TRAVELLING across tiers should be banned and enforcing a "rule of two" at Christmas is the only way to save the NHS, docs have warned.
The British Medical Association says that without tough measures in place when England's lockdown ends, the health service won't be able to cope.
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In a stark new report, the country's leading medics warn that hospitals and GP practices risk being unable to provide even the most critical care.
They have called for new measures to be introduced to "bridge the time" between the planned end of England's lockdown on December 2 and "an effective vaccine programme getting underway".
The BMA outlined a three-phased approach to "keep infection rates low"and "pull back the NHS from collapse this winter".
The first phase – before lockdown ends – involves a wide-scale reform of the testing and contact tracing programme.
Once England exits lockdown, the second phase doctors want to see is "far more effective and robust national measures" already up and running.
Among the recommendations in the blueprint, they suggest replacing the "rule of six" with a "two households rule" to reduce social mixing.
They also want to ban travel between or across different lockdown tiers, while people shouldn't be encouraged back into the office if it's possible to work from home.
What is the three-phase approach the British Medical Association has recommended?
The British Medical Association (BMA) has set out a three-phased approach for controlling the spread of Covid-19 after England’s lockdown ends.
Phase One (before lockdown can be eased):
- The testing and contract tracing system needs to be reformed and revamped so that it is fit for purpose to test, trace and isolate infected persons and contacts in a responsive, timely and effective manner.
- A coherent national prevention approach including more stringent prevention control measures, support for vulnerable groups and making revisions to the current tiered system of local lockdowns should they be necessary.
Phase Two (after England exits lockdown):
- Reducing social mixing by replacing the ‘rule of six’ which allowed mixing of up to six households with a ‘two households’ rule
- The creation, monitoring and enforcement of COVID secure environments in public settings, hospitality and workplaces
- Consistent and widespread mask wearing, where people are less than two metres apart
- Continuing instructions to work from home where possible
- Clear measures to monitor, support and enforce compliance to infection control measures
- A fit for purpose one-stop NHS Covid-19 app that tracks contacts, provides local infection level data and public health information
Phase Three (Planning and effective delivery of a vaccination programme):
- Plan for the delivery of an effective vaccination programme
- Information and support from Government
- Effective national local and public campaigns to provide transparent information about the vaccine, address misinformation and build trust in it
The full report is available from the BMA website.
The NHS Covid-19 app also needs to be updated to include infection information at a local level, with guidance in a simple "airline safety" style, they say.
Medics also want to see more targeted support for the clinically extremely vulnerable and for communities hardest hit by the pandemic, including BAME communities.
They also want to see these made official rules which can be enforced, rather than guidance.
Phase three would be a widespread uptake of a safe and effective vaccine, when one becomes available.
Doctors say a vaccination programme needs to be "properly planned and resourced" so that staff are ready and able to provide the jabs.
As more vaccines become available, there needs to be public information campaigns to help everyone know how where and when they can be vaccinated, they added.
'IMPACT COULD BE WORSE'
Dr Chaand Nagpaul, chairman of the British Medical Association's (BMA) Council, said: “We must not squander the efforts of the many people who have followed the law, stayed at home, sacrificed freedoms and incurred financial loss in order to contain the virus.
“When the first lockdown ended, there was no coherent plan for keeping Covid-19 at bay, no clear and simple public messaging.
"This was followed by spiralling infection rates, more businesses failing, new ‘local’ lockdowns, and now we have a death toll at more than 52,000.
It is unthinkable that we make the same mistakes again because this time, the impact will be far worse
“As England prepares to exit its second lockdown, it is unthinkable that we make the same mistakes again because this time, the impact will be far worse.
"It’s reasonable to conclude, that without these measures, the NHS will not be able to cope with caring for even the most critically ill patients.
“This report demonstrates a sustainable plan for reducing the level of infections from Covid-19 until a vaccine programme is underway.”
Their report concludes that with these recommendations in place, "past mistakes can be avoided, lives saved, and the NHS can be pulled from the brink of collapse."
It comes after Dr Nagpaul warned that NHS workers are at risk of burn out and have reported high levels of stress and fatigue.
As many as two in five not taking a break since the first wave of the pandemic in March, he told the Health and Social Care Committee yesterday.
Dr Nagpaul said that not only were staff working "flat out", they were dealing with the emotional impact of seeing their colleagues get ill, being fearful of getting ill themselves, and helping patients say their final goodbyes to loved ones over smartphones or iPads.
He said that even before the pandemic there were already high levels of stress and anxiety.
Many went in to work every day worried that they would make a mistake – often for reasons outside of their control, he added.
A BMA poll of doctors has found that once the pandemic is over 51 per cent are more likely to work fewer hours, 26 per cent say they are more likely to retire early and 22 per cent said they are more likely to leave the NHS for another career.
Meanwhile 40 per cent of doctors said that their stress levels and their levels of burnout are now higher, 59 per cent say they are severely fatigued and 40 per cent haven't even been able to take an adequate beak or leave from work since March
"They have been working flat out," Dr Nagpaul told MPs.
Meanwhile he raised concerns about GPs seeing "double" the number of patients they should be.
He said that GPs sometimes deal with 100 patients a day – with the average seeing between 50 and 60.
Dr Nagpaul said that research shows that changes to the ways doctors are treating patients during the pandemic mean GPs are having 20% more contacts than previously.
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