BLOG: An exhausted NHS workforce faces a second wave of COVID-19

“Clinicians everywhere however are feeling incredibly worried about the next few weeks and months. There has been considerable learning from the first wave, but much of the focus has been on “what went well?” and “what should we continue to do?” rather than “what could we have done better?” and therein lies the problem. If we fail to learn from past experience, we risk repeating the sub-optimal practices of the past.”

BLOG: An exhausted NHS workforce faces a second wave of COVID-19

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In this guest blog, College President Professor Jackie Taylor sets out her concerns for how the NHS across the UK has prepared for a second wave of COVID-19, and what’s required now to ensure that we can rise to meet the challenges ahead for our membership.

“One of the advantages of being president of a Medical College is to be in regular communication with other Colleges and organisations and to hear what is happening on the ground all over the UK, indeed around the globe and in particular, what the concerns of clinicians are. As we enter the second wave of COVID-19 cases we are in many ways in a better place: we have a much better understanding of the virus, higher testing capacity, the ability to perform contact tracing, clearly developed pathways of care, and actually some effective treatments!

Clinicians everywhere however are feeling incredibly worried about the next few weeks and months. There has been considerable learning from the first wave, but much of the focus has been on “what went well?” and “what should we continue to do?” rather than “what could we have done better?” and therein lies the problem. If we fail to learn from past experience, we risk repeating the sub optimal practices of the past.

There has been a huge focus, quite rightly, on trying to play catch up over the last few months: we have encouraged patients to come for important treatments and investigations, procedures and operations, as the NHS struggles with reduced capacity. None of us wishes to see an epidemic of secondary harms of delayed presentations of cancer and vascular disease. Maintaining this work is essential. My concern is that the eye has been slightly off the ball, and that planning for second wave has taken second place. An exhausted workforce which is still trying to cover the workforce shortages which have been inherent in the NHS for years is now trying to provide non-COVID care and look after rapidly rising numbers of patients with COVID-19; quite simply the sums do not add up.

There has been a very welcome focus on physician wellbeing in recent months and we are grateful for it. The access to a place to rest, have a cup of coffee (socially distanced of course) and have informal peer support is so valuable. The development of mental health networks and improved psychological support is also very welcome-though we would prefer not to need it! But NHS leaders cannot express their concern about the wellbeing of the workforce on one hand, while insisting on unmanageable and unsustainable workload on the other.

Moreover, what seems to be emerging during this second wave is less of that wonderful team working and planning which essentially helped us to survive the first wave, and more of a retreat into unhealthy silo working. Sadly an adversarial atmosphere is developing in some hospitals trusts and health boards. Clinicians are worried that their concerns about patient safety are not being heard at a time when decision making should be transparent, robust and informed by clinician experience. As senior clinicians tell me, it is difficult to feel valued if you are not being listened to, to have faith that the organisation is interested in your wellbeing, when being asked to take on even more additional work on top of an impossible workload. The pandemic has highlighted what we have been emphasising for years, that the NHS is chronically understaffed, under bedded  and is itself in need of a little intensive care.

Clinicians, clinical and non-clinical leaders are all under the same tremendous pressure. So my plea to those in hospital, trust or health board leadership positions is this: please listen to clinicians and value their opinions. Their advice is not given in self–interest, but in the interests of their patients for whom they will always advocate and try to deliver the best care that they can. And to clinicians, please consider the well-nigh impossible decisions which those in leadership positions are having to make on a daily basis. Only by seeing the situation from the other person’s perspective and by close team working can we find the solutions to a whole range of challenges which are facing us.”

“The strength of the team is each individual member. The strength of each member is the team”

Phil Jackson

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