GPs need ‘emotional support’ after extreme levels of burnout during Covid, inquiry finds

Pandemic initiatives with significant GP involvement such as the shielding programme and vaccination provision ‘worsened GP wellbeing’ and ‘increased levels of burnout’, a report into the UK’s response to the Covid pandemic has found.

Baroness Hallett’s report said that ‘very little’ had been done to prepare general practice for a pandemic.

The 400-page document, based on module 3 of the independent Covid-19 inquiry, recommends all four Governments develop psychological and emotional support programmes for healthcare workers in the event of a future pandemic.

The report quoted testimony from Professor Adrian Edwards, expert witness on general medical practice during the pandemic, who told the inquiry that the pandemic had ‘worsened GP wellbeing and increased levels of burnout’.

On support for GP practice staff, the report criticised the ‘lack of support from health boards or clinical commissioning groups to enable staff risk assessments to take place, with the responsibility largely left to individuals’.

While GPs’ patient-facing workload initially reduced to around 40% early in the pandemic, it had returned to normal by August 2020 and by December was at an average of 127% capacity.

By mid-April 2020, GP practices in England were spending 26 hours a week identifying clinically extremely vulnerable patients as part of the shielding programme.

Changes to guidance on who should shield further ‘increased the burden on GPs’ who were obliged to re-review patient lists. One GP who completed a survey for the report described going through 3,300 patient records over the Easter weekend.

The report acknowledged the work done by GP practice staff to support the vaccination programme later in the pandemic, pointing out that staff ‘supported the vaccination effort, all of which was undertaken alongside their usual workload’.

The report recommends that the UK Government and devolved Governments ‘put in place plans to deliver effective support for healthcare workers at scale from the outset of a pandemic’.

It said: ‘The inquiry agrees that more support should have been offered to healthcare workers and that the support should have been available earlier. It is critical that support for the impacts of the pandemic is available to all healthcare workers from the outset of a pandemic.

‘The health departments in the four nations should review the ongoing psychological and emotional support available to healthcare workers to ensure that staff have access to the help they need.’

Elsewhere, the report said that the pandemic exposed limitations of patient data sharing and recommended greater integration of systems.

In March 2020, when GPs were identifying vulnerable people through ‘digital cohorting’ – analysing clinical codes in electronic patient records – the individual data systems used in each of the four nations ‘were not always easily accessible or accurate’, the report said.

The report quoted the RCGP’s evidence provided to the inquiry, which said: ‘None of the individual databases were fully “accurate” and they were not properly linked up, causing delays. For example, if someone was prescribed an immunosuppressant in a hospital setting, it did not appear automatically in either their GP record or a hospital record.’

From this finding, the report recommends that the four Governments ‘ensure that health data and digital systems have the capability to identify individuals at high risk of morbidity or mortality from a pandemic disease quickly and accurately in a future pandemic’.

Specifically, Governments should ensure care records are compatible across primary and secondary care by enabling ‘secure data-sharing and linkage across multiple health datasets’.

The report was critical of the healthcare system’s approach to patients with Long Covid during the pandemic, highlighting GPs’ lack of confidence in diagnosing patients.

It highlighted an RCGP survey conducted between August and September 2020 which found ‘very few GPs’ were confident in diagnosing and treating Long Covid patients in the absence of guidance or a NICE clinical definition of the condition.