Working as a locum at the height of the pandemic – in a ward where the wearing of surgical masks was frowned on as it might upset patients – Ellie wasn’t too surprised when she caught COVID-19.

But she didn’t imagine for one moment that, several months on, she would be unable to work, applying for Universal Credit, and relying on grants and family help simply to pay her bills.

Ellie, a GP trainee who was taking a year out of training and working as a locum while she moved across the country, is one of the growing number of doctors affected by long COVID, still suffering debilitating symptoms months after contracting the virus.

Although this devastating syndrome is recognised by the World Health Organization and, last month, by the National Institute for Health Research, that’s still not universally the case in the NHS. While some employers and GP partners are treating it as an occupational exposure issue, providing a measure of financial protection for healthcare workers, others aren’t.

The Doctor has spoken to GPs, consultants, medical academics, trainees and locums from across the UK, who report variable experiences. All are living with long COVID, all are facing uncertainty, but some are facing a financial as well as a health nightmare.

And the fear of the possible implication of COVID, even to the young and previously fit and healthy, is already having an impact on the rest of the medical workforce – at a time when hospitals are filling once more.

‘It’s very scary for doctors,’ says David Strain, co-chair of the BMA medical academic staff committee, who is playing a leading role in the BMA’s COVID work.

‘In the first wave, the younger and fitter doctors and nurses were actually quite confident that because this was a disease particularly affecting older people, they felt that even if they did get it, they would shrug it off really quickly and just get on with things.

'This time there is actually a palpable fear amongst all of the trainees and the nurses and the therapists knowing that if they get it, yes, they are less likely to need to be admitted to ICU, but they nearly all know somebody directly or indirectly who has been affected by long COVID. It’s making things like staffing the COVID wards a lot more difficult because people are nervous.’

STRAIN: 'Some people are being left without any source of income’

At the time of writing, there is still some debate over the status of long COVID and the BMA continues to press for clarity – and a fair deal for doctors.

‘It’s being seen differently by different places,’ says Dr Strain. ‘But what we do know is that some people are being left without any source of income after six months of standard sick pay because it isn’t universally being accepted as a consequence of an occupational exposure.’

The BMA is hearing stories about doctors who are losing their livelihoods, he adds. ‘We are fighting each case as we hear about it and obviously we want to do what we can to help. We think this should be coming with central funding and central support from the Government as part of the COVID response.

‘We are working very hard for recognition that long COVID is a consequence of occupational exposure, particularly the long COVID that came from cases early on in the pandemic when there was insufficient PPE.’

Ellie is as sure as she can be that she contracted COVID while she was working as a locum in an ENT ward in an NHS hospital.

‘A colleague caught it and collapsed on the ward, I helped her, then a week later I developed it as well,’ she says.

‘The trust refused to swab me because I was a locum, but I had all the symptoms and ever since then I’ve had persistent breathlessness and a racing heart with palpitations whenever I try to do anything. All my tests have come back normal, so it’s now suggested that I have a long COVID kind of thing. I’m still having fevers, and it’s been six months.’

As a locum, she doesn’t get any sick pay – and she still has around £40,000 in student debt. ‘I’ve had to get a loan from family just so that I can pay my mortgage. I’ve just heard I will get some money from the Royal Medical Benevolent Fund, which the BMA advised me to contact. This is such a relief.

‘I’ve had to apply for Universal Credit. It’s humiliating, to be honest. That money should be for people who need it, and I shouldn’t need it – although how they expect £400 a month to be enough for anyone, I don’t know.

‘I feel that when I was working in the NHS I didn’t get enough protection – this was at a time when this particular ward would tell you off for trying to wear a mask because it was frightening the patients. There was next to no understanding. They said that ENT isn’t a risky specialty but they’ve clearly never tried to use a tongue depresser on someone with a good gag reflex, because it is.’

Claire, a consultant physician, caught COVID-19 at the end of May. ‘I had been so careful about wearing PPE and washing all my clothes and so on to protect my children, but I had popped into an office at work to speak to someone, then realised later that one of my colleagues was unwell and I had been exposed. I felt a bit annoyed, but thought, OK, I’ll just have to wait it out until I get better.’

When we speak at the end of October, Claire is still waiting.

‘June, July and August passed and I still felt awful,’ says Claire, who has three children. ‘I also felt hassled by some colleagues. One got in touch and wanted me to talk about a new rota – they didn’t mean to do anything wrong, but I had to tell them I wasn’t up to it. At one point, a colleague asked if I was planning to come back to work or if I was just going to stay off feeling miserable.’

Claire sought help from the BMA when her employer tried to cut her pay against the trust’s own policies. Although the money side of things has been sorted out for now, she still feels isolated – and has continuing symptoms. ‘I don’t think doctors are always very good at supporting each other,’ she says.

‘I’d much rather be at work – and I know it’s harder for my colleagues because I’m not at work – but I didn’t choose this. Quite honestly, I’m scared about the future.’

Some doctors have had a better experience with their employers. Consultant anaesthetist Jennifer Blair was part of the intubation team at Epsom and St Helier University Hospital Trust when she became unwell in early April.

After around two weeks she tried to return to work but still had debilitating symptoms and had to go off as well. ‘It’s a mix of physical and cognitive symptoms which is obviously a concern when you’re doing a high level job,’ she says.

‘It’s not just a matter of being able to stand up and work – you’ve got to be able to think clearly as well.’

Her employers have been ‘very understanding’. ‘I have a clinical lead, who is a friend as well, who has been keeping in touch, which has been very nice on a human level. We’ve had good chats every month or so. The management side initially we weren’t sure how my leave fitted into things, but once NHS Employers made COVID leave a bit more specific, that was a big relief knowing that sick pay was going to be continued. It means I don’t have to worry about the money side of things for a time and can focus on getting better.’

She is uncertain what will happen when she feels ready to return to work as under the usual ‘phased return’ rules she would be paid only for the proportion of time she was working, or would have to use holiday entitlement to cover the time off.

‘I think what would be helpful would be something explicit from NHS Employers to say that a much more gradual return was possible – that you could retain your rights to your full pay, but try to work for the time you feel able, even if that’s an hour a week of administrative tasks. I can’t imagine even thinking about doing a phased return because I can’t imagine being able to do full time within the short number of time it would take to use up any annual leave that I had to fill in the gaps.’

As the mother of two boys with all the responsibilities that involves, she needs to get to work for financial reasons – but that’s not the only driver.

‘Getting back to work is important for all sorts of reasons, in terms of your identity, in terms of the fact that it’s so much a part of you – it’s a massive thing. Increased flexibility around a return to work would be very welcome.

I do worry that some people might give up their jobs because they can’t see a way back.’

Ellie returns to GP training in December and hopes that by that time she will be able to work. She believes doctors – including locums – deserve greater financial protection. ‘Organising people to clap for us once a week is great, but when you can’t pay your own mortgage – and you can’t pay your mortgage because there wasn’t enough PPE to start with – it feels very shallow. Like the money for people on furlough, there should be further financial government help for healthcare workers.

When Gillian joined a five-partner GP practice around a decade ago, the wording of the partnership agreement wasn’t her priority. Eager to get stuck in, she didn’t run the document by a lawyer.

But the implications of one clause proved serious. This stated that any partner had who not been ‘fulfilling their partnership duties’ over a six-month period could be ‘expulsed’ from the partnership; in other words, they could lose their job.

This happened to Gillian last month. After years of training then working as a GP, she has developed ‘long COVID’ and doesn’t know when she will be able to work again. Now she doesn’t have a job.

‘My partners couldn’t cope with the uncertainty,’ says Gillian. ‘They wanted me to say when I’d be well enough to come back to work as normal, and I simply couldn’t give them that certainty. I think they couldn’t cope with the idea of having a partner who was disabled.’

Gillian believes she contracted COVID-19 in April from a colleague who had tested positive and been sent home from work the day before she (Gillian) felt unwell. She then passed the infection on to her husband, who is also still off work six months later. Both had thought they would be ill for a short while and then bounce back, but this wasn’t the case. She tried to go back to work in June, but just one session left her unable to leave her bed for 10 days. Now, having been expulsed from her partnership last month, she doesn’t know what she will do.

‘The partnership agreement at our practice was poorly worded and out-dated. I would encourage all GPs to get any partnership agreement independently reviewed by a lawyer before signing. It’s worth the initial outlay to save a lot of trouble further down the line.’

Gillian had taken out income-protection insurance but it won’t kick in until she has been off work for 12 months – leaving her without any income for six months. If she takes up any paid work in the meantime, for example, a locum session to see if she is able to return to work in any capacity, the ‘clock’ goes back to zero and she would have to wait a further 12 months for income protection.

‘I’m stuck between a rock and a hard place. It seems very hard that I contracted COVID-19 at work, but now I’m left with no job and no income and no idea about what will happen in the future for me and my family.’

Guidance on employment contracts