Workforce - COVID-19 guidance for clinicians in Wales

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, support colleagues but also get the support that you need.

It includes information on:

  1. General principles
  2. Staff ways of working, including PPE, staff safety and wellbeing, staff management and remote working
  3. Releasing time to care and returning to practice
  4. Training, CPD and professional standard activities
  5. Staffing models

*This guidance is consistent with UK-wide RCPsych COVID-19 Guidance for clinicians with the addition:

 

New publications

 

Mae'r wybodaeth hon hefyd ar gael yn Gymraeg, ar ochr dde'r sgrin.

  • People with mental health needs, a learning disability or autism should receive the same degree of protection and support with managing COVID-19 as other members of the population. This may mean providing additional support including making reasonable adjustments.
  • In preparing for and responding to COVID-19, staff within MH / Learning Disability and Autism providers may need to make difficult decisions in the context of reduced capacity and increasing demand. These decisions will need to balance clinical need (both mental and physical), patient safety and risk. Due to the need for rapid decision-making providers may choose to use an existing patient panel or an ethics committee to advise on decisions.
  • When considering plans, providers should consider not just patients’ vulnerability to the physical infection but vulnerability stemming from mental health needs, a Learning Disability or Autism too. People will be at risk of mortality through suicide, injury through self-harm and of self-neglect, and therefore changes to services need to have patient safety as the paramount concern.
  • Partnership working is crucial and responses will need to be co-produced where possible. To both maximise the use of community assets and to draw on the insight and expertise of partners, response plans will need to be developed alongside patients, families, carers, voluntary community sector (VCS) organisations as well as neighbouring MH / Learning Disability and Autism providers. This will include planning within an NHS-led Provider Collaborative, with social care partners, the Criminal Justice System, commissioners, and education providers for children and young people (CYP).
  • Providers will need to maximise delivery through digital technologies to ensure continuity of care where patients are asked to isolate and in response to reduced staff numbers or mobility. Digital technology can also be used to support continuity of social contact for patients, families and carers.
  • Providers should bear in mind the longer term impact of the pandemic and associated impacts on the mental health needs of the population and seek to minimise changes that impact on the capacity and capability of the system longer term.

Releasing clinical capacity for direct patient care

Clinical leadership will be required in support of redeployment of staff as appropriate.

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.

Multi-disciplinary 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.

Returning to practice

College members that have either temporarily or permanently left the NHS are being urged to provide support to the efforts to tackle COVID-19.

Welsh Government have issued guidance for doctors returning to the NHS to assist with COVID-19, as well as guidance for allied health professionals and healthcare scientists.

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, audit and training events

  • Most health boards 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.
  • Health Boards 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. Health Boards 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 Health Board’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

  • 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 Welsh Government 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.

The College is producing podcasts that are similar to those on the RCPsych website, but have been recorded specifically for CPD Online. Access to the recordings is free, but you need to be a CPD Online subscriber in order to take the test at the end and gain CPD certification. Please note that the views of the interviewees are not necessarily those of the College.

The College is looking at producing or signposting more CPD modules, podcasts and webinars. Please check this page regularly if you are interested.

Professional standards

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.

We'll be updating this page with updated guidance once received.

Personal protective equipment (PPE) and infection control

The UK Government has issued guidance jointly with the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS), Public Health England and NHS England.

Key changes to the guidance include:

  • All health and social care staff within 2m of a suspected or confirmed coronavirus patient should wear an apron, gloves, fluid repellent surgical mask and eye protection
  • Some PPE (masks, visors and gowns) which are currently classed as “single use” will be classed as “sessional use” in some situations
  • The use of gowns will be extended, particularly when aerosol-generating procedures are taking place.

Whilst this guidance seeks to ensure a consistent and resilient UK wide approach, some differences in operational details and organisational responsibilities may apply in Northern Ireland, England, Wales and Scotland.

Our information is consistent with that published across the UK College, You'll find that information here (opens in a new window).

Additionally, we'll update ministerial statements as they are received.

 

Staff safety and wellbeing

Assisting colleagues and other frontline staff 

As all health practitioners go through stressful, anxious and traumatic experiences, you will have a role in assisting them with their mental health. Below are some ways you can assist.

  • Do not assume that everyone will become ill. Continue recommended practice of not psychologically debriefing others after challenging events; remember leader led discussions/reviews are however a good idea as long as they are conducted in a psychologically safe way. It is best to provide proactive managerial/supervisory led support as well as peer/colleague support for the majority.  
  • You are well-equipped to help other frontline teams by helping supervisors to properly support their staff respond appropriately and try to improve the socially cohesive interpersonal bonds within their teams. Those who are understandably distressed should not be referred to mental health services immediately but managed within the team by a sensitive and psychologically informed supervisor.  
  • Psychiatric services may also be able to provide a rapid, bespoke clinical service for other frontline healthcare staff who do become mentally unwell. This will depend on what capacity is available locally, doing so would help the overall effort to maintain a pool of efficient frontline healthcare workers to deliver care. Such an offering needs to adopt a ‘return to duty’ mindset whilst remaining vigilant for workers who might have significant, and therefore occupationally impairing, mental disorder. Liaison with occupational health staff in relation to this task is recommended. 

Leading or managing a team 

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

Getting wellbeing advice and support

You may feel stressed for many reasons such as the amount of work, being uncertain about the future, having to make difficult decisions about patients’ care, worrying about taking the virus home with you and infecting others, and/or less contact with family and friends. 

Stress can lead to feeling overwhelmed, finding it difficult to think clearly, feeling exhausted and/or tension in working relationships. This is a marathon and not a sprint. To make it to the finish line you need to look after both your physical and mental health. You can’t look after your patients unless you look after yourself. So:

Take care of yourself 

  • Take regular breaks and find time to unwind between shifts. 
  • Get enough sleep. 
  • Eat enough healthy food.
  • Exercise regularly. 
  • Avoid using tobacco, alcohol and drugs to cope. 

Be kind to yourself 

  • Make room for your feelings - feeling upset or worried is not a sign of weakness. 
  • Think about how you usually cope at times of stress and use these strategies. 

Stay connected 

  • Keep in touch with family and friends – by phone or social media if necessary. 
  • You may unfortunately experience avoidance by family members or the community due to stigma or fear. This can make an already challenging situation far more difficult. If possible, stay connected with your loved ones including through digital methods. Turn to your colleagues or other trusted persons for social support. 
  • Check how your colleagues are doing and support each other. 
  • Recognise that different people will cope in different ways. 
  • If possible, consider setting up or joining a Balint Group to discuss difficult cases and find support from your peers. This may be operated virtually using e-mail, phone, skype etc as well as meeting with colleagues face to face where social distancing can be carried out. 

Manage information 

  • Too much information can be overwhelming. Keep work-related COVID updates to key times.  
  • Take breaks from watching, reading or listening to news.  
  • Obtain information from trusted sources and focus on facts not speculation.

Make use of available support 

We listed below a number of resources which can help you get the support you need. There may also be local support services available in your area. Please contact your Trust for further information, as it is very important for you to know know who to contact in your own Trust if you are unwell or if stressed/distressed. 

A) Psychiatrists’ Support Service (PSS) 

The RCPsych Psychiatrists’ Support Service (PSS) provides free, rapid, high quality peer support by telephone to psychiatrists of all grades who may be experiencing personal or work-related difficulties. Our service is totally confidential and delivered by trained Doctor Advisor College members. It is available during office hours Monday to Friday. To contact the support service 

  • call our dedicated telephone helpline on 020 7245 0412 
  • email us in confidence at pss@rcpsych.ac.uk.

Please note: we are looking at expanding the PSS to ensure all members can get the support they need. As we expect to see an increase in calls, we are currently looking for volunteers interested in getting involved. If you are interested, please contact the PSS at pss@rcpsych.ac.uk. Information on PSS will be updated regularly. 

B) HEIW Professional Support Unit (PSU)

Health Education and Improvement Wales operate this particular service, offering guidance and support to trainees throughout Wales. Contact details and further information can be found here.

Trauma-informed care

Patients with suspected or actual infection who go to hospital for treatment in an intensive care environment may experience their situation as traumatic. These experiences may have profound, and at times lasting, psychological and emotional repercussions even after the patient’s recovery from the physical illness. 

  • Consider what can be done to make the environment less threatening and more familiar for the patient and provide them with as much reassurance as is feasible given the situation.It is also noteworthy that having a loved one in intensive care, is likely to be extremely anxiety-provoking or distressing for patients and their relatives. Where a patient dies, family members may suffer traumatic stress symptoms related to what happened to their loved one or indeed what they imagined happened to them. 
  • For both patients, and their families, it is appropriate to make sure that they are actively monitored, in accordance with NICE guidelines, for a month or so after the patient recovers to ensure that their mental health is stable. Where someone is suspected of having a trauma-related mental health problem, they should undergo a thorough assessment and where necessary provided with evidence based care in accordance with NICE. 
  • Trusts should be mindful that healthcare staff, family and carers may experience traumatic stress and/or grief due to deaths that occur. Active monitoring of these individuals should also occur and where such difficulties are severe and/or persistent, a full assessment and where necessary evidence based treatment should be provided. 

Relevant papers on coping with traumatic stress in health settings can be found below:  

Get in contact to receive further information regarding a career in psychiatry