COVID-19: Workforce

Last year, the Government passed legislation requiring vaccination as a condition of deployment. This was due to come in from 1 April 2022.

This is now being reconsidered. In January 2022, the Government announced their intention to remove the legal requirement for health and social care staff to be double jabbed, subject to consultation and Parliamentary approval.

NHS England and Improvement has published a letter about this change.

If you are leading or managing a team:

• ensure good quality communication and accurate information updates are provided to all staff
• rotate workers from high-stress to lower-stress functions routinely rather than based on a staff member identifying their need to be rotated
• partner inexperienced workers with their more experiences colleagues. A ‘buddy’ system may help to provide support, monitor stress and reinforce safety procedures
• in situations where risk is uncertain, consider whether outreach personnel can carry out visits in pairs
• initiate, encourage and monitor work breaks
• implement flexible schedules for workers who are directly impacted or have a family member impacted by a stressful event
• actively monitor team members and remain vigilant for signs of stress; adopt a ‘nip it in the bud’ approach rather than waiting for people to become unwell or experience a crisis
• facilitate access to, and ensure staff are aware of where they can access mental health and psychosocial support services
• managers and team leads are also facing similar stressors as their staff, and potentially additional pressure in the level of responsibility of their role. It is important that the above provisions and strategies are in place for both workers and managers, and that managers are able to role-model self-care strategies to mitigate stress.

NHS England has published guidance for line managers on winter workforce preparedness.

Multidisciplinary teams (MDTs)

Consideration should be given to the role of the whole MDT in supporting the delivery of prioritised direct patient care. The whole MDT should, where appropriate, be trained in responding to incidents, for example, in the likely event of a decreased workforce trained in the appropriate physical interventions for the services.

The Academy of Medical Royal Colleges has published a report exploring what the COVID-19 pandemic has revealed about the enablers for and barriers to effective multi-professional team-working. 

Clinical leadership will be required in support of redeployment of staff as appropriate, with further guidance on this provided in  Managing Capacity and demand within Inpatient and Community mental health (MH), Learning Disabilities and Autism services for all ages.

As per contingency plans, organisations will be required to reorganise tasks to ensure clinical time is released to focus on delivering direct patient care. This may mean that staff vulnerable to COVID-19, or non-clinical staff are asked to fulfil non-direct patient contact tasks to free up direct clinical capacity.

There was an amazing response to the recruitment programme urging clinicians to consider a return to the NHS to provide support to the efforts to tackle COVID-19.

Due to the success of the vaccination programme, the Bringing Back Staff programme closed to new placements at the end of June 2021, however NHS England has published more information for clinicians interested in returning to practice, whether full time or through flexible schemes.  

The Academy of Medical Royal Colleges has also published a factors for consideration template for doctors wishing to reassure themselves that they are competent across the whole scope of their work.

NHS England have published education and training resources to help staff to identify the skills required to deliver safe care for the population during the pandemic.

The College has produced a range of podcasts and webinars to support you. Please note that the views of the interviewees are not necessarily those of the College.

Professor Stephen Powis, National Medical Director for NHS England and NHS Improvement, has written to all responsible officers and medical directors about changes to professional standards activities. Key points include:

• Appraisals and revalidation: Medical Appraisal 2020 describes the restart of appraisals using rebalanced appraisal processes that reduce the documentary requirements for the pre-appraisal documentation. This will remain the default model. The GMC have confirmed that these appraisals are consistent with existing GMC guidance for appraisal and revalidation.
• Framework for Quality Assurance: the  Annual Organisation Audit has been cancelled for 2020/21 but organisations will still be able to report on their appraisal data and impact of the Appraisal 2020 model later in the year. The annual Board report and Statement of Compliance is being updated to support this. The date for submission of this report was 24 September 2021. Because they are already covered in the annual Board report, the Framework for Quality Assurance Quarterly Reports will cease from 1 April 2021. 

As part of business continuity planning, all psychiatric teams should consider what service it can deliver with reduced staff numbers and how it will cope with various scenarios. In particular:

Clear lines of delegation

• Consultants and team leaders/managers need to have clear lines of delegation in case they are incapacitated.

Safe communication

• During this period, safe communication of complex clinical information will continue to be critical within teams.
• Maintain good communication with colleagues/trainees even when isolated or working from home (e.g daily brief medical wellbeing hubs (catch-ups) in units/team via skype/telephone).
• Local solutions should be found for doing this in the most appropriate way to enable social distancing e.g. several staff members coming together in a small office should be avoided and alternative methods of meeting together introduced. This will also have implications for ward rounds and whiteboard meetings in in-patient settings, and alternatives to group gatherings must be sought.

Research and training

• Please visit our most up to date guidance and information for trainees during the COVID-19 pandemic, which includes the ARCP Decision Aid.

Get additional staff

• Discuss with your local voluntary and third sector organisation including willing members of public (university students, volunteers, retired staff) who can provide support if resources are depleted. However, be mindful of precautionary steps.
• Mental health Trusts should look to get staff from other industries (i.e. those that have recently lost jobs (travel, hospitality etc)) and encourage them to work in the NHS. Trusts need to develop really quick ‘onboarding’ processes to get staff up and running.
• If possible, try to get support from Physician Associates who are ideally equipped to deliver a holistic type of care and treatment.

Difficult decision-making and incidents

• If in doubt, please ask your peers/colleagues and provide support and supervision when colleagues come to you. This is the time to break artificial barriers and work together to keep both staff and patients safe.
• Where possible, psychiatrists should seek advice from their Trust’s Ethics Committee to support staff making difficult decisions in ways they have not before.

• In case of incidents, a post-incident debrief should still be conducted to help the organisation to identify and address any physical harm to patients or staff, ongoing risks, and the emotional impact on patients and staff. As usual, the person who was involved in the incident should be offered the opportunity to contribute to the immediate debrief and discuss the incident with a member or staff, an advocate or a carer. This is quite different to psychological debriefing which should not be used.

Staff redeployment

• If required, local services may be asked to redeploy foundation doctors training in psychiatry to general hospital settings. While this needs to be done where possible, we must be sure that patients with mental illness continue to receive the care and support that they need. We will monitor the situation closely and work with HEE to ensure that this happens. We have published information relating to the redeployment of Foundation Trainees during the pandemic. This document includes recommendations for the future.

As per guidance on ‘redeploying your secondary care medical workforce safely’, NHS England does not envisage redeployment of staff from mental health services due to increased demand for mental health services. However, based on local factors, organisations can consider redeployment of non-specialty grades from or to this service.

NHS workers have been inundated with kind offers of support from a wide range of companies – from discounted taxi rides, to dedicated supermarket shopping times, to free food and discounted products.

NHS England and NHS Improvement have been working to verify these offers and bring them into a single list of offers and resources, so that NHS staff can take advantage of them. The list includes details of how to access the offers, and any terms and conditions to be aware of.

Please note that this is not an exhaustive list and it should be updated regularly with any changes and new offers.