The COVID-19 outbreak is likely to have a huge impact on the role of psychiatrists and the wider mental health workforce.
This section aims to provide you with the latest updates and advice to help you manage your teams.
NHS England has now published their workforce guidance for mental health, learning disabilities and autism, and specialised commissioning services during the coronavirus pandemic (PDF).
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.
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.
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.
College members that have either temporarily or permanently left the NHS are being urged to provide support to the efforts to tackle COVID-19.
This doesn’t necessarily require a return to frontline care. NHS England have emphasised that you are free to determine how much time you can contribute and that any contracts will be in line with standard terms and conditions. It has published a set of FAQs for those considering a return to practice and a survey to support efforts to ensure skills are most effectively utilised.
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.
As per the letter from Simon Stevens and Amanda Pritchard to system leaders (PDF), refresher physical healthcare training should be provided to all mental health, learning disability and/or autism staff delivering patient care covering physical health care, vital signs and the deteriorating patient.
We have developed an eLearning hub to support psychiatrists and other clinicians working in mental health settings in gaining or refreshing knowledge and skills to support patients and staff during the COVID-19 outbreak.
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 (PDF). Key points include:
- medical appraisals – a strong recommendation that these are ‘suspended until further notice... unless there are exceptional circumstances agreed by both the appraisee and appraiser.’
- revalidation – GMC has confirmed that any doctors due to revalidate by the end of September will have revalidation deferred by one year.
- framework for Quality Assurance for Responsible Officers and Revalidation – the 2019/20 Annual Organisation Audit has been cancelled.
- mandatory training and other activities – local requirements for mandatory training, CPD and quality improvement work not directly related to COVID-19 should be amended.
- oversight of professional concerns is maintained, but with high risk cases prioritised.
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.
- 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, audit and training events
Most HEIs and Trusts have suspended all research. If you have not, consider putting research, audit and training events on hold to free up clinical resource but be mindful of training needs of staff if they move from community to inpatient to support the service.
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’ process 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.
- As we come together to support the NHS during this difficult time, 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 will regularly share any other guidance document on staff redeployment that may affect mental health services. We will also add information on staff working flexibly in different settings and with different cohorts.
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 has been working over the past week 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 will be updated regularly with any changes and new offers.