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** 22 March 2022
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** UK
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** Chancellor 'doubles NHS efficiency target' (#1)
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** 'Uberisation' of general practice creates safety risk, warns Hunt (#2)
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** Over 80% of UK GPs think patients are at risk, survey finds (#3)
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** Verdict on drive to cut sugar in UK diets now expected a year late (#4)
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** International
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** US: State and local governments can ban flavoured tobacco products, court rules (#5)
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** Study reveals consumer interest in 'nicotine pouches' (#6)
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** Parliamentary Activity
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** Parliamentary questions (#7)
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** UK
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**

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** According to Treasury sources, Chancellor Rishi Sunak is doubling the NHS’s annual savings targets from 1.1% to 2.2%. This will reportedly deliver an annual saving of £4.75bn, but comes as trusts grapple with large gaps in their financial plans for 2022-23. Sunak said the move was linked to the new “health and social care levy” which will see a rise in National Insurance from next month.

It is not clear whether the move represents a change to the underlying efficiency expectation in NHS planning, which would require all systems and trusts to revise their plans for 2022-23, or whether it simply restates the fact that the effective efficiency requirement was already well above the 1.1% envisaged under the pre-Covid NHS Long Term Plan.

Sunak also said he would be setting up and chairing a new Cabinet committee focused on efficiency, value for money, waste, and reform in the NHS.

Source: HSJ, 20 March 2022
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** Former health secretary Jeremy Hunt has warned that the NHS is moving towards an “Uberisation” of general practice, with patients not typically seeing the same doctor each time. Speaking at the launch of a new campaign, ‘Rebuilding General Practice’ led by the BMA and the General Practice Defence Fund, Hunt said that patients seeing a different doctor each time “cannot be good for safety of care” and it would be “a big mistake to move away from continuity of care.”

Hunt said that new doctors do not know a patient’s context, making them less likely to see health-related ‘red flags’. Hunt cited a Norwegian study from 2021 suggesting there is 30% lower chance of patients going to hospital and 25% lower chance of a patient dying if they have the same GP over a long period. Hunt, who now chairs the health and social care Parliamentary committee, also said it was important to be “honest with people” about GP workloads and workforce issues. He said that the Government had “its head in the sand” over NHS workforce pressures with future workforce planning “never on top of anyone’s list” in spending review discussions.

His comments came after Kieran Sharrock, deputy chair of the British Medical Association’s (BMA) GP Committee, talked about “excessive” workloads in his keynote speech, saying recent data showed GPs had 46 appointments every day, “significantly more than the recommended safe number of 25 contacts a day”, on top of all the admin work being done. The BMA and the General Practice Defence Fund is leading the new campaign, urging the government to deliver on its commitment of an additional 6,000 GPs in England by 2024, to tackle the factors ”driving GPs out of the profession such as burnout”, and to offer a plan to reduce GP workload.

Source: HSJ, 21 March 2022
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** A new survey has shown that more than 80% of GPs believe that patients are being put at risk during an appointment. A poll of 1,395 GPs found that only 13% said that their practice was safe for patients all of the time, whilst 85% expressed concerns about patient safety. Of this 85%, 2% said that patients were “rarely safe” and 22% said they were safe only “some of the time”. A total of 70% of respondents said that risk to patient safety was increasing in their surgery.

Asked why they thought patients’ safety was at risk, 86% of the GPs surveyed in England, Scotland and Wales cited not having enough time to fulfil patients’ needs. Others cited the widespread shortage of GPs (77%), having too many patients to look after (66%), and too few staff (63%). Overall, 91% of GPs said that more GPs would improve the state of general practices.

The survey also looked at mental health around work. It found that 84% of GPs have anxiety, stress, or depression over the past year linked to their job, and 24% know of a member of GP staff who has taken their own life due to work pressures. Over half either agreed (29%) or strongly agreed (24%) that working as a GP is incompatible with a healthy family life, while just a quarter (24%) would recommend being a GP as a career.

Dr Kieran Sharrock, deputy chair of the British Medical Association’s GP committee, said that evidence showed that after a doctor has made 25 to 35 decisions about patients’ health in a day, the chances of making a bad decision, like missing key cancer red flags, rises. Sharrock said this was a “turning point” for general practice with current trends meaning “general practice will fail”.
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Source: The Guardian, 21 March 2022
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Ministers have delayed the publication of a report that will show whether they have achieved their goal of reducing the sugar content in a wide range of foodstuffs by 20%. The official assessment of the government’s drive to cut the amount of sugar in Britain’s diet was originally due last Autumn but was put off until early this year and will now not appear until this Autumn, one year late.

Campaigners believe publication is being delayed because ministers are embarrassed that food producers and retailers have ignored their demands to cut sugar levels by a fifth. They say that problems such as obesity, type 2 diabetes and tooth decay will continue to worsen unless the government is open about how much sugar was removed from foodstuffs by the deadline of 2020 as a result of its exhortations to the food industry to make products healthier.

Barbara Crowther, of the Children’s Food Campaign, said the year-long delay was “frustrating and quite frankly unacceptable”. Campaigners are also concerned that the government seems to be backtracking on a pledge that it will force food producers to strip significant amounts of sugar if they do not do so voluntarily. The pledge was first made in the 2016 childhood obesity plan when the Government told the food industry to cut sugar levels by 20% by 2020. In October 2020, Public Health England published a progress report showing that supermarkets, cafes, and restaurants had reduced the sugar content of their products by only 3%.

The campaign group Action on Sugar said the findings showed that the government’s strategy of relying on food businesses to voluntarily remove the required 20% was “simply not working”.
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Source: The Guardian, 21 March 2022
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** International
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** A federal appeals court in the US has ruled that state and local governments can ban the sales of flavoured tobacco products to protect young people from becoming addicted. In a 2-1 ruling on Friday (18 March), the Ninth US Circuit Court of Appeals said that a 2009 federal law regulating tobacco products does not prevent states, counties, and cities from going further on flavours.

The ruling was on the legality of Los Angeles County’s 2019 ban on flavoured tobacco products, with the court rejecting tobacco companies’ challenge. Around 300 communities in the US have outlawed most or all flavoured tobacco sales, with around one-third of these in California.

The original 2009 federal law authorized regulation of tobacco products by the US Food and Drug Administration, which has banned some flavoured tobacco products and announced plans to outlaw menthol-flavored cigarettes in forthcoming regulations. But under the 2009 law, only the federal government, and not state or local governments, could set “tobacco product standards.” However, the appeals court has now said that the ban on flavoured products was authorized by another provision of the law, allowing states to regulate flavoured tobacco products.

Source: San Francisco Chronicle, 21 March 2022
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** A new study by Rutgers University in the US, published in the journal Tobacco Control, has found that consumer interest in and awareness of nicotine pouches is growing in the US. The study, the first independent analysis assessing consumer interest in nicotine pouches in the US, found that just under a third (29%) of smokers were aware of nicotine pouches and 6% had tried them.

The study also found that the use of nicotine pouches was seen by smokers as a possible way to quit. Of the 17% of respondents who were interested in trying the pouches in the near future, those most interested in this were smokers with plans to quit and those who had tried and failed to quit before. Smokers in the study expressed more interest in using the pouches to quit than more traditional forms of smokeless tobacco such as “snus”. The research also found that smokers aged between 18 and 44 were three times more likely to use nicotine pouches than older smokers.

The research asked 1,018 smokers in the US about their knowledge of nicotine pouches. Pouches are relatively new on the market and work by users inserting them between their upper lip and gum. Sales of the pouches became more popular between 2019 and 2020 and have continued to grow. Until now, most studies on their safety and use have been conducted by the tobacco industry, with the researchers saying that more independent studies are needed in this area.
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** Source: Medical Xpress, 21 March 2022

See also: Tobacco Control - Nicotine pouch product awareness, interest and ever use among US adults who smoke, 2021 ([link removed])
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** Parliamentary Activity
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PQs 1, 2 & 3: Electronic Cigarettes: Regulation

Asked by Paul Maynard, Conservative, Blackpool North and Cleveleys

To ask the Secretary of State for Health and Social Care, what powers the Medicine and Healthcare Regulatory Agency has to regulate the production of e-liquids for vaping products in domestic settings.

To ask the Secretary of State for Health and Social Care, whether he has plans to (a) regulate or (b) restrict the artificial colouring of e-liquids used in vaping products.

To ask the Secretary of State for Health and Social Care, what monitoring is undertaken on the safety of imported e-liquids used in vaping products.

Answered by Maggie Throup, Public Health Minister
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** The Medicine and Healthcare Regulatory Agency (MHRA) is the competent authority to manage the notification system for vaping products in the United Kingdom. The MHRA monitors imported e-liquids used in vaping products through this system but has no powers to regulate their production in domestic settings.
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** Businesses supplying vapes and e-liquids to the UK market must ensure their products comply with the Tobacco and Related Products Regulations 2016 (TRPR), including relating to the safety of their products. Local trading standards have enforcement powers to remove non-compliant products. There are no current plans to further regulate or restrict the artificial colouring of e-liquids beyond what is contained in the TRPR for product requirements.

Source: Hansard, 21 March ([link removed])

PQs 4&5: Electronic Cigarettes

Asked by Paul Maynard, Conservative, Blackpool North and Cleveleys.

To ask the Secretary of State for Health and Social Care, whether he plans to bring forward legislative proposals to include vaping products within the scope of Tobacco Advertising and Promotion Act 2002.

To ask the Secretary of State for Health and Social Care, whether he has made an assessment of the risk to public health of the provision of samples of free vaping products to people under the age of 18.

Answered by Maggie Throup, Public Health Minister
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** There are no plans to bring vaping products in scope of the Tobacco Advertising and Promotion Act 2002. Advertising restrictions for e-cigarettes are outlined in the Tobacco and Related Products Regulations 2016. As part of our Smokefree 2030 plans, we are exploring a range of regulatory measures to prevent children and young people from using vaping products.
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** Source: Hansard, 21 March ([link removed])
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