Me and Ben Prater have a frank discussion about the state of primary care as evidenced in the Darzi report and what may be the recipe to save British general practice.

A whopping 39 percent GPs are thinking of leaving the profession in the coming 5 years , if something isn't done soon, we may be 22000 GPs short which could very well be a fatal blow to the NHS . The current GP workforce crisis seems to be a product of increasing workload , reduced staffing and increasing complexity of cases due to an ageing population. The need for action by the government is now and the consequences of inaction are going to be dire for the NHS. It is time for some bold and radical action by the government .....(and it's not just about the pay).

As a part of the 'living with Covid Plan' published in mid February 2022, today from 1st April the government is scrapping free Covid tests (with the exception of patient-facing NHS and care staff and Clinically extremely vulnerable patients). The UK Government mentions high levels of population immunity secondary to a successful vaccination programme and effective antiviral treatments as a reason for the scrapping in addition to the prohibitive cost to the taxpayer. 

However, both Care bodies and Doctor's organizations have criticized this move. Blood Cancer UK has mentioned that "Protection from Covid should be a right, not a privilege". BMA has said that providing free tests only to clinically vulnerable people once they develop symptoms, and not providing any free tests to their friends and family, was “completely illogical, as the priority should be protecting them from infection in the first place.” Patients Association, said that charging patients for lateral flow tests “creates a barrier” that would exacerbate health inequalities for those who may not be able to afford them. “Charging for tests will contribute to covid-19’s continuing spread.”

Here are my thoughts on this subject, telecast live today in the morning show with Ben Prater about this thorny issue on BBC Radio Wiltshire. 

Covid toes are the most common dermatological manifestation of Covid 19. They are seen in predominantly white caucasian ethnicity and patients are usually young and thin. They also seem to occur in the later half of clinical disease. Most cases are asymptomatic and self resolve within 15-30 days. What's quite fascinating about them is that majority of them test negative on Covid 19 RT PCR and Antigen tests. Listen to the podcast to discover what might be causing that and what might be the clinical significance and future application of this finding. 

Listening time : Approx 20mins 

The NHS enters the winter phase surrounded by the "perfect storm" with an unprecedented backlog of cases, the threats from Flu and RSV which may act synergistically with Covid 19 infection and cause infections of greater severity, an expected increase in wintertime hospitalisations from non-communicable diseases (eg Asthma, COPD, IHD), staff and equipment shortages and what is an already overburdened service seeing an unexpectedly high demand on its resources. The fact that > 75% of our population is double vaccinated is indeed a feat of science. Vaccine confidence nationally seems to be high. The risk however is "Vaccine Over-confidence", where all other preventative measures such as social distancing, wearing masks, well-ventilated workspaces, meeting people outdoor wherever possible is put aside for the sense of security that being vaccinated brings. Indeed there is data from Israel that antibody levels wean after 6 months or so. This may increase susceptibility to infection but the vaccines still continue to provide protection from developing a serious infection. There is also data that records a three-fold reduction in transmission in those vaccinated. 99.5% of the mortality in the last 6 months occurred in those who weren't double vaccinated at the time of infection. There is the risk of a "triple lethal combination" of Flu, RSV and Covid 19 working together to overwhelm an already outstretched health service. The Covid 19 causing virus may also experience a natural "selection pressure" when it will need to compete with the other winter prevalent respiratory viruses and this may also force a new mutation. 

What could the general public do to minimise their risks? The unidimensional approach of either focusing on any one intervention such as testing, lockdowns or mass vaccinations are bound to fail and a multidimensional approach will need to be adapted to keep ourselves safe and to safeguard the NHS. This means utilising any and all of the above options should they be deemed necessary along with basic pillars of managing respiratory infections such as face masks, social distancing, hand hygiene,  good ventilation etc. This will safeguard us from both Covid 19 and Flu/ RSV infections common in the winter season. Additionally, it is important for those who are vulnerable to self assess their risk and exercise greater caution. By exercising the above precautions the population could safeguard themselves and others dear to them. It is a fallacy to assume that the governments would need to walk a tight rope between securing the economy vs managing the covid pandemic as the data from other countries already shows that for the economies to be truly secured, the covid 19 threat needs to be managed first and foremost. 

The Government was given guidance around managing Covid 19 in Mid July with respect to the planning for the 2nd Winter with Covid-19. We start the winter with a higher number of cases as compared to the same time last year.  We hope that this guidance is heeded this time around and a more proactive approach is adopted by the policymakers. Our personal freedoms are important but when they interfere with the safety of others then it becomes a separate matter altogether and leadership needs to step in. Getting this timing right for such a government intervention will always be a difficult act to pull off for anyone in power. 

References 

1. https://blogs.bmj.com/bmj/2021/09/09/john-middleton-is-the-nhs-prepared-for-the-coming-winter/

2. https://www.bmj.com/content/374/bmj.n2270

3. https://acmedsci.ac.uk/file-download/4747802

Punjabi Detox is a channel geared towards the subsection of the Asian population struggling with alcohol addiction in the United Kingdom. In this episode we look at the new data from the Office of national statistics which has recorded a 19.6% increase in alcohol specific mortality.

This data is available here :

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/quarterlyalcoholspecificdeathsinenglandandwales/2001to2019registrationsandquarter1jantomartoquarter4octtodec2020provisionalregistrations

The 2nd covid wave in India is the worst covid 2nd wave for any county with 2.2 million cases in the last week alone. 

Here I discuss the multifactorial causes behind it.