Protect doctors during this pandemic, or lose them

Phil Banfield says doctor wellbeing needs to inform advice given on Personal Protective Equipment (PPE)

The BMA’s number one priority during this national emergency is to ensure doctors are as safe and supported as possible in order to carry out their vital work treating patients.

Much has been made of the science of coronavirus’ spread and what can and should be done to minimise it.  Appropriate provision of Personal Protective Equipment (PPE) for all staff is absolutely essential for this to happen – and we have been in constant discussion with the Welsh Government to ensure staff in Wales are protected.

We cannot become desensitised to the fact that healthcare professionals are risking their lives to protect us, and we must do whatever is needed to mitigate this risk.

The problem is that what is deemed ‘appropriate’ feels to many like it is being driven by limits on what PPE is available rather than by the necessity to prevent infection in healthcare workers. This applied initially to eye protection, until the challenge was taken up magnificently by local industry and schools, but persists in limited supplies of, for example, FFP3 masks or their equivalent.

While many of our members report that enough PPE is available on the front line, we are aware that this is not always the case; last weekend, when England was facing an acute lack of gowns, Wales reported adequate supplies, but this was at odds with some members’ experience.

Too many doctors are reporting feeling pressured into seeing patients without what they believe to be appropriate provision of PPE – a situation perpetuated by variations in the level of PPE recommended between public health bodies and medical royal colleges. This has left individual clinicians suspicious and doubtful that their well-being is behind such advice and concluding – as many have – that the NHS of all four nations were wildly underprepared despite repeated warnings that a major pandemic represented an enormous threat to our country.

The response from frontline clinical teams since, and the support from all sides, has been astounding. They have stepped up to the challenge, and Welsh Government needs to step up; frontline staff simply cannot be expected to treat patients without appropriate PPE.

Transparency with staff about what supplies are available is essential, along with a national strategy to ensure supplies continue at pace. We hear multiple stories of companies offering to supply PPE and being ignored as they are not ‘approved suppliers’ – the supply chain remains painfully slow, when the modelling of the disease and therefore the potential PPE need has been obvious for weeks. 

If ever there was a place for a precautionary approach, the appallingly high rate of health carers’ deaths, particularly in black, Asian and minority ethnic groups, is justification enough. We must not belittle the fear of others. Being in a position of needing to triage the lives of healthcare staff in the workplace is unacceptable.

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Until we have a cast-iron guarantee that all staff will be fully protected, the BMA is advising its members who do not have access to appropriate PPE to follow guidance to determine the best course of action. Doctors are under no obligation to provide high-risk services without appropriate safety and protection and can decline to treat patients if this is inadequate; they are at high risk of infection and there is no other way of delivering the care.

There are limits to the risks that doctors can be expected to expose themselves to and the risk here is their lives. We must not forget this. We cannot become desensitised to the fact that healthcare professionals are risking their lives to protect us, and we must do whatever is needed to mitigate this risk.

For most, this means following social distancing rules to ease pressure on the NHS. For Welsh Government, this means providing the equipment healthcare professionals need to be able to do their jobs safely.

From those bravely saving lives in surroundings saturated with aerosols, to those caring in our communities, everyone needs the best protection because ‘adequate’ doesn’t inspire confidence when healthcare workers are dying.

We must protect doctors, or we will lose them. It should be possible to do more, and we must – however demanding this may seem. Until this is achieved, not everything has been given that the NHS needs to beat the virus – but our doctors’ lives may have been.

All articles published on the welsh agenda are subject to IWA’s disclaimer.

Phil Banfield is the chair of BMA’s Welsh Consultants Committee. He is a consultant in obstetrics and gynaecology. @drphilbanfield

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