The fifth survey of RCP fellows and members shows that doctors are concerned for patients as practice and rotas return to normal.
As the first wave of COVID-19 reaches its end, on 21-22 July the RCP conducted its fifth survey tracking the impact of the pandemic on the workforce. The first four surveys took place on 1–2 April, 22–23 April, 13–14 May and 3-4 June.
In this survey we asked our members about risk assessment, testing, reset of services, preparedness for further waves of COVID-19 and winter, and remote consultations. We hope we will not need to conduct another this year, but we will do so if there are additional outbreaks or an increase in cases.
Commenting on the results of the survey, RCP president Professor Andrew Goddard said:
“Delays to treatment are so often a major issue for the NHS but as a result of the COVID-19 pandemic, it’s fair to say we’ve reached crisis point. Doctors are, understandably, gravely concerned that their patients’ health will have deteriorated to the point where they will need much more extensive treatment than previously, at a time when NHS resources are already incredibly depleted.
“We also cannot underestimate the need to prepare for a second wave of COVID-19 infection, which threatens to compound the situation. Without careful and rigorous preparation, a second wave coupled with the winter flu season, could overwhelm the NHS.”
The majority of respondents have now returned to their normal areas of clinical practice. 10% are still working in a different clinical area, but this is down from 22% in early June. 74% report that their rotas have returned to normal.
56% of respondents report having had a formal risk assessment, up from 24% in our last survey.
79% of respondents report having had access to an antibody test for COVID-19. Of them, 25% report that their result was positive for COVID-19 antibodies.
60% of respondents report being concerned for patients under their care who might have suffered harm or complications following diagnosis or treatment delays during the pandemic.
Almost two thirds (64%) of respondents report that they have not been involved in conversations about preparing for a second wave. Of those who have been involved, 93% say they are preparing on the assumption that a second wave of COVID-19 is likely or extremely likely.
Working patterns and practices
Working patterns are largely returning to normal for RCP members. The resumption of services means a high workload for many - 72% are as busy as they were just before the pandemic.
10% reported working in a clinical area that was different from their normal practice, down from 22% in June. Of this group, 20% were working on a COVID-19 ward, down from 40% in June.
Rotas had returned to normal for almost two thirds (74%), although in the north west of England only 64% had returned to normal rotas.
With the shift away from face-to-face appointments, almost three quarters (73%) are now conducting remote consultations. 19% reported they still did not have access to a webcam to carry out video consultations. Although this figure was as high as 51% in our third tracker survey in May, this is still a problem that needs to be quickly remedied by hospitals.
Resumption of services and patient care
60% of clinicians are worried that patients in their care have suffered harm or complications following diagnosis or treatment delays during the pandemic. The overwhelming majority (94%) are concerned about the indirect impacts of COVID-19 on their patients. Delays to diagnosis or treatment was the most common concern, cited by 58%.
86% report that their hospital has restarted diagnostic procedures, but of these a third (34%) say only a very small of procedures have restarted. London appears to face greater challenges than the rest of England –46% report only a small number of procedures restarting, compared to 30% in the rest of England.
Delays accessing diagnostic testing are compounding these problems. Endoscopy testing is particularly affected: only 8% reported no delays for outpatients, and over a third (36%) are experiencing long delays. For inpatients, 72% are experiencing delays. Delays to clinical physiology testing are seeing similar delays – 75% for inpatients and 90% for outpatients.
Delays to elective surgery are also anticipated for some time yet. Only 13% think the NHS will recover its 18 week referral to treatment target within a year. 40% believe the target will be met again within two years, but almost half (47%) think it will take up to five years or ‘not within the foreseeable future’.
Time off work
As the COVID-19 pressures have reduced, more clinicians have taken time off or have arranged to have time off. 68% had either already taken time off or arranged to, an increase from 47% in June.
79% were able to access an antibody test, significant progress from the 26% who were able to in June. A quarter reported a positive test for antibody infection, with no notable differences between ethnicity, gender, grade and London and other English regions.
13% had had a PCR test in the previous two weeks, up from 9% in June. Results are being received more quickly than in June – 34% are now receiving results within 24 hours (up from 15% in June) while it is taking over 48 hours for 15%, down from 25% in June.
Progress with risk assessments continues to be sluggish, with just 56% having had a formal risk assessment (up from 24% in June). 10% reported using the risk reduction framework hosted on the Faculty of Occupational Medicine website, while 4% have had informal risk assessments.
Preparedness for a second wave and winter
Almost two thirds (64%) of respondents have not been involved in conversations about preparing for a second wave. Of those who have been involved, 93% say they are preparing on the assumption that a second wave of COVID-19 is likely or extremely likely.
Views on how prepared their organisation were was mixed. Only 5% felt their organisation was ‘fully prepared’ and 10% said their organisation was ‘not at all prepared’. The majority (54%) felt their organisation was ‘somewhat prepared’, while 31% said ‘quite prepared’.
When asked about measures to prepare for a second wave, sufficient PPE and staffing levels were identified as the single most important factors. But respondents felt a full package of measures was needed, including ensuring enough bed capacity, access to testing and working closely with social care.
Concerns about second wave preparation were unsurprisingly reflected in similar concerns about preparation for winter. Just 2% felt ‘fully prepared’, while almost a quarter (23%) felt ‘not at all prepared’. Adequate staffing levels and bed capacity were the key measures identified needed to prepare for winter.