this week GP NUMBERS page 254 • BREAST SCREENING page 256 • MEDICAL SCHOOLS page 258 JONATHAN KLEIN/GETTY IMAGES JONATHAN MPs take legal action over PPE contracts Three MPs and the Good Law Project clear, mandatory, and unconditional Cross party MPs are have launched legal action against the legal obligations to publish details of its demanding the government government over what they allege is a spending.” defend the lack of published “persistent and unlawful” failure to disclose In a pre-action protocol letter sent on PPE contracts to a court details of huge sums of money spent on 23 August to the health secretary and the contracts for personal protective equipment. Cabinet Offi ce minister, the claimants The government has approved £15bn refer to data from Tussell showing that the for procuring PPE since the start of the government has published contract award pandemic. But fi gures compiled by the notices in relation to covid-19 contracts data provider Tussell show that details of on average after some 47 days, whereas only £2.68bn of that spending have been for non-covid contracts the average is 29 made public, while further analysis shows days. They also argue that publication of persistent breaches of the requirement to the covid-19 contracts, many of which were LATEST ONLINE publish information within 30 days. The awarded without a competitive tendering claimants argue the government is in breach process, seems not to be occurring routinely. US drug agency of legal regulations requiring it to publish Lucas said, “The lack of transparency may fi ne clinical all contract award notices and government and potential misuse of tens of millions trial sponsors that policy requiring that all contracts with a of pounds urgently needs investigating, don’t report data value of more than £10 000 be published in particularly as we have spent far more on Health worker full within 30 days of being awarded. PPE than any other European country. ” strikes, limited The action has been fi led by the Green Abrahams added, “The government’s testing, and clinic closures hamper Party MP Caroline Lucas, Labour’s Debbie failure to comply with its legal obligation is Zimbabwe’s covid Abrahams, Lib Dem Layla Moran, and the due to either incompetence or dishonesty. response Good Law Project, a not-for-profi t company Ministers may try to argue the emergency Covid-19: 70% that uses the law to protect the interests of meant they could award contracts without of infected the public. Jolyon Maugham, director of going through the competitive tender health workers the project, said, “Vast amounts of public procedure, but this does not exempt them in Victoria, money—billions and billions—are being from their duty to publish the contracts.” Australia, acquired rushed out the door. And yet what we can Gareth Iacobucci , The BMJ virus at work see is that the government is simply ignoring Cite this as: BMJ 2020;370:m3333 the bmj | 5 September 2020 253 SEVEN DAYS IN GP numbers in England fell by more than 600 in past year, data show The BMA has called for more support for GPs ahead of a potential second wave of covid-19, aft er fi gures showed a fall in the number of full time equivalent (FTE) GPs in the past year. Data published by NHS Digital on 27 August showed that in the year to June the number of fully qualifi ed FTE GPs fell by 2.3%, from 28 256 to 27 605. Richard Vautrey, chair of the BMA’s General Practitioners Committee, said that the continuing decline in the number of GPs in England was of serious concern but not a surprise. “Before covid-19, GPs were contending with chronic underfunding, rising patient demand, and toppling workloads, all of which has been exacerbated by the virus, with many surgeries going above the call of duty to keep patients safe,” he said. “And yet, despite the clear need to do more to attract and retain GPs, the government have just undermined morale further by failing to use the DDRB [Doctors’ and Dentists’ Review Body] recommendations to recognise the incredible work GPs and their teams have done during the pandemic.” Vautrey added it was important for the government to ensure that GPs had the resources needed to keep patients safe and well during the expected second wave of covid-19. Abi Rimmer , The BMJ Cite this as: BMJ 2020;370:m3366 Covid-19 people in England, and the ONS essential healthcare in its independent Africa Regional Government will expand will also extend the survey to existing programmes worldwide, Certification Commission after trained vaccine workforce Scotland, Wales, and Northern including interventions in Italy, four years without a case. Nigeria The government will expand Ireland. The survey started as Spain, Belgium, and France. was the last African country to the trained workforce who can a pilot in May to track infection be declared free from wild polio. administer covid-19 and flu rates outside of hospitals and High risk areas get Afghanistan and Pakistan are vaccines to boost access, as part care homes, regardless of payments for self-isolating now the only two countries that of a raft of measures designed whether a person has symptoms. The government will offer a continue to see wild poliovirus to facilitate the safe future mass payment for people with low transmission. Tedros Adhanom roll-out of a covid-19 vaccine. The “Alarming conditions” in incomes in areas with high rates Ghebreyesus, WHO director government said that it would European care homes of covid-19 who need to self- general, said, “Ending wild clarify the scope of protection isolate and cannot work from poliovirus in Africa is one of from civil liability among the home. Eligible people who test the greatest public health additional workforce who positive for covid will receive achievements of our time.” could be allowed to administer £130 for a 10 day period of self- vaccinations. It also pledged to isolation. Other members of their Medicinal cannabis reinforce safeguards to support household who have to self- Parents can challenge the Medicines and Healthcare isolate for 14 days will be entitled NICE guidance in court Products Regulatory Agency to to £182. Non-household contacts The parents of a 3 year old boy grant temporary authorisation for who are advised to self-isolate with severe epilepsy were given the use of a new covid-19 vaccine, A report on the global response through NHS Test and Trace will permission to mount a landmark provided it meets the highest to coronavirus outbreaks also be entitled to as much as High Court challenge to guidance safety and quality standards. heavily criticised “alarming £182, depending on the length of from the National Institute for living conditions” in Belgian their isolation. The scheme will be Health and Care Excellence England will test and Spanish care homes, the trialled in Blackburn with Darwen, regarding cannabis prescribing 150 000 every two weeks former being described as a “true Pendle, and Oldham. on the NHS. Matt and Alison The Office for National Statistics humanitarian crisis.” The report Hughes argue that the will expand its infection survey by Médecins Sans Frontières Infectious disease guidance is so restrictive to 150 000 people a fortnight documented the first phase of Africa is declared that it could effectively in England by October, up from the organisation’s global covid- free of wild polio be barring hundreds of 28 000 now, to provide more 19 response from March to May. In a milestone children from accessing information about the spread of During that time it had committed announcement, the cannabis treatment covid-19 in the community and to “substantial resources” both Africa was they need on the NHS. The help identify local outbreaks. The to developing dedicated covid- declared free of family has legal aid for aim is to eventually enrol 400 000 19 projects and to maintaining wild polio by the the judicial review case. 254 5 September 2020 | the bmj SIXTY SECONDS MEDICINE ON . International news MANAGEMENT US approves emergency CONSULTANTS use of convalescent plasma The US Food and Drug WHAT HAVE THEY DONE NOW? Administration approved They’ve only gone and snared themselves convalescent plasma for another huge government contract. emergency use in hospital YOU SURPRISE ME. TELL ME MORE patients who have covid-19, It emerged last week that McKinsey & Co after it concluded that plasma was paid a whopping £563 400 for six from recovered patients “may be Potential benefits from weeks’ work to decide the “vision, purpose, effective” in treating the virus and using recovered covid patients’ and narrative” of England’s new public plasma outweigh the risks, says the FDA that the “potential benefits of the health body, the National Institute for product outweigh the known and Health Protection. potential risks.” The move came Northern Ireland in January and NICE WORK IF YOU CAN GET IT despite the absence of results February. Almost 60% said they OBESITY Indeed. And the likes of McKinsey, Deloitte, from randomised controlled wanted to be more involved in More ambitious and PwC have been getting plenty of it during trials. To date, only a preprint research. Time was the biggest the pandemic. Whether it’s for building paper on the effects on covid-19 obstacle to more participation action to help testing capacity, fi nancial advice, or strategic inpatients has been published. (cited by 53%), followed by reduce childhood vision, the government seems to have them Experts warned that there was not funding, a perceived lack of skills, obesity to 1980s on speed dial. enough evidence to show that the and a lack of supportive culture at levels would BUT THIS IS DOWN TO COVID, RIGHT? treatment worked.