Winter pressures - letter to the profession

Dear colleagues,Thank you very much for everything you and your colleagues have done and continue to do for patients, the public, and all those receiving care as we head towards another busy winter.

The past few years have been some of the most challenging faced by health and social care professions. With increasing demand as we go into winter and with a newly announced prolonged period of industrial action by junior doctors in late December and early January, it is likely that there will be further challenges in the months to come. As we did last year, we wanted to ensure you had national recognition of this challenging situation.

We are confident all clinicians will continue to respond and carry out their duties professionally, informed by the values and principles set out in our respective professional standards.

But we also understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care. Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision-making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure. In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and
circumstances in which you were working.

One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance Category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance. It is vital that we have a whole system approach to risk across the urgent and emergency care pathway to provide the best outcomes for our patients. This includes considering actions within hospitals to help improve flow and reduce pressures on emergency departments. All national regulators will consider the need to keep regulatory oversight proportionate at this busy time, whilst maintaining the focus on patient safety and protection of the public.

It is the responsibility of all providers commissioned by the NHS and healthcare leaders to ensure that all clinicians working in their organisations are well supported, and that channels for raising and acting on concerns remain open and accessible to all staff. Your professional code and duty of candour are there to support you to speak up where necessary, in the best interests of the public and people receiving care. It’s also essential that you look after your own health and wellbeing during this period. Asking for help from others when you need it is good professional practice, so we ask that you seek support from your organisation if you need it as well as supporting one another.

Finally, we would like to thank you again for the large amount of work that has already been done to prepare for winter and to ensure the best possible care for those who need it, and please keep encouraging eligible frontline team members to come forward for their winter vaccines. Whether you are providing direct care, supporting colleagues or leading services and teams, all contributions are essential components of providing the best possible support and care to the communities we serve.


Professor Sir Stephen Powis, National Medical Director, NHS England

Dame Ruth May, Chief Nursing Officer, England

Dr Emily Lawson DBE, Interim Chief Operating Officer, NHS England

Ian Trenholm, Chief Executive Officer, Care Quality Commission

Andrea Sutcliffe CBE, Chief Executive, The Nursing and Midwifery Council

Charlie Massey, Chief Executive and Registrar, General Medical Council