Protected but cut off

by Achuthan Sajayan

Some doctors have been 'shielded' from COVID-19 but the isolation that comes with it has left many feeling anxious and guilty

Location: UK
Published: Friday 3 July 2020

‘Shielding’ is a term that was added to the medical vocabulary in March 2020, one that I did not pay much attention to until I received a shielding letter myself.

Being actively involved in my department’s pandemic preparations at that time, I was training the theatre team in ‘donning’ and ‘doffing’ and helping to prepare the COVID-19 airway management team.

Though it did not come as a complete surprise, the letter left me feeling guilty, anxious and, in some strange way, relieved as well.

Getting in touch with fellow doctors in the same situation through a WhatsApp group made me realise that I was not alone in this situation and the feelings of isolation, frustration and guilt were common among majority of them.

The group also helped me realise the multitude of reasons one might need to shield, with one example being to protect vulnerable family members.

Many of these shielding doctors have been working from home to various extents, but for those of us in specialties such as anaesthetics, emergency medicine and intensive care, we could only help with educational or management work rather than clinical.

Unlike my positive experience, many of the shielded doctors felt a lack of support from their employers and educational bodies and an absence of any national guidance from the Department of Health, NHS Employers or trade unions made this even worse.

The recent Government plans to end shielding (England and Scotland from 1 August and Wales 16 August) has created some uncertainty, anxiety and anger among the shielded medics, especially because it coincides with greater relaxation of the national lock-down.

A survey of shielded doctors has shown that many are worried that they will not fit into their departments when they return to work. Having been out of clinical practice for more than three months, they feel apprehensive and anxious.

Difficulty in strictly adhering to social distancing in clinical areas is another worry. Unlike other professions, there is inherent risk of infection in hospitals which makes the return to work process more worrying for healthcare workers.

There are doctors who want to take longer to return to work or, like myself, want to end shielding before the official deadline. But currently, the information about the implications of these decisions on their contracts, pensions, death in service benefits or life insurance is limited.

Though BMA, NHS Employers and ACAS websites provide some useful information in this regard, the shielded doctors still have many unanswered questions.

Coordinated planning between the employee and the department is important to make the return as smooth as possible. As the clinical vulnerability varies between people who are shielded, an individualised approach will be required when they return.

The variety of risk assessment systems used by different employers, some deemed superior to others, is another cause for confusion, anxiety and grievance among the vulnerable doctors.

It is also important to make sure that this assessment process do not end up becoming another tick-box-exercise in which doctors feel pressurised to make unsafe decisions about their return.

For returning trainees, the Professional Support Units and SuppoRTT system could provide some useful resources.

While it is nearly impossible to make our workplace ‘COVID-free’, it is the employer’s duty to take reasonable steps to protect employees’ health and safety and to make the workplace as safe as possible.

It is important to make sure that the returning doctors are additional help to the NHS as they want to be, not a burden, by keeping them as safe as possible during these uncertain times.

Achuthan Sajayan is a consultant anaesthetist based at University Hospitals Birmingham