COVID-19 and the workforce: the impact of the second wave

With this second wave of COVID-19 hitting harder than the first, the RCP conducted its eighth survey tracking the impact of the pandemic on the workforce. In this survey we asked our members about the COVID-19 vaccine, testing, training, PPE and morale.

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

“There is no way to dress it up – it is pretty awful at the moment in the world of medicine. Hospital admissions are at the highest ever level, staff are exhausted, and although there is light at the end of the tunnel, that light seems a long way away.

“I am extremely concerned about the mental health of frontline doctors, who may be suffering from burnout and a feeling of not being valued. I'm not sure that before the pandemic many physicians would have contemplated that they might need formal mental health support in their career.

“Staff will be in desperate need of a break and will need specific time away if they’re to be at their best after the pandemic.

“Doctors have demonstrated remarkable resilience throughout the pandemic, working under the most challenging conditions the NHS has ever faced, but they can’t continue working this way forever. Workforce shortages need to be urgently addressed post-pandemic if we’re ever to reduce the immense pressure on NHS staff and ensure that they are prepared and supported to get the NHS back on an even keel.”

Chair of the RCP Patient and Carer Network, Eddie Kinsella, said:

“These survey results confirm the huge challenge that hospitals face in the coming weeks to deliver care with COVID-19 admissions surging, both for COVID and non-COVID patients. We hope they will go some way to counter the drip feed of misinformation which apparently seeks to downplay the severity of the pandemic.

 “Dedicated healthcare and support staff are demonstrating extraordinary commitment to help tackle the pandemic. It must be very upsetting to be repaid with accusations that hospitals aren’t really busy. We instead pay tribute to them and the many personal sacrifices that they have made.

 “We know first-hand from our members of the severe, and often tragic consequences of COVID-19, particularly for people who are already vulnerable. They are not limited to the impact of the virus itself, but the damaging knock-on effects on communities and the wider healthcare system.

“By continuing to follow social distancing guidelines in the coming months while vaccines are rolled out, we can all help to save lives, reduce the enormous burden on frontline staff, and protect our NHS for future generations.”

Headlines

• There has been good progress with vaccinating frontline staff: 85% of doctors had received the first dose and 16% had also had the second.
• Three quarters of doctors are finding this second wave either slightly or much busier compared to the peak in April. 56% were very concerned about the impact of rising COVID-19 admissions on their organisation’s capacity to deliver safe and effective care.
• For the first time in this series, we asked about the personal impact of working under such challenging conditions. Almost a fifth (19%) reported that they had sought informal mental health support and 10% had received formal mental health support from either their employer, GP or external services.
• 20% of clinicians reported working in a different area to usual, compared to 29% in April last year. This was highest in the East of England where 25% were currently redeployed, and lowest in Thames Valley (13%).
• A third (33%) of trainees, whose medical training has been disrupted by COVID-19, said that working in the pandemic had made them question medicine as a career. At the same time, a fifth (19%) said it had reaffirmed their commitment to becoming a doctor.
• Sickness rates were much lower than during the first wave of the pandemic. 6% in London and 7% in the rest of England were currently off work, compared to 21.5% and 18.3% in early April 2020.
• There are concerns about infection prevention and control (IPC) personal protective equipment (PPE). While 60% were fairly or completely confident that IPC measures are effective, a fifth (21%) felt that they did not have the PPE they needed for managing patients with COVID-19.

The impact of the second wave

Doctors are busier this time round with rising COVID-19 admissions. 56% were very concerned about the impact of rising COVID-19 admissions on their organisation’s capacity to deliver safe and effective care. Only 3% were not concerned at all. Of the 97% who were at least somewhat concerned, over half (52%) were more concerned for their non-COVID patients.

20% of clinicians reported working in a different area to usual, compared to 29% in April last year. This was highest in the East of England where 25% were currently redeployed, and lowest in Thames Valley (13%). While some staff had been redeployed to work on the COVID-19 vaccine rollout, clinicians were most likely to have been redeployed to work on a COVID-19 ward – 45% in London and 52% in the rest of England.

While the frontline workforce has demonstrated remarkable resilience throughout the pandemic, working under such challenging conditions for almost a year is beginning to take its toll. Almost a fifth (19%) of physicians reported that they had had informal mental health support and 10% had received formal mental health support from either their employer, GP or external services.

A large proportion (64%) felt tired or exhausted, and many felt worried (48%). It is welcome to see that over a third felt supported (35%) and that feelings of determination (37%) continue despite the challenges faced.

Almost half of respondents (49%) said they believed that their organisation had enough medical staff to safely manage daily demand before the pandemic, although not during winter and summer peaks. A quarter (23%) felt that they had enough staff to both safely manage daily demand throughout the year and manage the pandemic.

Vaccine

85% had received the first dose of a vaccine and 16% had also had the second. 71% of those who had not yet had it said there were plans in place for them to have it. Respondents reported concerns about the delay to the second dose, with 58% either very or slightly worried about waiting 12 weeks. But 17% were not worried at all, and 25% only slightly.

Trainees

The vast majority (88%) of trainees were concerned about the impact of the pandemic on their training. But 46% understood it was unavoidable, and 12% thought the experience of working in the pandemic had given them new skills.

A third said that working in the pandemic had made them question medicine as a career, but only one person said they had decided to leave medicine as a result. And almost a fifth (19%) said it had reaffirmed their commitment to becoming a doctor.

PPE

21% said they felt they currently did not have the PPE they needed to wear for managing patients with COVID-19, around the same as in April last year. Many of the comments on PPE provided via the survey were concerned with the PPE guidance for non-ITU settings.

80% said they had been, or were able to be, fit-tested for the PPE they were currently using, compared to 69% last year. 77% said they were confident fit checking their PPE, compared to 65% last year.

Testing and sickness

Fewer doctors were off work compared to April 2020. 6% in London and 7% in the rest of England were currently off, compared to 21.5% and 18.3% last year. But of those who were off, the top reason (24%) was confirmed COVID-19, compared to 7% in April 2020. 4% were off work in relation to COVID-19.

Of those who needed it, 95% were able to get a test for themselves within 24 hours. This is a vast improvement from the first wave, where only 31% were able to.

Throughout the first wave access to testing for household members was a persistent problem. This survey found that only one person was off work because they were self-isolating while waiting for a test for someone in their household. Of those who needed it, 87% said they were able to get a test for their household within the first 24 hours.

About the role of physicians in the frontline response to COVID-19

On 12 April at the peak of the first wave there were 21,684 patients in hospital with COVID-19, 15% of which were ventilated (3,301 patients). In comparison, on 15 January, 10% of the 37,475 patients in hospital with COVID-19 were on ventilation (3,789 patients). That represents a 73% increase in the number of patients with COVID-19 being treated by the wider medical team beyond ITU.

Improvements in treatment for COVID-19 mean that in this second wave a much smaller proportion of hospitalised COVID-19 patients are requiring ventilation on Intensive Treatment Units (ITU)... However, their conditions are still severe enough to require inpatient hospital treatment on a general COVID-19 ward. This is placing huge pressure on the wider medical team in all specialties, particularly respiratory medicine, as the physicians, nurses and other healthcare practitioners staffing these wards work hard to provide care to a rapidly increasing number of patients.

About the survey

This survey was sent out via an email to approximately 25,500 RCP members in England, Wales, Scotland, and Northern Ireland on Friday 15 January 2021 and was filled in by 1,890 people over a period of 48 hours.

This is the eighth survey the RCP has sent to its members during the COVID-19 pandemic.
Further information about our surveys can be found on this website.