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'NHS staff are exhausted and need a break, but there aren’t enough of us'

RCP publishes new workforce data showing doctors in Wales are frustrated.

As the Royal College of Physicians (RCP) publishes new findings on doctor wellbeing from its 2020-2021 annual census of consultant physicians in Wales, colleagues working in intensive care medicine in Wales have written an open letter to physicians, thanking them for their ‘extraordinary’ contribution to the NHS, and acknowledging that without the efforts of acute medicine, general medicine, respiratory and infectious disease teams, critical care could have been ‘completely overwhelmed’.

But this has come at a cost. Early results from the RCP’s 2020-21 annual census found that in Wales:

  • 38% said they have regularly have problems sleeping.
  • 23% don’t feel healthy.
  • 26% don’t feel as though they have control over their life.
  • 50% tend to dwell on things more than they should.
  • 13% don’t find their work fulfilling.
  • 19% do not feel satisfied with their life.
  • 45% frequently feel frustrated.
  • 36% often get annoyed.

Many doctors fear the NHS will take years to recover, with backlogs and waiting times exacerbated by workforce shortages and continuing delays for diagnostic testing. In an April 2021 RCP membership survey, 59% of respondents thought it would take at least 18 months for the NHS to recover from the pandemic, while 30% thought it would take over two years.

Many doctors in Wales are exhausted, demoralised and frustrated, which is why the RCP is especially pleased to welcome political commitments from Senedd candidates to increase the medical workforce by establishing a medical school in north Wales and increasing the number of doctors and healthcare professionals in the NHS. This must be an urgent action for the new Welsh Government in their first few months in office.

Dr Olwen Williams, RCP vice president for Wales said:

‘To put it bluntly, we need more doctors. Waiting lists are getting longer. NHS staff are exhausted and need a break, but there aren’t enough of us to go round. By 2030, older people in Wales will make up a third of the total population and many of them will need support from the NHS and social care. Yet it takes more than 10 years to train a doctor which is why it’s so important that the next Welsh government increases medical school places as soon as possible.’

Dr Jack Parry-Jones, Faculty of Intensive Care Medicine lead for Wales said:

‘How did critical care cope with the impact of successive pandemic waves? In short, we couldn’t have coped without help. The Faculty of Intensive Care Medicine would like to draw attention to, and publicly thank, our physician and anaesthesia colleagues for the vital support we have received.

‘Even with increased critical care capacity, we would never have managed without the care physicians provided. The support from acute medicine, general medicine, and more directly respiratory and infectious disease teams in providing care for large numbers of critically ill patients in high respiratory care areas has been extraordinary. These areas are providing high-dependency care usually done in critical care units and have provided a crucial buffer in stopping critical care from being completely overwhelmed.’

He added:

‘In Wales we have been more vulnerable than many to the worst effects of the COVID-19 pandemic. It came as no surprise that chronic social deprivation, poverty, obesity, old age, and close living conditions are all excess risk factors for serious morbidity and death. The medical community in Wales has a long, proud history of highlighting these inequalities, alongside efforts to mitigate them.’

The RCP has previously joined with more than 30 other organisations in Wales to call for a cross-government strategy to tackle health inequalities.

An open letter to physician colleagues in Wales

Dear physician colleagues

As you know, in Wales we have been more vulnerable than many to the worst effects of the COVID-19 pandemic. It came as no surprise that chronic social deprivation, poverty, obesity, old age, and close living conditions are all excess risk factors for serious morbidity and death. The medical community in Wales has a long, proud history of highlighting these inequalities, alongside efforts to mitigate them. More surprising has been the sad recognition that those Welsh people with an ethnic minority background have been even more vulnerable. The exposure risk of those working in the care, social and transport sectors has been highlighted – work often done by those in our ethnic minority communities.

SARS-CoV-2 has brought critical care into everyone’s living rooms. It would have been very difficult – if not impossible – to avoid on television, radio, blogs or social media the latest instalment of COVID-19’s impact on critical care capacity, staffing, bed numbers, ventilators, nursing, wellbeing etc. All this is true; the critical care multidisciplinary team, while struggling to provide the best service it possibly can, has also used the attention to raise awareness of the relative lack of staffed critical care capacity in Wales compared with the rest of the UK, and even more in comparison with our neighbours in Europe.

How did critical care cope with the impact of successive pandemic waves? In short, we couldn’t’t have coped without help. Our gratitude to anaesthetic consultants and trainees has been highlighted elsewhere. The Faculty of Intensive Care Medicine, however, would like to draw attention to, and to publicly thank, our physician colleagues for the vital support we have received. Even with increased critical care capacity, we would never have managed without the care you have provided. The support from acute medicine, general medicine, and more directly respiratory and infectious disease teams in providing care for large numbers of critically ill patients in high respiratory care areas has been extraordinary. These areas are providing high-dependency care usually done in critical care units and have provided a crucial buffer in stopping critical care from being completely overwhelmed.

Intensive care medicine (ICM) in the UK has always had good links with the Royal College of Physicians. The pandemic has made this more apparent and necessary. Together, we should look to strengthen these links further. More intensivists now have dual training with ICM and a medical specialty. The input during the pandemic from intensivists with dual training in respiratory and ICM (as well as general internal medicine) has often been vital in coordinating care between high respiratory care areas and possible treatment options, including escalation to invasive ventilation in ICUs. This effort on the clinical floor needs to be mirrored by collaboration and communication at national level in evolving our specialties and necessary care in future.

We couldn’t have managed without you.

Diolch yn fawr.

Dr Jack Parry-Jones FRCP FICM

Faculty of Intensive Care Medicine lead for Wales