COVID-19 and the workforce: facing the second wave

As the UK tackles the second wave of COVID-19, the RCP conducted its seventh survey tracking the impact of the pandemic on the workforce. In this survey we asked our members about testing, diagnostic delays, time off, risk assessments, the flu vaccine, ‘long COVID’ and the second wave. 

Commenting on the results of the survey, RCP president Professor Andrew Goddard said: 

“These results confirm that the NHS is in the midst of a second COVID-19 wave, and we face a long and difficult winter ahead. 

“Hospitals have been gearing up for this challenge, and access to staff testing and PPE is clearly much improved. We are still seeing delays in processing test results though, and this needs to be addressed urgently to ensure we maintain the staffing capacity to cope. 

“We must also do all we can to ensure that services are maintained for our non-COVID patients. This survey shows that patients are starting to present with more severe illnesses than prior to COVID-19, and they need to know the NHS is able to care for them.” 

Headlines 

• The second COVID-19 wave is hitting the NHS, with rising admissions in all regions. There is widespread concern among doctors about the impact this will have on their hospital’s ability to deliver effective care. 
• Delays to diagnostic testing remains a serious problem, especially for endoscopy and clinical physiology services. 
• Doctors are generally able to access COVID-19 tests within 24 hours for themselves, members of their household and their patients. Problems persist in receiving results back quickly– only 29% of doctors tested received them within 24 hours. 
• ‘Long COVID’ is an emerging problem, with a quarter of doctors treating patients with symptoms in the previous two weeks. 
• 30% of respondents said that non-COVID patients are presenting with more severe illnesses than prior to the pandemic. 
• 80% of doctors have already had the flu vaccine, with a further 14% planning to. 
• At least 22% of doctors have had COVID-19. 

Impact of the second wave  

89% of respondents had seen increasing COVID-19 admissions over the previous two weeks, with over 90% citing increases in all midlands and north of England regions. 92% were concerned about the impact these rising admissions will have on their hospital’s ability to deliver effective care. 

Almost half (49%) were very concerned, and that rose to 70% in the north west, 67% in Yorkshire and the Humber and 58% in the West Midlands. 

82% felt their organisation had the necessary PPE as we tackle the second wave. Despite this generally positive picture, the three London regions reported the lowest levels of confidence – all below 75%. 

40% reported that rotas in their team were still different from the pre-COVID norm. 

Time off 

Only 6% of respondents were currently taking time off from their usual work schedule, similar to results from September. 38% of these were self-isolating either because they had COVID-19 or someone in their household did.  

Flu vaccine 

80% report having had a flu vaccine, with 14% planning to, 3% unable to get one, and 3% not planning to get a flu vaccine. It is important we get as close to 100% as possible to address the risk of a flu outbreak alongside the second COVID-19 wave. 

Risk assessments 

69% of respondents have had a formal risk assessment, up from 65% in September and 56% in July. 12% reported using the risk reduction framework hosted on the Faculty of Occupational Medicine website, while 6% have had informal risk assessments. 

Only 8% of respondents from a black, Asian or minority ethnic (BAME) background had not had a risk assessment, compared to 24% of white respondents. This shows the NHS is rightly taking seriously the additional risk that COVID-19 may present to BAME staff. 

PCR testing 

58% of respondents reported having a PCR test for COVID-19 at some point, up from half in September. The result was negative in 79% of cases. 

Of those tested in the previous two weeks, 84% were able to access the test in the first 24 hours. That is up from 80% September, but lower than the July figure of 88%. 

29% of those tested in the past two weeks received their results within 24 hours, a small improvement from September. There has been little progress otherwise – 36% waited up to two days, 18% three days and 13% waited over three days. 

Just under half (47%) reported that they had symptoms at the time of testing. Of the 21% who tested positive, 18% reported still having symptoms while 32% said symptoms persisted for more than two weeks. Fatigue and breathlessness were the most common. 

Of those who needed a test for members of their household (46%), 88% had been able to access it in the first 24 hours – a notable improvement on the 72% figure in September. 2% had been unable to access the test despite trying. 

Of those who needed a test for their patients (86%), 94% had been able to access it in the first 24 hours and only 2% were unable to access the test despite trying. These are both small improvements on the September figures. 

Antibody testing 

Similar to the September figures, over three quarters (77%) of respondents had been able to access an antibody test for COVID-19. 6% had wanted one but been unable to access it. The result was negative in 77% of cases for those who had been able to access the results, with 1% still waiting for results. 

Diagnostic delays 

Delays to diagnostic testing for both inpatient and outpatient services remain a problem. Endoscopy and clinical physiology services are the worst affected, with 82% reporting delays in endoscopy tests for outpatients. 83% reported delays for clinical physiology testing for outpatients, including 36% experiencing long delays. 

‘Long COVID’ and patient health 

A quarter of respondents had treated patients with symptoms of ‘long COVID’ in the previous two weeks. Fatigue was the most common symptom cited. 

Following the first wave, 30% of respondents said that non-COVID patients had more severe illnesses, with only 12% having less severe illnesses. The majority (58%) reported no difference in the severity of illness, but we should continue to monitor this as an indicator of the impact of the pandemic on other health outcomes. 

Respondent profile 

• 451 responses 
• 95% worked in the NHS 
• 93% worked in a hospital 
• 16% were in London and 74% the rest of England 
• 78% were consultants, 9% were in training, 4% were physician associates and 5% SAS doctors 
• 16% worked in geriatric medicine, 14% in respiratory medicine, 9% in acute internal medicine and 7% gastroenterology 
• 51% were women and 47% men 
• 51% were aged between 41 and 55 
• 21% were from a black, Asian or minority ethnic background 
• 10% were disabled