Doctors have launched a campaign to curb the use of unregulated assistants being deployed as a “short-term fix” to plug gaps in the NHS workforce.

By Nick Gutteridge, Political Correspondent www.telegraph.co.uk

Medics say that the health service is turning more and more to “associate” practitioners because they are much quicker and cheaper to train.

They have warned patients, often unaware when they are seen by such staff, that they are not being treated by a qualified doctor.

Associates do not go to medical school, and instead do two years of post-graduate training on top of a degree in a subject like biomedical sciences.

Ministers have unveiled ambitious plans to increase the number of them working in the NHS by almost fourfold to 12,000 by 2036-37.

Currently there are about 3,000 physician associates who support doctors in diagnosing and managing patients and 300 anaesthetist associates.

Unlike doctors and nurses, they are not overseen by a dedicated independent regulator.

Alarm

For several years the Government and General Medical Council, which oversees doctors’ standards, have been discussing plans for associates to be regulated by the GMC, but the watchdog says this will not happen until “the second half of 2024 at the earliest.”

Senior medics have now sounded the alarm on their expanding use and said the NHS should put more money into training fully-fledged practitioners.

They have set up a group called Anaesthetists United and are piling pressure on the Royal College of Anaesthetists into opposing the plans.

“The Government is trying to solve the NHS workforce crisis, not by recruiting and retaining more doctors, but by training cheaper replacements,” it said.

“They wouldn’t do this in other safety-critical industries, why in medicine?

“We are calling for anaesthesia associates to be properly supervised and we’re not prepared to see individual hospitals opt-out of proper supervision just to save money.

“Patients need to be made aware when they are being anaesthetised by a non-doctor.”

The group is now set to trigger an extraordinary general meeting of the Royal College of Anaesthetists after securing the signatures of almost 500 worried doctors.

Regulatory system

Richard Marks, a consultant anaesthetist in London, said associates need to be brought under the oversight of an independent regulator.

“As a doctor, you are registered with the GMC and in order to get onto and stay on the medical register you have to do a lot of things,” he told The Sunday Telegraph.

“There definitely needs to be some sort of regulatory system for individual medical associates, so the public has the assurance that they are properly qualified and are still fit to practise.”

He also warned that associates had been through “much narrower” training which raised concerns about “how people manage the 1pc of the time when things go wrong”.

“It’s like flying a plane. Most of the time it’s alright but it’s when things go wrong that you see the difference,” he said.

Dr Marks said hiring associates rather than training fully-fledged doctors was a “short-term fix” to the NHS’ staffing problems.

He added: “Patients are often confused about the terminology. They have a right to know who is looking after them, especially when they are asleep and unaware.”

There have also been concerns raised about the use of physician associates in place of fully qualified doctors, including at GP surgeries.

Emily Chesterton died last November after she was misdiagnosed by a physician associate who she mistakenly thought was a GP.

Blood clot

The 30-year-old, who lived in London, was seen twice by an associate and told that her calf pain was an ankle sprain when she actually had a blood clot.

A coroner ruled at her inquest that she should have been sent to A&E straight away and that if she had been then it is likely she would have survived.

Her mother, Marion, told the BBC that she “didn’t know she hadn’t seen a doctor” and that more regulation is needed around associates to guarantee patient safety.

“Physician associate sounds grander than a GP,” she said.

“If I had known earlier that she had not seen a doctor, I would have marched back to the surgery or gone straight to hospital.”

In June last year an investigation by BBC Panorama found that the UK’s biggest chain of GP practices was allowing associates to see patients without adequate supervision.

A spokesman for the Department of Health said: “Our Long Term Workforce Plan will deliver the biggest training expansion in NHS history and recruit and retain hundreds of thousands more staff.

“Patient safety remains of the utmost importance, which is why we are working with the General Medical Council to regulate physician associates and anaesthesia associates.

“We are clear that the role of associates is to support doctors, including GPs, and not to replace them. This supports the government’s plans to grow the multidisciplinary NHS workforce.

The chief executive who was in post during the Lucy Letby scandal was stopped from running Cornwall’s hospitals trust by former staff who were “outraged and distressed” that he had applied, it has been claimed by a senior NHS source.

Make you wonder how Chiefs of public sector bodies are chosen. – Owl

Lee Trewhela, local democracy reporter www.radioexe.co.uk

The Times reported this week that Tony Chambers, who was chief executive of the Countess of Chester hospital trust at the time Letby was murdering babies, was due to be made the permanent boss of the Royal Cornwall Hospitals Trust until senior staff were alerted to the Letby investigation by someone who worked at the Chester hospital.

Last week Dr Stephen Brearey, Chester neonatal unit’s senior paediatrician, claimed that Mr Chambers insisted that consultants who raised concerns about Letby should apologise to her and warned them that a line had been drawn and there would be “consequences” if they crossed it. Dr Brearey also claimed that Mr Chambers had told them he had spent a lot of time with Letby and her father, and had apologised to them. Mr Chambers said his comments to consultants had been taken out of context.

After leaving the Chester trust, Mr Chambers earned £345,000 as interim chief executive of Barking, Havering and Redbridge University Hospitals, where he worked between January 2020 and August 2021.

He then moved to Royal Cornwall Hospitals Trust (RCHT) where he earned £90,000 for a five-month stint between August 2021 and January last year. A senior NHS source told The Times that Mr Chambers was thought to be the frontrunner to become its permanent boss until the trust was alerted to the Letby scandal by a member of the Countess of Chester’s staff, who was “distressed and outraged” that Mr Chambers could lead another trust.

According to The Times’ report, Dr Mairi Mclean, chairwoman of RCHT, telephoned an executive in Chester and, following the call, Chambers was not appointed.

We approached RCHT to comment on the report. A Royal Cornwall Hospitals Trust spokesperson said: “Tony Chambers was interim chief executive for less than five months between August 2021 to the start of January 2022, whilst we went out to recruitment for a substantive chief executive. This interim appointment followed due process for an executive position and fully considered information available at the time.

“We cannot comment on personal information relating to a recruitment process. Mr Chambers was not appointed to the substantive position.”

A spokesperson for Dr Mairi Mclean referred to the above statement.

Last week Mr Chambers said that he was “truly sorry for what all the families have gone through”. He added: “As chief executive, my focus was on the safety of the baby unit and the well-being of patients and staff. I was open and inclusive as I responded to information and guidance.”

“Just look at it, this is the middle of the summer holidays,” says Phillip Garnsey, the exasperated co-owner of the Oggy Oggy pasty company, as he surveys an empty high street in Torquay.

Joe Middleton www.theguardian.com 

Just a few hundred metres up the road in the Devon town, the juxtaposition could not be more stark as families relax on the beach, enjoying one of the first sunny days of August, and paddleboarders make their way through the crisp blue ocean. Squeals can be heard from the nearby funfair as children play on the rides and later beg their parents for ice-creams or candy floss, while young couples browse inviting street food at the market.

However, away from the levity of the seafront, shopkeepers in Torquay told the Guardian about a lack of footfall, decline in the town centre and struggles caused by the cost of living crisis.

Michael Jamieson, the owner of Café Crème, says: “It’s been the worst summer in 14 years. Look how quiet it is for August, usually the town’s packed. June, July, August and May, they’ve all been quiet, super quiet. It’s not just me, it’s everybody, cafes, the clothes shops, souvenir stores, you name it, we are all down, we’re all struggling to pay our bills.”

He adds: “When we’re in season, from April until the end of September, I start serving breakfast at 8am. Now, I’m opening at 9am and hardly anybody is coming. You look outside and it looks deserted, the town.

“Believe me, wait until this winter, it will be a lot [worse], I guarantee you, come March, April, there will be a lot more empty shops, because people are struggling.”

The town centre is already pockmarked with empty shops and the streets are quiet. Ryan Hanlon, the manager of the Cider Rooms, says demand at the sports bar was good but did not compare with the previous year, when the high street was packed “with a sea of people”.

This is the heart of the problem. Last summer, trade was exceptional for seaside towns as people embarked on domestic breaks after the pandemic lockdown, due to restrictions on travelling abroad. But this summer, travel providers and airlines have reported strong demand for foreign trips, with a spike in last-minute bookings due to the wettest July on record in some part of England and Northern Ireland.

Tony Galinos, 74, a professional musician, has owned and operated The Guitar Man music equipment shop in the town centre for the last four years and has seen the area’s decline. “Our turnovers have dropped, conservatively, from 50% to 80%, we’ve got 50 vacant shops on the Torquay high street … Without support from the government, I would say within the next 12 months at least another third of the remaining businesses will close.”

He says these economic difficulties are being faced by seaside towns up and down the country. “It’s everywhere, if you go to Southend-on-Sea, even places like Brighton are suffering.” He adds that trade is “not even close” to what they experienced in the town last year and “80% down”.

Galinos says part of the reason is more people flying to Europe this summer, but that the poor weather in July and early August has also put people off heading to the seaside.

Garnsey says the summer has been terrible for visitor numbers, “at least half down on last year”. But the 58-year-old argues that is not the only problem: “I don’t think there is anything to do down here. If you go to Cornwall there is a bit more … there is nothing much on down here, I don’t think, and the town is very grubby-looking. We have had a lot of holidaymakers say that they wouldn’t come back.”

The most recent data supports the idea that the domestic holiday trend is fading post-Covid. Analysis from the recruitment firm Reed, published by Bloomberg, says that job vacancies in 25 of the major seaside towns have declined significantly since last year.

James Reed, the chair of Reed, said: “Given how heavily reliant many of these coastal towns are on strong summer trading, it is certainly concerning that the usual summer boost in job postings hasn’t materialised. The staycation boom has come to an end.

“Even those in a stronger financial position may opt for a less costly foreign holiday package over a domestic staycation where UK businesses, hit particularly hard by rising costs, have had to hike up prices for consumers. Just by comparing the costs of travelling by road and rail in the UK with the costs of flights abroad, it’s clear why the staycation boom has failed to re-emerge.”

Just over 270 miles away from south Devon, in the popular Welsh coastal resort of Abersoch, Tom Leslie, the owner of the Potted Lobster, says the restaurant is still busy but businesses in the area think its quieter than last year. “People are still coming out and spending, but the spend is more limited. They’ll buy one bottle of wine instead of two.”

Leslie also part-owns a hotel, the Whittling House in Alnmouth, Northumberland, and said occupancy rates were 98% in the domestic holiday boom after the pandemic, but this summer they had dropped to 70%.

After the economy opened up following Covid-19, he said, there were “freakish” high levels of trade due to the specific circumstances around the pandemic, but this could now level out.

The post-lockdown visitor spike bucked a decades-long trend of economic decline in Britain’s coastal communities. A House of Lords report released in July titled The Future of Seaside Towns found such places had “significant potential” but faced a “persistent sense of disconnection” as well as complex social issues, a lack of jobs and deprivation.

Last month, the shadow chancellor, Rachel Reeves, said she wanted to “supercharge seaside towns” to boost their economic prospects and create new jobs. If Labour won the next election she promised it would crack down on sewage dumping in rivers and the sea, scrap the current business rate scheme, let councils introduce a holiday lets licensing scheme, and help create new, high-quality jobs through an apprenticeship levy.

Analysis released by Labour at the same time found the economic output of seaside towns had increased by 12% between 2009 and 2019, far below the 20% overall increase in the UK gross added value, a measure of economic output.

Another key issue is poverty. A 2020 analysis of coastal towns published by the Office for National Statistics showed there was more likely to be higher levels of deprivation than in inland towns.

Alan Tilley runs Turning Heads, a community interest company in Torquay that runs a social supermarket offering food to struggling families at lower prices than traditional retailers.

He says demand has increased and every week someone new, who is almost always in paid employment, is asking to use the shop. “I’m astounded about the state of what’s going on,” he says.

Garnsey says not enough is being done to support seaside towns, and his pasty business is likely to close. “We’re finding it tough, but it’s not just because of the lack of visitors, it’s the cost of living going up.

“We’re not the only ones. If you look down the high street at the shops that are shut … It’s such a shame, we have a lovely shop and such fantastic customers, but it hasn’t worked.”

The UK competition watchdog has said it will probe land banking by the country’s biggest housebuilders as it identified a number of concerns regarding the sector.

City AM reporter www.cityam.com

The UK competition watchdog has said it will probe land banking by the country’s biggest housebuilders as it identified a number of concerns regarding the sector.

The Competition and Markets Authority (CMA) formally started a probe into the housebuilding sector and the private rental market in February.

It said it was looking into the housebuilding industry amid worries that developers were not delivering homes at an adequate pace or scale.

“Having seen four previous housing market reviews in the last 25 years, we believe this one is very unlikely to lead to a different outcome or material changes for the sector,” analysts at Peel Hunt said in reaction the the news.

“This CMA review has been politically driven, as the conservative government has turned anti-housing under the current secretary of state, in light of the Chesham and Amersham by-election in June 2021,” a note from Peel Hunt read. 

“The lack of housing and poor current affordability has been driven by supply bottlenecks, in particular planning. The deficit looks set to grow further, although a new Labour government may provide the industry with a shot in the arm.”

The CMA outlined five main areas it is investigating in relation to UK housebuilding.

It said this will include estate management charges, where homeowners pay private companies to maintain things such as parks and roads.

The regulator will also look at issues regarding land banks, amid concerns over whether some large portfolios held by bigger firms are slowing competition or housing availability in some areas.

It is also looking into wider concerns regarding planning rules, competition between builders and barriers for new businesses wanting to build homes.

In relation to the rental market, the CMA said it was taking action to provide updated guidance for letting agents regarding the rights and responsibilities of tenants and landlords.

The CMA also identified concerns related to zero deposit schemes, sham licences, onerous guarantee clauses, and possible unlawful discrimination.

It said it will investigate further and will take enforcement action if needed.

Sarah Cardell, chief executive of the CMA, said: “The CMA alone can’t resolve the problems in the UK housing market.

“But we have a role to play and will do our part to help ensure the private rental and housebuilding markets work better for people and businesses.

“In housebuilding, we’ll press on with our investigation of the five areas that are the focus of our market study so that we can get to the bottom of any potential competition concerns.

“Once complete, we will consider what actions the CMA can take to tackle any concerns identified or whether there are more effective ways to deal with those concerns such as through recommendations to government for legislative change.”

By Henry Saker-Clark, PA Deputy Business Editor