Under fire on the front line – doctors share their experiences of work during the COVID-19 crisis

The BMA has conducted the largest survey of frontline doctors during the COVID-19 crisis thus far – with more than 15,000 respondents. Peter Blackburn reports what the findings tell us about the effect of the crisis on workload, staff wellbeing and patient care
Location: UK
Published: Monday 4 May 2020
Person on gurney rushed through A&E

‘I feel terrified that I will lose colleagues, friends or family. I am worried that I could become unwell myself and potentially infect my other patients … I worry about the impact of this trauma on the mental health of our profession.'

Those few words, from one doctor working on the front line of the COVID-19 crisis, illustrate the unfathomable stress and strain of daily working life in this frightening new world.

Doctors sharing their experience with the BMA’s COVID-19 portal speak of ‘toxic cultures’ in their workplaces, ‘overwhelming anxiety’ and feeling ‘unsafe and undervalued’.

And these are far from isolated anecdotes.

A BMA survey, responded to by more than 16,000 doctors in just over 48 hours, has revealed a catalogue of concerns – with unmanageable demand threatening the wellbeing of staff and the future of services.

The survey shows that 66 per cent of doctors are seeing an increase in workload during the crisis – with staff redeployed to new roles, covering for sick colleagues or directly dealing with the surge of COVID-19 patients.

‘This is unsustainable,’ BMA representative body chair Helena McKeown says. ‘Colleagues are feeling broken and are visibly exhausted. Many have had little sleep in recent weeks, have had annual leave cancelled and rotas of 13-hour shifts imposed.

‘There has been very little rest – people just work and then try to go to sleep, and this has been their existence for weeks.’

Dr McKeown adds: ‘This is all going to be crucial planning as part of the Government’s exit strategies – we are going to have to work on sharing out rest and enabling people to take a proper break. We know people were already working under pressure and now they are even more emotionally and physically exhausted. And we need to be talking about a week or two off – three days is just not a proper break.’

Unhealthy environment

The survey also found that redeployment of staff – which for many was not voluntary – is causing issues: 35 per cent of those redeployed say they were not given inductions, 32 per cent have not received training, 17 per cent feel they are working outside their area of competence. And 74 per cent don’t know how long their new arrangements will last. Some doctors say they felt ‘bullied’ into changing job plans and working arrangements.

This could hardly be a less healthy working environment. It is perhaps as unsurprising as it is frightening that nearly a third of doctors (30 per cent) are more stressed and burned out than before the pandemic.

One emergency care doctor said they felt ‘dispensable’ – and described ‘hating every moment of work’, feeling ‘unsafe and undervalued’. They described their working environment simply as ‘dangerous’.

Another said: ‘Feeling unsupported and unsafe at the front line.’

For Dr McKeown one of the most ‘exhausting’ and worrying parts of working life under the COVID-19 crisis has been dealing with death in such great quantity.

‘It is a great concern for the service – this has just been exhausting for people,’ Dr McKeown says. ‘There are a few very special doctors in the world who choose to do palliative care and things like that but many of us aren’t used to several patients dying in a working day and that’s a huge thing for people. It has been very difficult.’

At a time like this support services could hardly be more vital – but 22 per cent of doctors feel they do not have the access to help that they need.

Dr McKeown says it is crucial the doctors were not made to feel guilty for leaving holes in service provision if they need time away from work – and urged regulators and NHS leaders to step back from buzzwords like ‘resilience’ when talking about staff under extreme strain.

She says: ‘Doctors may need to be given proper time off from working – not just occupational health while they continue the job. They need to be given permission to have time away and have therapy or find headspace to get back to work. Burnout is absolutely horrible – some people never get back to work and it is absolutely crucial we take this seriously.’

Sparing the NHS

Ultimately, this is not just a huge problem in the present – but is storing up trauma and tragedy for the future.

It is the future that many doctors are worrying about, most particularly. When asked which areas were most concerning them, respondents said the upcoming demand from patients and future working arrangements.

One doctor said they worried about ‘collateral damage’ and future impact on services of missed diagnoses of cancer or illnesses like sepsis not being treated. He said: ‘There is a real sense of patients sparing the NHS for non-COVID issues.’

While the UK may be slowly passing the first peak of this crisis, a great deal of damage has already done and there are many serious decisions still required. This significant survey shows doctors’ wellbeing – and the realistic capabilities of the service and its staff – must be placed at the heart of any plans made.

BMA members who need help in the current crisis can call and speak to advisers on 0300 123 1233 (Monday to Friday, 8am-8pm, Saturday 9am-5pm) or email [email protected]

The BMA also has counselling and peer support for doctors and medical students available. If you need someone to talk to in confidence – call 0330 123 1245.

NHS Practitioner Health

Read the survey