Working together this winter

National medical director, Professor Stephen Powis, discusses the pressures facing NHS staff this winter and the importance of continuing to provide the safest and best possible care for our patients and colleagues. 

I’m approaching my second winter as NHS national medical director, and my 35th working as a doctor.

Despite what we say about winter coming every year, the main issues facing the NHS and its staff are rarely completely the same from one to the next.

As usual, our preparations have been extensive, and we know that local clinical leaders and their teams have worked hard with their local partners to put in place extra services, staff and processes to make sure they can best meet people’s needs, building on lessons and experience from the past.

In particular, we have seen further improvements to and use of NHS 111 as the ‘front door’ for urgent care, same day emergency care services now in almost all major A&E units helping people avoid unnecessary hospital stays, and work to safely help patients return home faster, which is better for them and has freed up thousands of bed days for others.

But despite that planning and hard work, there’s no doubt that a combination of increasing demand and workforce pressures are going to make for a very tough few months for NHS teams.

Our doctors, nurses and other staff are pulling out all the stops to look after more and more people, with A&E attendances rising sharply and summer offering no respite this year.

So far in 2019 (Jan-Oct) we’ve had a million more people come to A&E than last year – and 200,000 more people were seen, treated and discharged or admitted within four hours.

We also know clinicians are seeing a particular increase in people who are older and have more complex illnesses, with the rate of growth for people aged 65+ double that for people aged under 65, and emergency admissions are up by almost a quarter of a million year on year.

The reasons for much of this lie outside of the hospital – and outside either the remit or the influence of the NHS.

But we also know that workforce pressures are playing their part in making life more difficult for clinicians – not just in A&E but across the whole system.

And that’s a problem we’ve seen become even more acute over the last year as the impact of pensions policy has restricted many of our most experienced clinical colleagues from making the contribution they would like to the effective running of emergency departments, wards, clinics and theatres – and in the community as well.

We have heard very clearly from the British Medical Association and others what effect this is having – on those staff directly affected, their colleagues and most importantly on our patients, who are waiting longer they should for both urgent and planned care.

So with the General Election delaying any Treasury decision on a long-term solution, we have worked with the BMA pensions committee and Royal Colleges to develop and implement a short-term fix before winter really bites.

The temporary solution we have jointly developed means that colleagues are now immediately able to take on additional shifts or sessions over winter and to the end of March, without fear of being worse off financially now, or in the long term.

The scheme means that anyone in an active clinical role who exceeds their annual pension allowance will be able to choose the ‘Scheme Pays’ option on their pension form, meaning that they don’t have to worry about paying the fee out of their own pocket.

The NHS will then make a contractual commitment to pay them a corresponding amount on retirement, ensuring that they are fully compensated in the long term too.

The BMA in particular have rightly sought assurances that this commitment is legally sound, and are now satisfied that this is the case; the agreement will be supported by the Department of Health and Social Care and the Government more broadly, whatever the NHS looks in 10- or 20-years’ time, making it a gold-plated guarantee.

We know it’s not perfect.

We know that senior clinicians and local leaders want a long-term solution to be found – believe me, we all do.

But it is an immediate solution, and one that allows clinicians to focus on our number one priority as NHS staff; providing the safest and best possible care for our patients and supporting our colleagues to do the same.

So I would urge every colleague in England who has had to think twice about picking up sessions and shifts to familiarise themselves with the offer by speaking to their HR lead or visiting this webpage to find out more.

No two winters of my NHS career have been the same, but one thing remains constant: the determination I have seen from my colleagues to do everything possible to give patients the best outcomes we collectively can.

Let’s work together, and do the same again this year.

Professor Stephen Powis

Stephen Powis is the National Medical Director of NHS England and Professor of Renal Medicine at University College London.

Previously he was Medical Director (and latterly Group Chief Medical Officer) of the Royal Free London NHS Foundation Trust from 2006 to 2018. Professor Powis was also a member of the governing body of Merton Clinical Commissioning Group for five years and a Director of Healthcare Services Laboratories LLP.

He is a past Chairman of the Association of UK Universities (AUKUH) Medical Directors Group and has been a member of numerous national committees and working groups, including the Department of Health Strategic Education Funding Expert Group. He is a past non-executive director of the North Middlesex University Hospital NHS Trust, including a period of eight months as acting chairman.

He is a past chairman of the Joint Royal Colleges of Physicians Training Board (JRCPTB) Specialty Advisory Committee (SAC) for Renal Medicine and a former board member of Medical Education England. He was Director of Postgraduate Medical and Dental Education for UCLPartners from 2010-13. He is a past treasurer and trustee of the British Transplantation Society and a former member of the UK Transplant Kidney Pancreas Advisory Group.

He has also served as a member of the Renal Association Executive Committee. He was Editor of the journal Nephron Clinical Practice from 2003 to 2008. In 2017 he became the inaugural Editor-in-Chief of the journal BMJ Leader. He has been a trustee of several charities, including the Royal Free Charity and the Healthcare Management Trust.