Training Primary Care - NHS - GPs - Toast

“The biggest complaint about the NHS which is beloved by everyone is about the food, and the biggest complaint about the food is about the lack of toast.”

So wrote the food writer Prue Leith, who last week blamed draconian health and safety rules for the disappearance of toast from many hospital menus.

Her remarks caused a sensation. First there was the shock of discovering that after all the worries about staffing, funding and Brexit, dire warnings of a bleak winter for emergency departments and the persistence of numerous public health crises (obesity, mental health, antimicrobial resistance), that the NHS faces an existential threat that no one had properly considered.

Secondly was the reaction of the system as NHS England and Improvement, under pressure from the Department of Health and Social Care, rushed out guidance to restore public confidence in the NHS.

The At-a-glance Toast Checker (ATC), modelled on the Bristol Stool Chart, provides a visual aid for planning and quality assurance. Hospital staff will be encouraged to work with patients to agree the ideal colour, texture and serving temperature of their toast.

Top sliced

Simon Stevens said he would “work tirelessly to ensure that everyone has a person-centred toast experience”. He promised that the centre would roll out personal toast budgets (PTBs) by 2023, allowing patients to choose their health provider based on their preferred toast colour. PTBs are to be funded by top-slicing existing commissioning budgets.

A leading GP warned that the scheme could face practical difficulties: “We’ve been piloting personal toast budgets for a while. They led to more control and higher satisfaction, but we had to call a halt when someone used their budget to buy tea cakes.”

Existing regulations are to be amended to enable GPs to offer patients more choice when referring them to secondary care services. Leading think tank the Nuffield Crust cautioned that the proposed “any toast provider” rules could make it harder to implement integrated care and could increase procurement costs.

Choice agenda

NHS England and Improvement said it would launch a procurement framework to create a “level playing field for providers and enable NHS organisations a wide choice of value for money, quality assured pre-toast [bread]” but independent bakeries warned that the framework would be dominated by the “big four” – Hovis, Warburtons, Kingsmill and Tesco.

Hospital catering staff and nurses’ leaders expressed reservations about the impact of hurriedly drafted toast preparation provisions in forthcoming workplace health and safety standards. This could mean up to three nurses on every ward involved in the daily toast round – one to restock the toaster, one to monitor quality and collect feedback forms, and one with specialist electrical and fire safety training to tackle any small fires.

NHS leaders are privately concerned that the national toast policy will increase the regulatory burden on hospitals, following the news that the Care Quality Commission plans to introduce a new “well-fed” domain to its existing inspection regime.

Implementation and spread

Others have criticised the policy for being too closely geared to hospitals. GPs and voluntary sector leaders questioned why there was no mention of primary care and community services and pointed to research showing that most people preferred to access toast locally, preferably in their own homes.

Simon Stevens said he had listened to the concerns of colleagues but added: “If we want to make the NHS a global leader in the provision of toast-based services, the whole system will need to embrace innovation. Parts of the NHS already make world-class toast, but now we need to focus our efforts on implementation and spread.”

Editor: Julian Patterson

Acknowledgement: With thanks to those on Twitter whose gags were stolen for this week’s blog.


Reproduced at by kind permission of Julian Patterson.