The ongoing COVID-19 pandemic has left some doctors feeling forgotten and others questioning their career choices.

For Dr David Bremner, a Responsible Officer (RO) for Turning Point, a national charity specialising in everything from addictions to treating people with learning disabilities, doctors reflecting on whether their careers have been in vain is a reality faced by some of his colleagues.

The GMC’s Employer Liaison Advisers (ELA) have been supporting doctors, such as Dr Bremner, whose staff feel side-lined during the crisis. The ELA’s are part of the GMC’s Outreach service.

Jo HGMC ELA Dr Jo Hayman, who is also a practising GP, highlights the need to consider the wellbeing and value of staff in less obvious positions working tirelessly in unseen roles across health and social care.

The role of the ELA has always been, in part, to be a listening ear for the ROs. We advise and support and challenge in equal measure. The relationship is unique within the GMC, as the dynamic between each RO and their ELA is individual and fluid depending so much on what the RO needs and what we as the regulators need to see happening. However, across the country ELAs are available for ROs to sound out concerns, discuss difficult situations, and sometimes share good news. The role is a blend of offering support, giving guidance and challenging each other’s thinking.

When coronavirus hit, out went the routine face to face meetings, we lost that vital connection, the non-verbal cues that would prompt us to dig a bit deeper into an issue. We also had ROs and senior medical leaders who were having to devote their time to re-organising, mobilising and motivating huge numbers of staff, not to mention undertake their own clinical duties.

The role of the ELA became more supportive and less focussed on the specifics of regulation. We wanted our ROs to know we were there for them without over burdening them with routine meetings. That had to be balanced against maintaining standards and ensuring organisations were continuing to hold up their clinical governance structures.

Many of my calls with ROs during this time were emotional downloads for the ROs, some just wanted to tell me about the pressures, the lost staff and what they were facing. One, a senior doctor at their trust commented they felt they couldn’t seek the counselling / psychological help the trust was providing for staff. They felt they had to be ‘strong’ and as a neutral outsider – I was ‘safe’ to unburden themselves to.

It was a call from Dr Bremner though that made me realise the role an ELA can take in highlighting ‘hidden’ issues within the profession. During an unrelated phone call I asked him how he was coping, I was not expecting the conversation that followed. What he told me about his doctors feeling unappreciated and the colleagues feeling useless in the face of the crisis as they did not have the skillset or training to be on the ‘frontline’.  I was able to provide not just that all important listening ear, but I realised I could also provide the platform for this issue to be brought into the open.

Having the GMC recognise and acknowledge this is powerful evidence of how we can support all doctors, whatever their roles in this crisis. For me this has been the most important use of my role as the link between the RO and the GMC.

Dr Bremner and I will continue to share this ‘journey’ for his doctors. This will involve listening, offering advice, raising issues at the GMC, and I have offered to meet (later this year) with this cohort of doctors to have an open round table discussion and reflection about how the GMC can continue to support doctors who felt they were forgotten during the crisis.

Being a doctor myself, working during the pandemic I am only too aware of the risk of burnout. As part of the on-going work the GMC is undertaking to support the wellbeing of doctors, colleagues within the Outreach service of the GMC are going to be looking at examples of best practice where employing organisations have provided new initiatives and we are going to share them across organisations. We are hoping that the impetus that started during the COVID-19 pandemic can be a force for ongoing projects to support wellbeing.

We at the GMC are aware that many doctors take career breaks or leave the profession altogether, we are concerned that pressure from working through a pandemic may exacerbate this. To retain our doctors the role must not just be rewarding, but all doctors need to feel valued and included, this is especially important as we look to the future and recovery from this crisis.

To address this area as well as sharing the good ideas and inform them of ongoing projects, I am looking to join many of the ROs I support when they have training days or update sessions for their doctors. Alongside my colleagues in Outreach, I want to talk to the doctors on the ground, to listen to their fears, concerns and experiences and promote the support services available.

Dr Bremner reflects on the work of doctors during the ongoing COVID-19 pandemic and how different roles are seen.

David BIt took me several years as an RO to realise that the GMC is not just a regulatory body. It’s actually a great support structure. It was during one of my many discussions about the trials and tribulations of my doctors with Dr Jo Hayman, my GMC Employer Liaison Adviser (ELA), that I found myself questioning why every doctor doesn’t feel they count equally during the ongoing pandemic. 

To fully understand where I am coming from you need to understand who Turning Point are. We are a healthcare social enterprise. We deliver services to people at the narrow end of the healthcare resource wedge. Learning disabilities, addictions, mental health, public health. We are a large enterprise, thousands of staff across over a hundred sites delivering services to tens of thousands of people a year. We run eight independent hospitals with dozens of doctors all of which are open and operational during this crisis.

Despite our clinical clout (we hold 15% of the addictions market yet at one point held 75% of the CQC ‘outstanding’ services in the sector), I was surprised to detect a despondency and dissatisfaction in my doctors. A group who were usually boldly standing on the frontline of their chosen discipline.

This probably starts with us not being ‘NHS’ doctors. Our staff, nurses included, are not included in dedicated supermarket opening hours for NHS staff – not even to collect medication from their pharmacies for service users we support.

On Thursdays, clapping for the NHS is, by definition, not clapping for us. And the straw that certainly broke a few camels’ backs was when some of the services we deliver – such as alcohol detox – were considered to be non-essential by the NHS and across the third sector. And just when we thought we couldn’t be further forgotten, our Personal Protective Equipment (PPE) had to be sourced from providers that were not on the NHS providers list.

And despite all of this, when Turning Point was asked to medically support many of the thousands of people temporarily housed in hotels and hostels across the country, our doctors stepped up and offered this care, taking on large new workloads. One of them having returned to work after contracting coronavirus themselves. These are people who are missed as being in the trenches in the war against COVID-19.

I have had doctors in my social and professional circle question their career choices during the pandemic. Should they have worked in emergency care? Have their careers been true to their ideals? A friend described his retirement as his career coming to an end with a fizzle rather than a bang.

We have all been invited to microscope down into the minutiae of the COVID-19 crisis. We know the names of the people who treated the Prime Minister. Where he was treated, how he was treated and who the doctors were. Even what they wore – blue scrubs, theatre cap, marks on nose from mask.

But if we take the helicopter view we see that not every doctor treating COVID-19 positive persons is identified. Pull back even further to a satellite view and you realise that not every doctor ‘treating COVID-19’ actually treats COVID-19 sufferers. The vast majority of doctors responding to this storm are working on the vastly unrecognised periphery. Away from the eye of the storm but rather in the massive debris fields it creates in the surroundings. The doctors working from a converted campervan ensuring that hepatitis C testing still happens in the most vulnerable populations. The doctors doing telephone assessments for people in temporary housing away from areas where their GPs would be, if they ever had a GP. The doctors doing alcohol detoxes for people at home because they have lost their livelihood. And with it the access to life-preserving daily alcohol. And the doctors ensuring that the increasing numbers of women turning to the sex industry have contraception.

No one builds an emergency hospital for these. No PPE is flown in from Turkey for them to wear. And they aren’t critical care doctors working for the NHS. They are miles from the comparatively quiet Nightingale hospitals in the eye of this storm, but they are also its heroes.

And I know that when people clapped on their doorsteps every Thursday, the people they helped, those without doorsteps to stand on and communities to stand and clap with, were grateful. And I hope they realise that too.

Doctors in need of support during the COVID-19 crisis can refer to the GMC’s wellbeing resources on its website.