Existing pressure on the NHS can’t be ignored during coronavirus outbreak

With the coronavrius outbreak being declared a pandemic by the World Health Organisation (WHO) last week, Barney Gilbert, NHS doctor and CEO of Pando Health explores why existing pressures on the NHS such as communication tools and burnout, should not be ignored. 

As the NHS gears itself up to tackle the growing threat of a Covid-19 outbreak, a spotlight is being shone on the immense pressures soon to fall upon our already strained health service. We are seeing reports about doctors being asked to come out of retirement, GPs closing for deep cleans, and public panic ratcheting up.

As the NHS and overstretched clinicians prepare to cope with this crisis, the existing fault lines will begin to widen and the pressure our NHS has been labouring under will be laid bare.

NHS staffing has long been a cause for concern and a mass outbreak of Coronavirus will throw this reality into sharp relief. In recent years, increasing numbers of junior doctors have left the system temporarily or permanently following their second Foundation Year (F2).

Great swathes of senior staff have retired to avoid the well-documented pensions trap. And the number of staff leaving citing work-life balance concerns has tripled. As the system has come under increasing pressure, staff have reached burnout and stepped away. This has created a vicious cycle for those left behind.

Planning for an emergency

With a major emergency looming, mooted plans include asking recently retired medics or those on career breaks to return to the fold. This is undoubtedly a sensible strategy (as long as onboarding and safety procedures are handled effectively), but one that shouldn’t be needed.

The health service has long been calling out for the funding to recruit and retain more clinicians – a crisis of pandemic proportions shouldn’t be the prompt required to close staffing gaps. Going forward, protecting the health of and promoting the retention of NHS clinicians must become a national priority.

When an emergency hits, we must also ensure that the clinicians who are staffing our wards and surgeries have the tools they need to work effectively and safely.

Archaic tools

Despite successful campaigns to end the use of fax machines and pagers, these archaic tools retain their role in our modern day health service. As recent events show, these tools are too slow and cumbersome to be useful in a crisis. WhatsApp, despite its flaws, quickly became the communications platform of choice during the London Bridge terrorist attacks. Clinicians didn’t have the time to hang onto landlines, or chase down colleagues via bleeps; they had to move faster.

The old communications system, with all its 1970s hallmarks, has reigned for far too long. Whilst WhatsApp is far from an adequate solution, Trusts must use this moment to embrace an infrastructure that allows clinicians to share information, contact colleagues, and speed up decision making. In the NHS, every minute is already precious. In a pandemic, each second will be crucial.

Reliance on emergency services

This crisis is also on track to starkly expose the over-reliance the UK population has developed on emergency services and A&E.

GP surgeries across the country have been grappling with supply and demand issues for too long. As a result, A&E has become the default option for those seeking clinical care.

Waiting times have crept up as frontline staff try to triage as quickly as possible. Likewise, 999 crews are facing more calls than ever before, with call out targets being missed and A&E discharge waits growing ever longer.

Despite the crisis being in its early stages, public anxiety and the concerns of travellers recently returned from virus hotspots has seen demands on NHS 111 spike. Some report conflicting advice, others long waits to speak to a clinician.

Not new demands

The demands are not new; those working in healthcare are all too aware that the challenges faced by primary care and the knock-on effects on emergency provision have been gradually worsening for many years.

With the support of the public and a clear information campaign around when not to present at A&E or call 999, our frontline services may be able to keep their heads above water during a pandemic. But these pressures won’t dissipate along with the virus – they need coordinated national action, long-term planning, and strategic funding to ensure we tackle the root cause.

As we approach what looks set to be an escalation of the virus, our incredible NHS will be one of the best prepared health institutions in the world.

Highly-skilled and passionate staff will be doing everything possible to keep people well. Yet the reality is that fissures in the system have been left exposed for too long.

This emergency will see serious existing problems compounded by crisis. As we strive to survive this most intense of challenges, we must not ensure we never find ourselves so weakened at a time of great need ever again.