“A pandemic fundamentally changes the social contract between the public and healthcare workers. The patients you saw in 2019 are gone. The harm of the pandemic will be experienced for a minimum of 10 to 30 years, and it will hit primary care the very hardest.
“GPs are now frontline disaster responders and will be for many, many years to come.
“You know the consequences of the pandemic better than me: illness, viral, and other types of delayed illnesses. We had to prepare for two types of deaths in pandemic planning: the acute deaths in the initial stages of the pandemic, and the excess deaths that occur 10 to 15 years after the pandemic from delayed cardiology, delayed oncology, from poorly managed diabetes, from other things from dental infections to urinary tract infections. At three years post-pandemic we would also expect to see somatic symptoms, with a massive increase in insomnia, rashes, respiratory pain, uncertain pain around the oesophagus, and gastric and back pain.
“Demand on healthcare will continue to increase, and satisfaction scores will continue to fall. You will see your workload increase further from social care challenges and more family members becoming unpaid carers. Patients might come to you with a cough that won’t go away, but that is not all they want to talk about.
“The New Zealand Red Cross put together guidance about leading through disaster recovery from 100 years of learning.1 It includes a graph, and the lowest point [on the graph] is where GPs currently find themselves in terms of recovery from a traumatic event [where feelings of altruism and heroism that surface in the immediacy of a disaster give way to disillusionment, anger, frustration, red tape, loss of support, and fatigue.]
“In 2020 the heroic honeymoon phase of the first lockdown was very alluring for the government. They didn’t realise what the disaster planners know, which is that this feeling lasts about 9-12 weeks. The other thing they didn’t know was the mistake of making healthcare workers into heroes, as the disaster narrative will always turn heroes into villains—which is why disaster planners urged against the ‘clap’ [for carers]. And that is what GPs are suffering right now.
“The most important message from the New Zealand guidance is that this phase is not a sprint, it is not [even] a marathon. This is one of the worst endurance events imaginable.
“You are at the forefront of what comes next. But how do you manage this? You get ready. You look inwards. You look after yourselves. You are a first responder and you require combat levels of self-care.
“Some of you may veer towards wanting a ‘great exodus,’ feeling ‘That’s it, I’m done, I’m handing in my contract.’ But what you could instead look towards is the ‘great epiphany,’ where you realise ‘I don’t want to do this specific thing any more, but I want to do something [different].’
“Many of you have suffered what we call ‘vocational awe’—you may have thought that what you had was a calling, and that makes you incredibly vulnerable to burnout. But it’s important to remember that this is just a job.
“You need to go back to your teams and talk about how this winter is going to be really hard. Don’t fall for ‘hope-ium.’ Talk about self-care in your team. Also remember that no government will fix the moral injury that you have every right to feel. You have to look within to fix that. You have to change your own mindset.”