Almost half of physician specialties, including cardiology, gastroenterology and rheumatology, expect to be working at less than previous pre-COVID activity levels for at least 12 months or more.
The Royal College of Physicians (RCP) asked nineteen medical specialties in England to estimate what capacity they expect to be working at over the next 12 months compared with pre-COVID-19 activity levels. Eight of them expect to be working under capacity for the foreseeable future.
This is in part due to the time it takes for the extra infection prevention and control measures to be carried out, all of which have been put in place to reduce the spread of COVID-19 and reduce nosocomial infection. For example, doctors are conducting fewer procedures due to the time it takes to don and doff PPE before and after each procedure, the need to implement social distancing to protect patients and staff, and the need for more regular cleaning of spaces between patient visits.
COVID-19 has also meant that patients recovering from infection will also need the on-going support of NHS services, especially in respiratory medicine, rehabilitation medicine, renal medicine and clinical psychology. This is additional activity compared to pre-COVID times.
Specialty leaders in respiratory medicine and gastroenterology expect it to take 2 years to recover from the backlog created by COVID-19, while those in cardiology are expecting it to take 18–21 months.
These figures bring to light the sheer scale of the challenge facing the NHS after the first wave of COVID-19 in England. Many doctors are still working in areas of medicine they were redeployed to at the start of the pandemic, meaning that patients in other areas are waiting longer for care and the resumption of services is still far pre-pandemic levels.
In the middle of May, 32% of RCP’s 25,500 members in the UK reported working in a clinical area that was different from their normal practice. By the start of June this had reduced by 10% to 22%, meaning one-fifth of the workforce were still working outside their usual area.
When asked how long it will take for the NHS to get back on an ‘even keel’ (defined as ‘backlogs managed and services stabilised to a “new normal”’), 98% of RCP members thought it will take at least 6 months, 70% believe it will take over a year and 39% more than 18 months.
Professor Andrew Goddard, president of the Royal College of Physicians said:
'We cannot underestimate the extent of the work that still lies ahead for the NHS workforce, and the very real possibility of further COVID-19 outbreaks and additional waves, which would of course increase the challenge ahead.
'Medical specialties are doing their utmost to keep up with demand, and will need the ongoing support of NHS England the Department of Health and Social Care to get services back on an even keel.
'In the short to medium term it is likely that doctors will need to further prioritise care, as they have always done, to respond to the reduced capacity levels across the NHS.
'We also need to be honest with patients that things will take longer and that we are working as hard as possible to restore services to pre-pandemic levels.
'The public can also play a critical role by following social distancing guidance which will keep COVID-19 infection rates down allowing services to focus on the recovery of normal NHS business.'
The RCP, in partnership with its specialty societies, has been working with NHS England to plan specialty-specific restart activity. Professor Goddard will be giving evidence to the Health Social Care Select Committee on Tuesday 30 June 2020 where he is expected to highlight how the scale of the challenge might lead to doctors having to make difficult decisions about which patients to prioritise until such time as COVID-19 is under control.
Read the full statement here.
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The RCP conducted an internal survey of its Medical Specialty Board which includes representatives from our 30 specialties. Each member of the board was asked to provide a response on behalf of their specialty. There was a response rate of 19 specialties.
During the COVID-19 pandemic, the RCP conducted four surveys of its UK members and fellows. The surveys took place on 1–2 April, 22–23 April and 13–14 May, and 3–4 June. More information can be found on our website.