The panel are Professor Chris Whitty (Chief Medical Officer for England), Professor Sir David Speigelhalter (Winton Professor of the Public Understanding of Risk at Cambridge University), Dr Margaret Ikpoh (RCGP Vice Chair for Professional Development) and Dr Gary Howsam (RCGP Vice Chair for External Affairs).
Hello, and welcome to the latest in the series of the rcgp live events. I'm Martin Marshall. I'm chair, the Royal College of GPS, and I'm a GP in new and East London. Thanks so much for joining us. Well, I guess the busiest time of the year, maybe three days away from Christmas, you had a choice. You could either go to a wild festive party or you could come to a work related webinar on Omicron and I'm confident that you've made the right choice. I'm absolutely delighted to be joined by panellists. Who are at the very centre of the pandemic and the college's response to the pandemic. We've got Chris ready, ready with us hardly needs any introduction, our chief medical officer for England and the most amazing advocate, general practice and we've got Professor David Spiegel halter from the Winton Centre for risk evidence Communication at the University of Cambridge, also a media star and I'm sure you've heard a lot of him on the radio and television. We've got Nicky Kanani Medical Director for primary care at NHS England. He Great to have you with us. And we've got Gary housing, who's a GP in Cambridge chair and vice chair of the college for External Affairs. I think it's probably fair to say that last four weeks have been rather preoccupied with Omnicon for general practice either directly because GPS had been very involved in the delivery of the vaccine, or indirectly because of the impact on our non pandemic work and the emergence of a new variant. I guess it is it was disappointing, just as it felt like things were starting to return to normal but it was hardly unpredicted. It was expected unsurprisingly, GPS have risen to the occasion yet again. And they're doing a tremendous job in contributing in programme and D to provide urgent care for our patients. And the goodwill is very clear in general practice, though I don't doubt that goodwill is more fragile than it was 18 months, two years. ago because people are battle weary and many are quite damaged by what they've been through over the last couple of years. But they're, they're probably gone and pulling through. Tonight we've got an opportunity to hear about the epidemiology of virology in the Public Health from Chris, an opportunity to hear a bit about the sociology and psychology, public understanding from David, obviously, to hear about the role of NHS England from Nicky, and the implications for practice and attrition of the colleges contributing to from Gary. You can put your questions to the panel, please do so. Either on hashtag rcgp live on social media or if you're watching on YouTube, please post your questions below the feed and members of the team are going to feed your questions through to me and I'll then convey them to the panel. This session is being recorded. So it will be possible to watch back to at a later date. Okay, so before we turn to you for your questions, I just want to ask a few quick questions of our power numbers just to warm up. So first of all to Chris, Chris. We're hearing so much from many different epidemiologists, many different virologists about how the pandemic is likely to play out. And we see lots of different predictive models which are predicting many different possible outcomes. So what's your prediction of what's going to happen over the next few weeks with Omicron? And what are the chances of a new variant hitting us sometime in the near future?
Thanks very much demand and before I start, I mean I really really want to say a massive thank you to people for what both what they have done and what they are doing on Omicron. But it what general practice done over the last two years and is continuing to do is absolutely amazing. And I just wanted to be really clear. That is my view. The in terms of where we're going to go over the next while I mean, there are obviously some considerably important some very important things that we don't know. But there are a couple of things that we do know which are the reason why we have to respond so rapidly to this variant. The first thing that we do is the this is spreading, not only in people who have not been exposed to the virus and not been vaccinated but actually spreading to people who've had previous infections and spreading to people who've been had one or two doses of the vaccine previously. And so this means it can spread much more widely through the population than previous variants, which has had a lot of control from prior movement immunity. So the size of the way we could get with this is considerably greater in theory than the size of the wave that we could have got with for example delta in theory because you're not getting that natural check on who you can go to from prior recent infection or prior vaccination. The second thing that we know is that in part because of that, but also in part because it is intrinsically more infectious that is really clear that previous variants, it is moving at absolutely extraordinary speed and the doubling time. In parts of the UK, this has been less than every two days. It's probably running for the sake of argument or the round every two days maybe standing slightly now because people have been more cautious to in the run up to Christmas but nevertheless moving incredibly fast. This is faster than any previous waves we had. Now the reason that's important is that we are going to get a two things happening in almost simultaneously. The first of which is and I'm sure all of you will have seen this because it is spreading to so widely through the population. Most notably in London now but it's going to be through the rest of the country very shortly. Colleagues are going down with COVID Simple taneous Lee so doctors nurses in all parts primary care and secondary care are going down with COVID and having to are unwell themselves trying to isolate or having to care for others. And so there's going to be a sort of supply side of healthcare problem and then we're going to get almost me to doctors are really beginning to see this in in London will begin to see it elsewhere. A people going into the health system through primary care and then into secondary care, a wave of hospitalizations and a wave into primary care. And those are going to happen at the same time. And we do not know how high this wave is going to be at the modelling in my view can't can tell us a theoretical upper limit or it can't tell us as where this is going to turn out. But what if what we do know though, you only need to build multiply by to work out doubling times. And if it's going that fast, you get from very small numbers to very large numbers incredibly fast. So it's the speed this is going out which is the issue. Now at a certain point it will you know always have a beginning middle of the end. The moment the beginning the middle is when it peaks, and then it starts to go down and cases going to hospital and into primary care are delayed slightly after that. But until we see the peak, we have to assume it just keeps on going up. It may slow down. But it'll keep on going up and we will with a delay then see people going into care who need more need need hospital hospital or at least general practice primary care care. With this disease. Obviously many people won't need to go into
other the doctor it to use old parlance I found a general practice they'll just be unwell for a bit and then get better. But some people definitely will at least need your advice and some will need to go into hospital. So that's the real problem is the speed of onset. That isn't the real issue. Obviously the wider society is also lots of other people are going to be sick in lots of other parts of society. And that's also going to cause wider issues. And these are going to be obvious I think, in many parts of the country from certainly the middle of next week and on until into January until such time as the peak occurs. So that I think is the principal thing for us really to turn and face. And in terms of could there be another variant? Yes, of course the could. As time goes by medical science D risks this. So we will get polyvalent vaccines we'll get better antivirals and new and more antivirals we've already got some early ones who look quite promising. So if I look to the long term while newborns will happen, they will cause fewer and fewer problems on average, as every six months rolls on. And population immunity will gradually build up and build up and the immune system will start to see different variants of the virus and that will over time, take the risk profile down but we're not we're not going to this is not the last round. We'll see. And this may not be the last significant variant we see. But this is certainly a very concerning one and principally because of this combination of immune escape and its speed of transmission.
Chris, thank you very much indeed. Just before I come back to the second question, Gary, can I can I turn to you because we've got some very preliminary quick and dirty data about staff absences and general practice which Chris referred to, could you just give us a headline very quickly?
Yeah, absolutely. So this was a very quick survey we sent out yesterday to about 200 of our sort of GP leaders. And the top lines have come back is saying practices are experiencing high levels of staff offset worse than usual. According to 95%. Around 14% of clinical staff and 17% non clinical staff are currently offset. But it's not being felt as you'd expect evenly across practices and 13% of practices reported having between 40 and 60% of their staff offset overall. So the lack of ability of staff or availability of staff and the lack of local staff to fill those gaps are the things people have been highlighting in the last 24 hours.
Thanks very much, guys. Just a quick question to follow up for you, Chris. You and I sent a letter to to rcgp members a couple of weeks ago about the need to prioritise the booster campaign and urgent care over routine general practice. Quite a difficult thing to say that to Taro practices and to patients. Was it an easy thing for you to revise on?
No because I mean, I think we all recognise that general practices. Always stretch to this time of year badly stretch or this time of year. And this year is even more difficult because we got a lot of backlog of things from the previous COVID ways that mean that there's you know, this is busier than an average year by some distance for most practices, as indeed it is actually in secondary care as well. And so deviating people away from that, you know, that part of their work is not something to do lightly. But the reason we thought we absolutely had to do it and we as a profession have to prioritise this and the NHS has to prioritise this is we have a narrow window of opportunity. I think we're now very confident that the booster vaccines work significantly better than the people who've had two vaccines. Obviously any vaccines are better than none for reducing severity but the booster definitely does. If we can get as much of the population and particularly the mother vulnerable population boosted before the absolute peak of this really hits us which are just going to very shortly. NSA tops out very quickly, which I think I think would be very optimistic to assume then the impact this will have on all areas of the health system and the impact on our patients health will be substantially lower. So we really had to accelerate getting boosters into people so that actually they are protected before we get the CDC the worst of this and in fact, in a sense, it's an investment for the future in terms of health system, and of course it's a protection for our patients. But it's the speed of this the men we had to move from what was already a very fast rollout to a one that was going at absolutely astonishing speeds. And if you look at the numbers of vaccines that are being produced, are being are being given through general practice and through other routes. We knew that without general practice that was not possible. And that if we did not do this as a health service, we would pay a heavy price for it and more importantly, population and the vulnerable population to pay a heavy price for us as we went into the new year. So I'm extraordinarily grateful for people's ability to turn around even at this incredibly difficult time of year to meet this new threat but I think we thought it was absolutely essential. We did that.
Chris, thank you very much indeed. Nikki, over to you. Thanks so much for joining. And thank you for the amazing job you're doing as a clinical lead for their vaccination practice. I suspect you don't see very much of your family at the moment. But thank you so much for everything you're doing. Certainly. How's the booster programme going? And how's the vaccination programme in general going now?
Thanks, Martin. I mean, like Chris will start off by focusing on what general practices achieved and not just in this accelerated phase but over the last year. You know, we are over just over a year with the first general practice run PCN run site opened and it has been phenomenal. You will have felt the energy we will all give that ability for general practice to very much come to the rescue after a very difficult year through the pandemic So huge thanks festival to our teams who have been delivering again and again and again consistently for the last year in the vaccine programme. I thought I might just pick up on a couple of Chris's points about the impact on staff and sort of the wider aspects of general practice because essentially when we had the pm announcement, which rightly said, we need to accelerate boosters, this has to be our nationwide priority. also recognise that this would have a huge impact on staff and staff absence rates. Just to flag we have sent out some guidance about you know, making sure you're reporting staff sickness because we really need to know local systems need to know what's happening in primary care so that we can get the right support in place as well because certainly many of you will be feeling this in London and sort of just outside London. Already we're getting practices with what we would describe as outbreaks. But if we don't have the data, we can't come back and support you. So Gary, that was really useful. Please do keep reporting it into your systems. So if you look at the kind of take a step by the word spectrum of what general practice will be doing over the next few weeks and we're certainly seeing that already is doing that really important job of prioritising the booster programme but also urgent care so my thanks to the College of BMA for producing some really helpful guidance around workload prioritisation so that practices can safely and competently focus on the care that needs to be delivered over the coming weeks. As Chris said, this is a urgency that we can't ignore and I know many of us feel anxious about it giving our patients the wider care but I think what's really clear in the messaging from yourselves ourselves government is the NHS is still open. What we don't want to see is that really steep drop off of attendance for care that we did in the height of the pandemic because actually, that was really detrimental to both patients experience of care, but their relationship with their care providers. So general practice is open, but it's focusing on certain elements of care. And you will have seen that through the message and the messaging that Chris has put out the pm has Secretary of State, myself and through kind of all of our various media opportunities. So So where has that got us? Well, a really phenomenal week, you know, up more than 70% on the week before in terms of numbers of visitors delivered. General Practice pulling out all the stops to ramp up really from the PMs announcement on Sunday night. By Tuesday we've seen the impact in general practice in terms of additional booster delivery. Notably, it was also a bumper day for community pharmacy. It delivered 200,000 vaccines on the Tuesday so primary care and really showing what it's able to do in the booster space. And everyday since then, has been a bumper day a record day for boosters, but also for unvaccinated people coming forward. So that's really key from our perspective, making sure that people are at least getting one dose or their second dose if they haven't had those already, and targeting really vulnerable populations. So last week, general practice we're particularly focusing on our house found okay home staff and residents are very grateful for that. And today, we're sharing in northwest London sent me a picture of a van which had found a number of people who are seeking asylum, got them onto the bus, got them over for their vaccine, offered health checks and gave Christmas presents to their children as well. That is general practice. at its finest. And I'm saying very proud to be part of a profession that does that. But that doesn't mean it's easy, right? So all of our colleagues are feeling the pressure at the moment. We're also talking about the need for more assessment of COVID in the community deployment of virtual Ward and pulse oximetry at home and as Chris mentioned, referrals for monoclonal antibodies and anti viral so a very big complex changing environment at the moment. But I do think that it's really worth reflecting on the incredible rate the teams have done. Over the weekend we delivered 1.5 million reads to vaccinations in one weekend alone, I think that's really quite incredible. And everyday now, as I said, people are extending, you know, opening seven days a week, opening 12 hours a day, going roving well into the community to make sure that everybody gets their opportunity. This doesn't happen by accident. And what we really need to do is for system partners to support general practice to do this. So from a workforce perspective, releasing additional staff through NHS professionals, the voluntary offers that we have such an ambulance and remembering the clinical and non clinical staff can be deployed at no charge to primary care network lbs is in community pharmacy offices. So there is a pool of money that we've deployed, that you can get additional staffing into your into local vaccine service with no additional charge. Last week, we were trying to get supply in the right place for there is plenty of supply and some really great work from our local pharmacists to make sure that we get the supply into the workplace through mutual aid and now through increased volumes of deliveries. lots happening in the region Martin to support the the uptake so you might have seen the mass media Monday so every publication had a booster wrapped around it. I was on drive time we were talking to everybody about the need to have the vaccine before Christmas. Definitely in the last couple of days people have described a slight drop off. People say that they don't want to get on well before Christmas. So anything we can all do in our messaging to make sure that people recognise that, you know, a few hours or a day of side effects from the beast is probably much easier to handle than COVID itself. And we've released some top tips about kind of generating demand locally, particularly by working with your local authority. We've got people who are out flowing their local supermarkets and shopping centres. We've got Tom criers calling about the beast of vaccination and where to get in, and particularly working with local faith and community partners, as many of us have done earlier in the year, particularly worth flagging that if you're having a slower, slower day lower footfall. Please use those opportunities to vaccinate people with severe mental illness or learning disabilities. That quieter environment tends to be more beneficial for certain of our community. We were thinking about and not everyone celebrates Christmas. So being able to rave into communities at a time when some groups who might have not come forward for the vaccine may choose to now is really important. This specific support martyred just to just finish off. We published a letter on the seventh of December that described a range of contractual measures to support general practice to deliver the vaccine programme. And of course we're very helpful guides with BMA follows on from that and talks about privatisation and we're really clear that we want to support the general practice to make the right clinically led decisions because what we can't do from the centre is decide or define what you're experiencing locally, what your local practices, what your patient interaction is, what your patient needs and what you're set for your surgery and your workforce needs. So what we clearly send the letters we have your back when you're making clinically clinically led decisions, and he was the guidance of course at the College of BMA have produced and the winter access fund is still a quarter of a billion pounds out in the system. I came in talks about it at the Royal College conference. It was a very long time ago now but you can use that to deploy additional capacity over the Christmas and New Year period. So please don't use that as a funding source to draw down on we've also worked with government departments to do things like extend the Fit note period, that we're not spending time signing fit nodes suspend the recertification requirement for existing prescription charges. Pause for firearm certification, suspend request for medical information for driver's licences, suspend friends and family tests and CQC have also suspended inspections in general practice and he leading unannounced inspections until the end of the year. Unless it is a life or death situation. From a funding perspective. I'm not going to call out the numbers because I know that's not why we're here. But certainly the funding has been increased for vaccines delivered on weekdays and Saturdays and furthering fees to cover Sundays and bank holidays and then further increase to cover the festive period to support all PCN and CP sites so that we can keep that capacity open. We've also just announced this evening, further support for travel and subsistence costs. So if you're open over the festive period and you want to pay travel, I hope you do want to travel and if you want to put on as somebody described a buffet for your team, the funding is there for that as well. And then I think the other thing, Martin, you know, the thing that I hear most from colleagues is we just need to have the messaging out there. They're a this is what general practice has been caused to do by the Prime Minister and be pleasing. Give us a difficult time if that's what we're doing. So we've got a set of campaign resources, face respect materials, how to access journal practice, but also the messaging I mentioned up top the CMA, Chris pm secretaries say all of our media outlets are focusing on so they were clearly saying that general practice has been asked to do this because you know what? General Practice is not just as good, not just good at delivering Pauline, but general practice is responsible for making sure that our most vulnerable protectors as well. So look, Martin, I'm always up for suggestions if there are other things that we need to be doing, really keen to hear, but I'm very, very proud of our profession for stepping up again, we will develop a longer term infrastructure so that we don't have to keep stepping up. But in the meantime, thank you, and we're here to support you.
Thank you. Thanks so much for that comprehensive summary that's incredibly useful and weren't nervous about the work HSE Minh is doing to support this programme. So thank you for that. David, I'm going to turn to you. The pandemic really has shone a light on on the capacity to deal with uncertainty and I conditions but certainly the public and journalists as well. What have you learned about how the public responds to risk and what are you what are you seeing in terms of kind of the public's response and how we deal with it? Particularly around things like vaccine hesitancy.
Okay, thank you very much. And I've also got to say, but I you know, I'm really humbled by the amazing work being done by a GPS in particular, I've got a GP in my family, and I know the stress that she's been under in this booster campaign only goes on top of it. I've also got to say I'm hugely impressed with the work being done by the analysts behind the scene, analysing all the data as a statistician I would say that because there's never been such attention to numbers. I did have what Chris feels but I don't I'm not sure if there's been a time maybe back last March, but March last year, when every day that numbers are being very important and and there's actually widespread misunderstanding the Telegraph has just written. latest data from the UK health security agencies shows that more than 106,000 people tested positive for the virus in the last 24 hours. No they did.
That is just not what that daily number means. It's reported some of those will have been tested positive a week ago. In fact, if you look at the days on which specimens were actually taken, there are 103 10,000 tested positive a week ago on the 15th. So again, it's just unbelievable. The lack of basic understanding of some people in the media, what these numbers actually mean. And yet people take a lot of interest in these. I mean, some journalists did a fantastic job, but it really makes me want to feel like banging my head against the wall in terms of risk, and risk is really complicated. And really difficult. And I people say this, there's sort of risk as analysis. There's all the numbers, the benefits and harms of vaccines, the effectiveness, the vaccine effectiveness, and so on.
There's all these numbers we're hearing all the time. But basically, we know that mainly risk is a feeling, you know, we respond to things with emotion and that works fine most of the time, but sometimes is like the Thinking Fast and Slow idea. We really should encourage others and encourage ourselves to calm down and cool it and think slowly hold Howell on the head and just think, okay, what are the benefits and harms of different interventions? And this comes into our work on actually on vaccine hesitancy which where we work on communication with a gang of psychologists. And and we know I should say my my unofficially adopted daughter GP is in the black African community and we talk a lot about the hesitancy in that particular community about vaccines and wonder family and others. So, you know, I know a bit about this, and it is a real problem because of this lack of trust in in silence evil in authority, and so on. So how does one deal with that? Well, we've kind of been exploring different ways of communicating and if you look at the government website on the vaccine, it's good stuff, but it's terribly persuasive. It really is hammering through, you know, when you got to get the vaccines afraid, minimal side effects, blah, blah, blah. And there there is another way to communicate, which has to do with really trying to inform people rather than trying to persuade them, which is actually acknowledging that wherever you do, there's benefits and harms. And that's true of all medical interventions. And, and so we've been actually doing experiments where we give one group of people the standard gene to government stuff on the government website, and another group people. One has been edited to include more information about the side effects to actually talk about the quality of underlying evidence, but also to pre bunk Miss Information to get in there and hard pre bank misinformation. And we randomly allocate people to get these two versions, we found that overall, their trust in the information, if you average over everybody isn't very different between the two. But if you look at the subgroup of people who were initially sceptical about vaccines, their trust in the information goes up with the more balanced version rather than the government. And we don't know whether we can't translate say, well, that will make them more likely to take the vaccine. But I think this adds to a growing body of evidence that one way one strategy for countering hesitancy is to actually be borrowed, but you've got to you've got to demonstrate trustworthiness. In the end. I don't think you're ever going to convince anybody by facts alone. It will come by from trusted messengers and by people feeling that you have a communicator has their interests at heart. But what this has shown we again and again, I'm experiment showing that actually been very open about the fact that yeah, there are some side effects these things are some very small benefits and, and so on does not reduce trust in the in the information source. But I think that's really quite important. And I could Martin do want me to just talk about the off the press data about the benefit, the relative severity of the of the of the variants, I think, is quite interesting.
So the Scottish study the Danish the South African study came out yesterday. The Scottish study came out at four o'clock this afternoon, the Imperial and UK HSA study came out at bypass six, I think so we've been hammered by by data. Broadly, the South African one, which is in a very different context showed that 80% reduced risk of omachron compared with Delta but that I think one more has to do with a huge pinch of salt the Scottish study was small showed a two thirds reduction risk reduction of hospitalisation of Omer Khan compared with Delta, much better, some really good quality study, I think, but quite small. It was just out of 22,000 omachron cases, we'd have expected 47 hospitalizations, we actually only observed 15 very encouraging, but you can as you can imagine a lot of uncertainty about that figure. The imperial study just came out is based on much larger data set. And they show if you can hospitalisation as at least one day and actually been coded as admitted 45 50% reduction in in risk from overcrowding compared with delta. And so which is encouraging. Absolutely. You know, it'd be nice as even bigger, but it is encouraging. And, uh, but they do also show the huge increase in a reinfection risk. But also that if you the other day that we find some great information. Great thing about if you catch omachron After you've been infected, there's 60s relative severity of the of the of the variants I think, is quite interesting. So the Scottish study the Danish the South African study came out yesterday the Scottish study came out at four o'clock this afternoon the Imperial and UK HMSA study came out at bypass six, I think. So, we're being hammered by by data. Broadly, the South African one, which was in a very different context showed that 80% reduced risk of omachron compared with Delta, but that I think one more has to do with a huge pinch of salt. The Scottish study was small showed a two thirds reduction risk reduction of hospitalisation of a merkon Compare with Delta. Much better, some really good quality study, I think, but quite small. It was it just out of 22,000 omachron cases, we'd have expected 47 hospitalizations, we actually only observed 50. Very encouraging, but you can as you can imagine a lot of uncertainty about that finger. imperial study just came out is based on much larger data set. And they show if you can hospitalisation as these one day and actually been coded as admitted 45 50% reduction in in risk from omachron compared with Delta, and so which is encouraging. Absolutely. You know, it'd be nice it's even bigger, but it is encouraging. And, uh, but they do also show with a huge increase in a reinfection risk. But also that if you the web, find some great information. Great thing about if you catch overgrown after you've been infected, is 60 70% reduction in risk of hospitalisation, and if you've never been in, so there's some there's some quite positive data here that doubtless at Chris would not have had this would be there's no currently being included on all the models to adjust the projections under different strategies. It's a very closely balanced thing, but as you said, but crucially and if we're thinking into the new year is the booster programme that is going to be the absolutely vital element. Okay.
David, thank you so much. So you say you've answered one of the questions that is coming from a member of our audience. Chris Bronston. About the latest research. I have to say that I wasn't aware of the results of the research has been published in the last 45 minutes. But David, you were and I very grateful to you for that. Talk to talk about hot off the press. That's, that's really that's really impressive. So, before we open it up for other questions, let me just turn to Gary. Very quickly, Gary, you've been leading the college's work. On workload prioritisation working with our colleagues in the general practitioners can be to the BMA and GA give us a quick summary on on what it shows.
Yeah, of course. And thank you, Martin. So we produced over the course of the pandemic several iterations of it to help with workload prioritisation, which has been something that our members have been asking for. And we've had good feedback on because I think as we've gone through various phases, whether that's acute waves, whether it's vaccine, booster pushes, or whether it's just been playing catch up. The last 21 months have been phenomenally difficult in general practice. And, you know, we've heard people saying thank you for the efforts over the last 10 days, but I think we just want to reflect on it's been a slog for 21 months now. And we knew when we got asked this time, again to pivot our focus onto the base advancing campaign that we can't do everything. We've got incredibly tight teams. Now, people are psychologically tired. They're physically tired, and there's only so many hours in the day even if you're working all your days off. So what we've done this time is produced another document. I'll start by saying what it isn't what it isn't, is a replacement for expert clinical judgement. And what it can't do is take into account those very local factors around the states, your your staff make up the demographic of your population. But it's a document that needs to be read by GPS and it needs to be supported by local commissioners, and it needs to allow us to focus on where we can add most clinical value. We've not produced the list of things that we think should be turned off. And we've not produced the list of things that we say absolutely must continue. But what we've done is highlighted things that we think are a current clinical priority, even with everything else we've been asked to do, and those things that we think it's safe for people to put on pause. Recognising that we're not actually stopping anything. We're just shifting work. And when the applause for the the booster campaign dies down again, we'll be playing catch up and our teams be working incredibly hard. So this is a document to facilitate local conversations. And we've published the latest version yesterday. And if I can just highlight one thing that's in there that wasn't in there before is a link at the bottom of page two to a document on business continuity, which may be something we'll pick up later. But it's just a link to a one hour checker, which highlights the sort of things that people should be thinking about in terms of business continuity, when we know that when the weight hits, if we're losing staff, we're in a bit of a perfect storm. But that's the summary of it. It's all available on our website if you just Google rcgp workload prioritisation, it'll take people to the link. It's very self explanatory. And hopefully it'll provide the sort of support that people are looking for on the ground where they're really sharp and where they're feeling the crunch.
Gary, thank you very much to do that's really helpful. So so if you're a GP do have a look at that guidance. I hope it's useful to you and and do feedback, if you've got any suggestions are going to move to questions from the audience. Now, before I do that, I just have to tell everybody that Nikki has had to drop off one of the tourism challenges of working with a top panel is they get called out at very short notice to do important things. So the key is just had to disappear. I'm not sure if he's going to be able to come back. But let's look at some of the questions from the audience. So one from where are we now? One from Ben cotton for you, Chris. I think probably how quickly do we think we'll see the benefit of the booster and the have we already how quickly will we see it? And then I think a link question from Flint dog one whoever Flint dog one is says Are there any vaccines new to Norwich that will offer a much longer benefit than the EMR? RNA ones, Bruce?
Thanks very much. I mean, on the first one that's kind of the individual answer level answer and there's a population level answer for individuals. I think that you get a faster response to a boost than you do to the very first time you get you see a vaccine. So I think people beginning to get some protection even within seven days probably, but actually it will then rise and by two weeks you'll have quite significantly better prediction than you had before you're boosted so it's relatively far not immediate of course and that's something we do need to remind people that they could they can't just have their booster and then go straight off to the nightclub it's it's there is going to be a period of development at a population level. I think we are already seeing it actually, I think that we will probably see many fewer older people in the hospital and coming into general practice, because the boosting programme has already happened gone through that age group group to a very large extent and once the whole population is boosted, then we would expect to see a reduction a slowing down of transmission as well because we think that it'll probably having been to a boosted in as opposed to people who've only had two vaccines or it doesn't make much difference is likely not definitely the likely it'll slow down transmission as well. So there's kind of three levels of benefit. But as I say, as an individual level, you can reassure people that they whilst they won't get immediate response, they should start to see see what they went see but they will will get significantly increased responses from probably from a weakened definitely from to in terms of new vaccines coming through. There's a lot of new vaccines kind of just on the edge really. Some of them are new types like the Nova vaccine vaccine, which is a protein based vaccine and that may have some advantages. And that's likely to be licenced very soon, I think. And then some of them are old, older, in the sense of older for this pandemic, still very new vaccines, the RNA ones where we're going to have either polyvalent or by Vaillant vaccines where they actually cover more than one variant or we may have Omicron specific vaccines. And I think they will be available probably within a few months. Now we'll then need to make a decision as to which are the right ones to deploy. And the reason that we would expect them to be helped protect for longer are twofold. I mean, the first thing is it maintains protection in the individual just with against the same number of viruses and the case of the polyvalent vaccines in particular. It also may broaden that protection so that if a new variant comes along back to Martin's second question to me, it is less likely to cause havoc in the way that Omicron is causing at the moment. So I think those will be solid improvements and will then need to really get work out. What is the kind of routine we're going to go through how often do we need to reboot, particularly vulnerable people to maintain their level of protection and then also, when do we need to reboost to meet a new variant and I think we'll just you know, we're in the foothills of our understanding of this, but they will definitely understand will improve over the next six months to 12 months.
And do care I asked Chris for your prediction and that I guess we all hope that the COVID vaccine might be alive for maybe for 10 years, like heavy. But of course it wouldn't be then we hoped it might be for a year like flu. Any idea of where we're going here?
I think I think it's so I don't think it's likely to be for life. I mean, I think that's pretty clear now but I think once people have been shown the ads shown the antigen vaccine plus minus infection several times the immune immune system kind of wises up, and so we may we'll be able to drop down to less frequent run through except when there's new variants, or in the very vulnerable populations. But that's not not having to do populations in the kind of way at the moment. But I wouldn't like to predict a number at this stage. I think it's too early to be confident.
David, how would you predict how the public will respond to the frequency of of vaccination what is what is their tolerance for engaging with
don't ask me I'm so I'm not a statistician. I'm not a social psychologist or whatever. It's just in my observation that the one thing that does always I think surprised me in the surveys is how or only tolerant of supportive of the, of the population of the majority of the population often very strict measures that the that always is a regular finding of the of that support now how that translates into, you know, attitudes to repeat vaccination and other things there. There is does seem to be, you know, there's a lot of concern, a lot of fear and anxiety in society, clearly. And there's and that, you know, although there's also communities that will that have got very different views the majority view seems to be that adhering to two measures of supporting stronger measures, and in other words, we seem getting vaccinated.
Date Gary got a question from actually list. Is there a role for recently retired GP during the potential workforce stresses or just GPUs I guess, all conditions? If so, can the performance less bureaucracy be reduced? We've got a group and I college for the career and retired medics and actually points out that they have made offers quite consistently over the last 18 months or two years, but often those offers haven't been taken up.
Yeah, thank you, Martina. That's a great question, Ashley. And I think one of the frustrations that we're all feeling on the frontline is when we've got recently retired colleagues, saying that they're willing to come back and help and they can't facilitate that. We've actually got my old senior partner and he's been retired for a few now, years now jabbing in our practice for the last couple of days. So people can be on boarded short messages, but it's really important that we, we expand the workforce in any which way we can at the moment whether that's to support the boost the campaign, whether that's the support business as usual. And obviously recently retired members have got a wealth of experience that they can contribute to the effort and one of the college's main policy aims over the last two years has been to reduce bureaucracy of all sorts because we know it has a detrimental impact on both work workforce, but more importantly on the workload as well. And at a time like this when we really need every clinician that can contribute contributing in a way to add most value, then if it's purely bureaucracy that's getting in the way then then that's a shame and we're doing everything we can at the college to make sure that those barriers are removed. And I just suggest if there are people out there who are recently retired, I know certainly within my CCG there collating lists of people who both need additional staff and additional staff offering their services and they can often help with the bureaucratic processes to speed them through.
Thank you very much, guys. We've got some questions on testing, Chris, I think probably for you. Dr. Gandalf says When will we see updated guidance or PCR testing for Omnicom dominance symptoms to protect our patients over the standard three, like shown in other countries that we that I know you've been asked quite a bit? I guess when does the UK definition of criteria for diagnosing COVID aligned to who one and then there's a question from Julie for D. Given the new guidance or do you do this a specific one actually, given the new guidance on using lateral flow test toward earlier release from self isolation when COVID Positive once a recommendation is still positive on that trickle flow test on day 11 moves to isolation
on the take the second one first I say that common sensical answer on this is basically if you are lateral flow positive, you are still likely to be infectious. And that's the reason in fact, why lateral flows are really extremely useful in a sort of straight public health terms. Is it is highly predictive of who is going to be infectious both at the beginning of their infectious period and the end of their infectious period. The great majority of the cause will cease to be infectious in smaller time. We know that a small, small minority can go out even beyond 14 days. They're a very small minority. And I think the advantage of a more test based approach is it means more people who actually are not infectious, are allowed to go about their daily lives and makes their lives easier and probably helps with adherence and a variety of other positive things. But the ones who are anyway needs still excreting virus in a way that levels which means they are infectious to others, hopefully, will take their families and their communities by remaining self isolating until that is through. So I think that's really the common sensical answer. I'm not sure what the official answer is, but that certainly if I was found out by a relative, and they said, Look, I'm still positive. What should I do? I would say, stay put it will get back he will get will go away. But I'd say stay put on the the question about PCR, which was was framed as if there's a right answer. There is a technical, technical medical answer and there is no there is a practical answer. But there's the technical The reason we've not moved quickly on this is we have with the PCR with the with the symptom issues. The usual specificity, sensitivity trade off, but the more sensitive you may something, the less specific you make it and at a certain point, it becomes nonspecific to the point of meaninglessness. And if you ask, we got together lots of academic groups, and each of them will say yes, there's an additional symptoms you should add, and they will give a list of their different lists. There isn't a consensus. I mean, obviously individual academic leaders are on the television very, very firmly say that their list is right. But the reality is if you take all of those, you're essentially saying anyone who feels unwell. And that gets us to a very difficult place. Now as doctors we all know that that people can have COVID with multiple symptoms. And I think the general public knows that as well. And I think really, what I would want is, is to encourage anybody with any symptoms that could be COVID to get a lateral flow, and then to use the PCR for people who are either unwell or vulnerable for whatever reason or our our piece, our lateral flow positive. And this brings me to the practical reason, which is, although we have substantially increased lab capacity, actually, the PCR capacity is finite. And I think that this the way we're getting at the moment, if it goes up anywhere near its theoretical maximum, it will strain the system we got very, very substantially and what we do want to do is make sure that people who most need PCRs are getting PCRs and there is a real risk that otherwise we could be in a situation where people could perfectly reasonably use a lateral flow. Instead, they're using a PCR in a way which is actually not like to be terribly helpful. But if people are sick people have got immunosuppression Is there a variety of other reasons people are doing it, but GPS seeing someone and they think they might have it and they would like to give a PCR for that reason. Clinical discretion is built into this. Finally, I would encourage you just think through how many of your patients even though that Cardinal three that we currently got, if we give people a list of seven or eight and say these are the things you should do, I think there's as much risk one of our concerns is as much risk as proposing the phone fusion as everything else. So I'd really like to have a relatively simple thing. Particular people get PCRs which include the three symptoms but include a number of other areas, and anybody who feels unwell or indeed is going to see someone who's vulnerable and doesn't feel unwell. Get a lateral flow, because that's the thing which will help tell you particularly whether infectious
Thank you Krishna, why doesn't why does that question about diagnostic criteria fit on your ranking of questions that keep coming back to me?
Thanks me. They they, well, it depends. There are certain certain experts who go on the on the media who will raise them every time they go in the media, and that's fine. But the reasons I've given all the reasons that we haven't lightly thought this has been debated endlessly in multiple groups, and the answer is the reason you know got to a perfect place for this is because there isn't a perfect base all the alternative options have got downsides. They've all got some upside and it's always about trading those off. I think the impression that some people give that there isn't there is a single good answer, I'm afraid is incorrect, technically. And that's really the problem.
Thank you very much, David. We've got a number of questions about non pharmacological interventions. social interventions. You mentioned earlier you thought that the public's tolerance for restrictions was higher than some people might suggest when they're interviewed some politicians remaining nameless. A bit more detail on that. What would people tolerate? I'm not asking you to predict what might happen after Christmas but
I'm dying. I didn't know. I mean, this is why you know a decision in the in the end, the thing that stops the virus spreading is people's behaviour. And that behaviour may be you know, completely voluntary just from people's own perceptions of protecting themselves and their families and their community. For example, making everyone has been changing their behaviour I'm sure just make sure they can have Christmas together and so it could be you know, influenced by guidelines or could encourage it, which, you know, not with rules, but just advice that's been given. And that's really what's being done a lot of man which is very reasonable, or you could have actual rules where which people have but in the end it's behaviour that matters. And so it's the mechanism to induce those changes in behaviour, but that's that's the vital, vital thing. And it's quite clear that people do vote with their feet the effect of lockdown start before the lockdown starts because people do change their behaviour. Similarly in the release in the release last July Freedom Day, then actually people didn't change their behaviour that much their degree of mixing didn't change didn't didn't seriously increase. So and therefore there wasn't a sudden burst we did carry on with a long period of relatively high circulation, but it wasn't a sort of splurge that people many had predicted. So and I and I'm not a behavioural expert. It's what I'm doing whether or not my I'm a statistician, but in the end, this is why if I would want to know what's the important data has been combing study and other other ways of identifying the amount, close contact people have each day, just seems to be absolutely crucial in determining the future of this. What's going to happen in this very difficult way. But in terms of, in a way, the levers to you know, manipulate to change that behaviour, but that's that's a big judgement and it is a political judgement. I think as much as as a public health judgement. I I'd love to know Chris's opinion on this he both far more than I do. I feel guilty talking about it when he's, he's there.
Great to be here, not to apologise for being a substitution Your time has come. To add to that,
well, I think one of the many heartening things when many terrible things are COVID but one of the many heartening things is just an extraordinary demonstration of the common sense of the general public. And if you give people clear reasons for doing something, and you're straight with them back to David's, earlier point, and he said, look, there are pros and cons and we have uncertainties, but we think on balance at this point in time we should do this thing. The great great majority of people are very supportive of that, and they wanted to happen. What they want is fairness. And one of the reasons they sometimes want government to intervene is they might think I'm going to do it, but is anyone else going to do it? And so there's also that element of it as well. But I you know, I think trusting people has almost always gone right? People are really sensible if they're given the right information.
Great. Thank you very much. I think we've got time for a couple more questions and Gary. And first of all, we a as a college we're hearing from some of our members that their local CCGs are really supportive of what they're doing. But we are hearing from some members who say this is us just they're not as permissive levels supportive as they were earlier in the pandemic, sometimes putting up hurdles to general practice being able to deliver the booster programme. What are what are you hearing?
I'm very disappointed to hear that any CCGs on supporting practice in the way that practice think is appropriate. As a chair of a CCG. Myself, I can only really comment on what I'm seeing locally. And I'm seeing my 350 staff members in my CCG equally as tired and worn out after two years. of working in in various roles at different times being redeployed. We've got a large number of staff redeployed out now into the vaccine programme. Primary Care team within the CCG are working with all the PCs working on the real practical logistics of how we can boost things how we can get cover and stuff shifting between different sites within a PCN and probably most importantly, is providing air cover and that's air covered with the local population. I think the comms around what's going on at the moment is absolutely critical. I'm spending a lot of time lately, trying to get the message out to the population that you know GP peas have been asked to do something different and that's why you can't have everything you might be expecting. We're seeing a lot of abuse directed at general practice staff and there's a strong role for the CCGs err in helping to defend that and you know, make sure that that is roundly condemned as totally inappropriate when you've got a bunch of extraordinary people doing amazing things under incredibly difficult circumstances. Business Continuity Planning is something we're focusing on as well. I think we're moving into a phase where we know we've got a whole host of things coming together. We've got an increased demand on services. We're working over the holiday period, we know we've got staff absences going up. We've got other staff deployed elsewhere within the system. And more importantly for business continuity, this time, supply chains and support services are also going to be struggling with staff as well. So we're spending a lot of time and RCCG asking practices to look at their business continuity plans to make sure that they're up to date, and they're relevant for the next period of time. But I think the CCGs and the practices relationship will really come into it. So in the next few months when this immediate sort of accelerated programme at the booster is over and we're going back to not only business as usual, but looking after the millions of people on electric waiting list and coping with our own type workforce and trying to give people a bit of rest. We need people to value general practice and that's important for CCGs it's important for an HSE and it's important for the public discussions around workforce debates it and workload that we're having out of the crisis, but let's get the next few weeks over then it's really serious conversations between commissioners, regional and national level about what we can do so to support general practice moving forward, we show this value in this crisis is appreciated and we need to show the value of general practices appreciated outside the prices too.
Thank you, Gary, and Chris couple of questions. We'll make them quick ones because we've got two or three minutes left both hopefully quite simple ones. PPE guidance for general practice, is it likely to change and secondly, antiviral rollout. Where are we where are we going?
PB has been looked at again in the light of Omicron rightly because I mean, this does seem to be even more transmissible. And so I mean, that's a UK HSAs looking at that with colleagues across all four nations in the UK are not absolutely confident. I know exactly where they're going to land yet. Because we're trying to work out actually what basically changes with this and what stays the same. And what we're trying to avoid is a situation where we either under do it or alternatively get people to do things which actually are probably largely pointless in terms of their actual risk and which are interfering with their ability to do their job. So I think it's a it's a kind of it's, as always a bit of a trade off. Question, antivirals. I mean, we're getting the first obviously, we lost one drug as a result of Omicron for sure, which is was an antibody based drug. One of the other ones probably survives, but we've also got the oral antivirals that are coming in on the probe is starting already, and we'll have those later down the line. At least one at least one other, probably both within within a couple of months, I hope, two or three months. Initially, what we're doing is we're deploying them into settings for people who've got extreme vulnerability, and they're obviously very vulnerable. And even if they're boosted, they're still going to be vulnerable. And they we hope we'll get some form of antiviral support, whether it's antibody or drug based, but the great majority of people are, what we want to do is to randomise them into a large trial. And I would really like to promote people getting this because the point about antivirals is you need to use them early in contrast to the other drugs which are we've been using things like dexamethasone, which are for late disease, the immunological area. antivirals have to be early so they're very much something where Primary Care has absolutely got to be central, to getting people in. And the reason why the trials are a good way to do this is the data we've got at the moment are really from unvaccinated populations in a pre Omicron era. So it's a way both of deploying them, but also finding out how they work under these new circumstances. So very much encourage people to take part in that and this trial has already started. But I think will really start to take off in the new year.
Transcribed by https://otter.ai