The tenth survey of RCP members and fellows during the COVID-19 pandemic shows that although life is returning to some semblance of normality for physicians, long backlogs are expected. It also highlights the changing working practices seen during the pandemic, such as widespread use of remote consultations, and what physicians want to change or stay the same long term.
Life is returning to something like normal for most physicians as the second wave ends - with rotas returning to normal, no respondents off ill with COVID-19 and the vast majority (88%) fully vaccinated.
Despite this improved picture, the pressure of the pandemic has taken its toll with over two thirds (69%) feeling tired or exhausted, an increase from February. Conversations about taking time off to recuperate are still generally not taking place, although 11% of respondents did report being on pre-booked leave.
A majority of physicians (59%) think it will take at least 18 months for the NHS to get back to an even keel, although respondents were more optimistic when thinking about their own specialty.
Physicians have worked very differently during the pandemic and want some of these changes to be embedded long term: a majority (55%) say at least a quarter of their outpatient appointments should be virtual.
Views on what they want their future working pattern to look like are mixed. While 36% want to return to their pre-pandemic pattern and 33% want to work the same number of PAs more flexibly, just over a fifth (21%) want to work fewer PAs. This will need to be taken into account in workforce planning.
Team working improved during the first wave, but deteriorated during the second wave due to the pressure of many months of pandemic working with too few staff.
Return to some semblance of normality
Rotas have started to return to normal for 83%, and only 6% were working in an area different from their normal practice.
No respondents were off ill with COVID-19. Of those who were not working, 9% cited long COVID as the reason for their absence, similar to the figure in February. This represents just 1.2% of overall respondents.
Almost all respondents (98%) had received at least one vaccine dose, and the vast majority (88%) have now had their second dose. 93% received the Pfizer/BioNTech vaccine and 7% the AstraZeneca/Oxford.
Delays and backlogs
Very long backlogs are now expected. A majority (59%) think it will take at least 18 months for the NHS to get back to even keel, with 30% saying over 2 years.
Respondents were significantly more optimistic when thinking about their own specialty, with the majority (52%) expecting to return to an even keel within a year. Just under a quarter (23%) anticipated that it would take over 18 months.
This masks significant variations within specialties though. For example, in gastroenterology backlogs of over a year were expected by two thirds (75%), including almost half (48%) expecting it take over 18 months to return to an even keel. Other specialties where physicians expect it to take over a year include dermatology (82%), rehabilitation medicine (67%), respiratory (59%), medical oncology (58%) and cardiology (52%).
These backlogs will be exacerbated by continuing delays for diagnostic testing. Clinical physiology testing continues to be worst affected, with 87% experiencing delays for outpatients and 73% for inpatients. Access to endoscopy testing is also difficult: delays in outpatients are cited by 82% and 64% for inpatients.
Reflections on working during pandemic and post-pandemic hopes
Reflecting on their experience of working during the first and second waves of the pandemic, over two thirds (68%) had seen their job plan altered. 29% said it had become more flexible, but almost a quarter (24%) had taken on more programmed activities (PAs).
Team working improved during the first wave: 46% said it improved and 33% said it deteriorated, meaning a net positive of 13%. It deteriorated during the second wave, resulting in a net negative of 25%, although almost half (48%) said it stayed the same as during the first wave.
Support from colleagues was a crucial factor in the first wave, cited by 86% of those who said team working had improved, along with support from the public (47%) and support from their employer (46%). For those who said it had deteriorated, the main reason (74%) was the pressure the service was under, followed closely by 64% citing a lack of staff.
The reason for the deterioration in team working experienced during the second wave appears to be due to the same reasons: the pressure of many months of pandemic working with too few staff. Those saying it was due to the pressure the service was under rose to 82% and those citing a lack of staff rose to 68%.
Physicians have mixed views on what they want their future working pattern to look like. 36% want to return to their pre-pandemic pattern, 33% want to work the same number of PAs more flexibly and 21% want to work fewer PAs.
There is a clear preference for more remote and online working practices being adopted long term. 69% want more online meetings, 57% more remote working, 57% more phone consultations and 46% more video consultations.
63% are still working remotely in some form, with remote consultations now widespread. 82% had started conducting telephone consultations and 35% video consultations. With only a fifth (21%) saying the switch to video has had a negative effect on their practice, and two thirds (63%) saying it had either no impact on or had reduced their workload, this suggests there is significant scope for changing the way care is delivered.
Over two thirds (68%) are currently conducting virtual outpatient appointments, with a majority of appointments now by telephone. Physicians are keen for this shift towards greater use of virtual outpatient appointments to be embedded: a majority (55%) say at least a quarter of their appointments should be virtual, and more than a third (35%) think at least 35% of their outpatient appointments should be virtual.
Video consultations are generally seen to have a positive impact on practice (37%), although the same proportion say video consultations have led to an increase in workload. Disappointingly 41% say they do not have everything they need to deliver good remote care. If greater use of remote consultations is to become the norm long-term, it is imperative that NHS trusts provide the right equipment and guidance to allow clinicians to deliver effective care remotely.
Tiredness, morale and recuperation
Over two thirds (69%) are feeling tired or exhausted, up from 63% in February. 31% are demoralised, slightly higher than in February (27%), but only 25% feel worried, continuing the welcome downward trend as the second wave comes to an end. There was also another slight increase in those feeling optimistic (22%). 57% reported getting the amount of sleep they needed all or most of the time, up from 51% in February.
62% reported no discussion in their organisation about time off to recuperate, with 23% unaware. This is virtually unchanged from February and remains a concern. 11% of respondents were on pre-booked annual leave though, and staff should continue to take leave and employers should continue to encourage their staff to do so. Even for the 29% who had had time off however, 59% still felt tired afterwards and only 27% refreshed and ready to return.
This survey had 1,142 respondents, and was conducted between 9-12 April.