frontline health workers may not be tested for coronavirus even if they have symptoms

Channel 4 News says they have seen a Public Health England document indicating that not all healthcare and other essential workers with symptoms will be tested because there simply isn’t the capacity to do so – with testing prioritised in order of clinical need.

Public Health England say they won’t comment on the contents of a leaked document and it is still subject to ongoing discussions.

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Source: Channel 4 News, 15 March 2020

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CQC suspends routine inspections amid covid-19 outbreak

The Care Quality Commission (CQC) has suspended its routine inspections due to the coronavirus outbreak following pressure from system leaders and NHS bosses.

The decision to suspend inspections where there are no immediate safety concerns is understood to have been taken by the CQC’s executive team this morning, senior sources told HSJ. Both the NHS Confederation and The Royal College of GPs said the decision had been made.

NHS Confederation called the move a “sigh of relief” for front-line staff, while the RCGPs said it would enable GPs to dedicate their time to providing care. 

NHS Confederation chief executive Niall Dickson said: “Front-line staff will breathe a sigh of relief that CQC has responded to our concerns and will now postpone its inspections where there is no immediate safety concern so that they can gear themselves up to prepare for the huge task ahead in dealing with the coronavirus pandemic.”

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Source: HSJ, 16 March 2020

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Family 'sick to stomach' as NHS calls TV report of son's death a 'malarkey'

The mother of a student, who took his own life, said today she felt 'sick to her stomach' after an NHS communications manager labelled a media report on her son's suicide a 'malarkey'.

Pippa Travis-Williams, whose son Henry was found dead days after leaving a mental health unit run by the Norfolk and Suffolk Foundation Trust (NSFT) in 2016, said an email sent by NSFT communications manager Mark Prentice to his boss was 'disgusting'.

It comes weeks after Mr Prentice gloated in another email to his boss that the NSFT had 'got away (again)' with media coverage of the death of a dementia patient.

In an email to his boss, explaining why NSFT chief executive, Jonathan Warren, was going on BBC Look East, Mr Prentice said the NSFT might look 'uncaring' if Mr Warren did not appear and then described the coverage of Mr Curtis-Williams' suicide as a 'malarkey'.

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Source: Ipswich Star, 10 March 2020

 

 

 

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Inside an ICU: how long can we stay calm in the face of the coronavirus crisis?

Matt Morgan, an intensive care doctor, describes in this Guardian article how his ICU are preparing for the coronavirus crisis.

"ICUs are as prepared as they can be. Locally business as usual has made way for preparations for caring for high numbers of patients. We are finding every ventilator we may have and identifying every suitably qualified member of staff. We will work together to fill gaps as best we can.

There’s a sense of anticipation about what the next eight, 10, 12 weeks are going to bring in terms of work. Anyone who works in healthcare is also a mum, dad, daughter, brother, son. We want to give everything to saving lives and work and care, but equally we’re thinking about the logistics of personal lives and elderly relatives too."

Matt says his worst nightmare is having insufficient workforce and equipment to meet patient needs. Whether or not that will come to fruition is tough to predict. 

He also says that his ICU has a psychologist who’s doing a huge amount of thinking about putting in place wellbeing resources for staff who might be in moral distress after having to prioritise one patient over another.

"If there are 500 patients and only 200 ventilators then that’s when we need national guidance from the government and other bodies. It can’t be up to individual doctors. The age of playing God is long behind us. The question is who should we be making decisions with: the public, government or within the profession?"

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Source: The Guardian, 13 March 2020

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Northern Devon Healthcare NHS Trust: 20 deaths or serious harm cases in maternity

At least 20 maternity deaths or serious harm cases have been linked to a Devon hospital since 2008, according to NHS reports obtained by the BBC.

A 2017 review which was never released raised "serious questions" about maternity care at North Devon District Hospital. The BBC spent two years trying to obtain the report and won access to it at a tribunal earlier this year.

Northern Devon Healthcare NHS Trust (NDHT) said the unit was "completely different" after recommended reforms.

A 2013 review by the Royal College of Obstetricians and Gynaecologists (RCOG) investigated 11 serious clinical incidents at the unit, dating back as far as 2008.

The report identified failings in the working relationships at the unit, finding some midwives were working autonomously and some senior doctors failed to give guidance to junior colleagues.

Despite the identified problems with "morale", the subsequent investigation by RCOG in 2017 expressed concerns with the "decision-making and clinical competency" of senior doctors and their co-operation with midwives. 

An independent review into midwifery in October 2017 noted "poor communication" between medical staff on the ward for more than a decade. The report identified a "lack of trust and respect" between staff and "anxiety" among senior midwives at the quality of care.

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Source: BBC News, 16 March 2020

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Coronavirus: GPs prepare for NHS's 'biggest crisis'

As coronavirus spreads widely across the UK, many of those who fall sick may seek treatment at their GP's surgery. But are family doctors ready to deal with a wave of patients, prevent the spread of the disease and protect the most vulnerable?

"This is a massive crisis, probably the biggest crisis the NHS has ever had to face," says Prof Martin Marshall, an east London GP who is also chair of the Royal College of General Practitioners' council.

He says not enough has been done yet to prepare family doctors for the epidemic, although he adds: "We need to be a little bit understanding of the pressures that the whole system is under."

As the virus circulates in the community, he says we need "urgent action" to protect healthcare workers, give them the information they need and provide technology to allow for more consultations by phone or the internet.

Given the pressures the NHS will be under, Prof Marshall says it is vital that doctors and nurses are not taken out of action for seven days of isolation unnecessarily.

"We're not saying that health professionals are more important than patients, we're saying that health professionals have a responsibility," he says.

"We therefore need to keep them as healthy as possible and we need to get them back into the workforce as quickly as possible. So we're asking that health professionals are tested early."

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Source: BBC News, 16 March 2020

 

 

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Majority of GPs do not have sufficient coronavirus protective equipment

Two out of five GPs have still not received any personal protective equipment (PPE) against coronavirus, a Pulse survey suggests.

The poll of over 400 GPs saw 41% of respondents say they have not received any PPE, while a further 32% said they had not received enough. Just 15% of GPs said they have sufficient PPE, with the remainder unsure.

This comes despite NHS England promising last week that it would ship PPE free of charge to practices.

The Welsh Government made the same announcement this week, while in Scotland health boards should be distributing PPE.

A GP who has received no proper equipment, Dr Kate Digby, in Cirencester, said she feels "woefully underprepared".

She told Pulse: "I'm becoming increasingly concerned at the lack of resources being provided for frontline primary care".

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Source: Pulse, 2 March 2020

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What front line staff are worried about

Frontline medics are juggling fears about a lack of beds, a crisis in staffing and worries about their own personal safety as the threat of a large-scale coronavirus outbreak looms, HuffPost UK has learned.

With public health officials warning that, in the worst-case scenario, up to 80% of the UK population could be infected with coronavirus, NHS staff said such a scenario would be a “disaster” for the health service. 

Meanwhile, medics working in the community have warned they are not getting consistent advice on how to protect their own health.

Dr Punam Krishan, a GP in Glasgow, told HuffPost UK that while the NHS deals with thousands of cases of cold, flu and norovirus each year, the threat of Covid-19 is still worrying. 

“Obviously as frontline workers we are most at risk,” she said. “So I’m not going to lie, yes – it does provoke anxiety. Particularly because the signs don’t show immediately – there’s an incubation period that’s up to 14 days.” 

This means that someone who has unknowingly been in contact with a coronavirus patient and is not yet showing symptoms of the virus could come into the practice. That thought “can trigger a bit of panic”, Krishan said. 

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Source: HuffPost UK, 11 March 2020

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HHS is seeking to open up patient data. MedStar Health says it's got tools to make those data useful

MedStar Health launched a new tool that automatically calculates a patient's risk of having a heart attack or stroke within 10 years. The tool enables doctors to more easily show patients their personal risk for heart disease, stroke and other cardiovascular diseases over time using easy-to-read graphics. 

"Seeing their risk on a visual display is more powerful than me telling them their risk,” said Ankit Shah, Director, Sports and Performance Cardiology for the MedStar Heart & Vascular Institute at Union Memorial Hospital in Baltimore.

The tool is embedded in MedStar's Cerner electronic health record (EHR), making it easier for physicians to use it during patient visits, health system officials said. The project highlights how MedStar Health National Center for Human Factors focuses on human factor design to improve technology for patients as well as providers. 

Final rules from the US Department of Health and Human Services (HHS) will make it easier in the future for patients to share their health data with third-party apps.

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Source: FierceHealthcare, 9 March 2020

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Revealed: The trusts which will struggle most to deliver quality care in 2020

The trusts which are likely to face the fiercest struggle to deliver quality care in the immediate future have been identified through an analysis carried out exclusively for HSJ.

Analyst company Listening into Action has taken data from the NHS Staff Survey 2019 to produce “a set of ‘workforce at risk’ numbers that point to the likelihood (or not) of workforce stability and continuity challenges adversely affecting the care a trust’s key assets are able to deliver in the year ahead”.

The analysis shows a strong correlation between staffs’ perceptions of how well they are supported, and care quality — and therefore reveals which trusts face the toughest challenge to improve performance.

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Source: HSJ, 9 March 2020

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Health expert brands UK's coronavirus response 'pathetic'

A leading public health expert has launched a devastating critique of the government’s handling of the coronavirus outbreak in the UK, saying it is too little too late, lacks transparency and fails to mobilise the public.

Prof John Ashton, a former regional director of public health for north-west England, lambasted a lack of preparation and openness from the government and contrasted Britain’s response to that of Hong Kong.

“Right at the beginning of February, they [Hong Kong] adopted a total approach to this, which is what we should have done five weeks ago ourselves. They took a decision to work to three principles – of responding promptly, staying alert, working in an open and transparent manner,” he told the Guardian.

“Our lot haven’t been working openly and transparently. They’ve been doing it in a (non) smoke-filled room and just dribbling out stuff. The chief medical officer only appeared in public after about two weeks. Then they have had a succession of people bobbing up and disappearing. Public Health England’s been almost invisible."

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Source: The Guardian, 12 March 2020

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COVID-19 health management service to care for patients at home

NHS England is commissioning a “COVID-19 home treatment service” of primary and community healthcare for self-secluding patients.

It is introducing “urgent primary care services to patients diagnosed with COVID-19” who are self-secluded at home. The service will care for patients’ symptoms relating to COVID-19 as well as other conditions until they are discharged from home isolation and referred back to their GP.

“There is likely to be a gradual handover of patients to CHMS providers as they come onstream to provide the service,” according to a letter from NHSE’s primary care directors sent to GPs today.

“As soon as the new service is up and running in your area, your clinical commissioning group will be able to tell you who will be providing care for patients in your locality.”

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Source: HSJ, 11 March 2020

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NHS prepares to cancel elective ops in readiness for covid-19 surge

System leaders are telling hospitals to prepare for a potential suspension of all non-emergency elective procedures which could last for months, as they get ready for a surge in coronavirus patients.

Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity.

HSJ understands trusts have been told to firm up their plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment.

An announcement is expected soon, with patients affected given at least 48 hours notice. It has not been decided how long it might last for, as the duration of any surge in cases and acute demand is unknown. But HSJ has been told it could stretch out for several months, with three or four months discussed, which would potentially mean tens of or even hundreds of thousands of cancelled operations.

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Source: HSJ, 12 March 2020

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Doctors told not to fear reprisal during coronavirus outbreak

NHS national leaders are set to reassure doctors they should not fear regulatory reprisals, within reason, if they end up working outside their areas of expertise during the coronavirus outbreak.

HSJ understands the UK’s four chief medical officers and the General Medical Council are drafting a letter to be sent to all UK doctors, which will contain the reassurances, as the system braces for a sharp rise in covid-19 cases. The letter will also urge doctors to be flexible and not to resist new ways of working, with senior figures expecting many clinicians working in other specialities or locations during the outbreak.

The letter will say doctors, while still expected to follow good medical practice, should not fear reprimand from their employers or national bodies such as the GMC, NHS England or other regulators.

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Source: HSJ, 11 March 2020

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NHS to pay £870,000 to whistleblower doctor who spoke out on patient safety

A London NHS trust has been ordered to pay a leading heart doctor more than £870,000 after he was sacked for whistleblowing about safety concerns following a patient’s death.

Dr Kevin Beatt, one of the UK’s most respected consultant cardiologists, was fired from Croydon Health Services in 2012 after reporting staff shortages, inadequate equipment and workplace bullying at the trust.  

The tribunal heard Dr Beatt’s dismissal “had a devastating effect on his career and his wellbeing”.

He told the Evening Standard: “I was forced into a position where I lost my career for trying to highlight dangerous practices in the NHS. It has taken seven years to get to this point, which is just appalling. It has been a huge ordeal and I have the greatest sympathy for any whistleblower who has to go through something like this.”

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Source: Evening Standard, 11 March 2020

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