Coronavirus: NHS facing shortage of doctors before second wave arrives as thousands set to quit, warns medics union

The NHS faces a possible exodus of doctors before the second wave of coronavirus arrives, a leader of the British Medical Association has warned – with Brexit making it harder to replace them.

A new survey of doctors found almost one in seven is planning to quit the NHS or retire when the current crisis subsides, with many more saying they aim to cut back on hours, and almost a third complaining of mental health problems related to four months of relentless struggle against Covid-19.

Speaking to The Independent, the BMA council chair Chaand Nagpaul said that a second coronavirus wave in the winter months could overwhelm the NHS with a “double whammy” of potential staff shortages combined with regular winter pressures and the massive backlog of work postponed during the pandemic.

While not all those considering quitting or retiring are likely to follow through on their plans, Dr Nagpaul said that restrictions on foreign travel caused by Covid-19 and the impact of Brexit will make it harder than ever to replace those who do leave.

Meanwhile, medical staff exhausted and traumatised by four months of battling the coronavirus are faced with a backlog of millions of delayed cases – some of them involving life-threatening conditions – ahead of the regular surge in demand over the winter months.

Dr Nagpaul said the “precarious” situation of the NHS makes it all the more essential for the government to throw all its resources into preventing a second wave, including by getting across forcefully to the public the message that the virus has not gone away and that they must not congregate in large groups in parks and beaches.

The NHS avoided being overwhelmed by the first wave of coronavirus in part because of the timing of the outbreak in the early spring when winter flu and other seasonal pressures were dying down, he said.

But he warned: “The combination of winter pressures and another spike would overwhelm the health service. Doctors are extremely worried about this.

“Half of doctors are saying that they are worried about the ability of the NHS to cope should we have a second spike because they are already feeling under pressure in terms of how to cope with the backlog.”

NHS bosses have warned that waiting lists in England alone could reach 10 million by the winter because of procedures including hernia repair, cataract removal and hip or knee replacements, which were postponed to allow frontline staff to concentrate on the coronavirus.

But Dr Nagpaul said much of the workforce that must take on this massive job is shellshocked by the trauma of the round-the-clock struggle to save the lives of Covid patients.

“We have been doing surveys throughout the pandemic, and over 30 per cent of doctors are reporting mental health conditions such as anxiety, burnout, depression at greater levels than before the pandemic,” he said.

“Mental distress has escalated since the pandemic. They are reporting exhaustion from working long hours and doing work they have never had to do before.”

A BMA survey of around 7,000 doctors around the UK, completed earlier this week, found that almost 14 per cent were planning to leave the NHS, retire early or work elsewhere once normal services are resumed.

A further 29 per cent said they intended to work shorter hours after the crisis was over.

Some 31 per cent said that they had suffered depression, anxiety, stress, burnout, emotional distress or another mental health condition relating to their work during the pandemic, while a further 13 per cent said that this was already the case even before Covid arrived.

Meanwhile, there are concerns that European Union national doctors may return to their home countries at the end of the Brexit transition period in December, with uncertainty about whether others will arrive from Europe to take their place, said Dr Nagpaul.

It is “vital” for the government to negotiate mutual recognition of qualifications as part of a trade deal with the EU in order to smooth access for European doctors, he said. Currently, the prospect of a deal on the future relationship is in the balance, with deep fissures between London and Brussels over issues like fisheries and a common regulatory regime.

“About 14 per cent said they are considering leaving the profession and there are others who want to work less than full time because they are exhausted,” said Dr Nagpaul.

“The workforce implications are significant. Before the pandemic, we had 10,000 unfilled medical vacancies. Last year more overseas doctors entered the medical register than new doctors qualifying in the UK. The NHS absolutely depends on its overseas workforce.

“With overseas travel likely to be limited because of Covid-19, we are not sure we are going to see the same numbers of doctors from the Indian sub-continent, so it becomes more important to retain the current workforce.”

The key to easing the pressure will be to stop a second spike of coronavirus cases, which the government should make its “top priority”, said Dr Nagpaul.

“Doctors have worked flat-out, they haven’t had any break, they haven’t had holidays, many of them haven’t been able to stay at home,” he said.

“It is really important that they are able to have rest, have breaks and take time off, because with the winter ahead we are going to need a workforce that is available to deal with the health needs of the population.

“That is why the government needs to redouble its efforts to prevent another coronavirus spike.”

This means improvements to the test and trace operation for identifying and isolating potential Covid carriers, as well as better public health messaging around any relaxation of lockdown restrictions, he said.

And he said localised data on infections held by central government should be shared on a daily basis, with public health officials able to respond on a local level.

Confusing signals about changes due to come into place on 4 July, when pubs and restaurants reopen, had left much of the public with the false impression that they can simply go back to normal life, said Dr Nagpaul.

He highlighted the switch from a simple and widely understood two-metre social distancing rule to the new “one metre plus” guidance in force from next Saturday, arguing that few people understand that the “plus” means they can only approach within two metres if they have taken mitigating measures like wearing face coverings.

“It would be fair to say that the crowds we have seen enjoying the weather on beaches do not demonstrate an approach that is about preventing at all costs a second wave,” Dr Nagpaul said.

“The government has to make sure it puts in place measures to prevent spread. That has to be the priority. The public has interpreted the government’s words as permission to mix without social distancing – that comes down to government messaging.

“We are still in a precarious situation. When you look at Germany, which we have seen as a nation that has done well, it is now seeing significant outbreaks leading to two local lockdowns. The virus is still very real. It really can escalate very rapidly.”

The BMA chair was among a group of eminent medics who signed a joint letter calling for a review to learn the lessons of the pandemic so far, in order to ensure the UK is prepared for further outbreaks.

As well as urging ministers to step up test and trace efforts, with robust measures to clamp down swiftly on any local flare-ups, they are calling for stockpiles of personal protective equipment and testing kits to be built up well in advance of the feared second wave later this year.