Author: Holly M.
Fourth Year Medical Student

Undoubtedly the COVID-19 pandemic will have wide reaching implications and effects on our society as a whole, as well as direct effects on the NHS. Whilst I don’t know exactly how the NHS will change following this pandemic, and can only guess, it is a very interesting topic to think about, and one that could easily come up in your medical school interviews.

This article should give you some ideas about how the NHS might change following COVID-19, and will hopefully get you to think and reflect on these and develop your own ideas surrounding this topic. The following points are topics I have discussed with fellow colleagues, doctors, or have read about in journals.

The NHS trusts in the UK will have very difficult decisions to make in the near future about deciding when to resume certain services and if this should be done all at once, or if this is even possible. Trying to weigh up which patients we need to prioritise and which patients need to be kept especially safe (for example the immunosuppressed) will play a key role in this, and will be especially difficult, as often these patient groups will overlap. “Prioritising” certain patients is also difficult, as all patients are patients for a reason, and do require care.

Effects on Medical Students

Medical education itself may have to adapt following COVID-19. Hopefully medical students will be allowed back onto placements, as this is clearly important in their training and if they are not allowed to return to their studies, we could end up with a future shortage and back-log of doctors. However, some students will undoubtedly worry about the placements and teaching they may have missed and how this could affect their performance in future exams and as a doctor. All of this clearly has to be balanced against the infection risk that medical students could pose to patients. Perhaps the COVID-19 pandemic and this countries’ response will shape medical school curriculum, and in future years universities may decide to dedicate more teaching to the epidemiology, virology and public health aspects of pandemics, including this one.

Effects on Patients

There will be a backlog of ‘non – essential’ surgeries and some cancer therapies that have been postponed, either by the hospitals themselves, or by patients who have decided that they do not feel safe or do not want to come into hospital during the pandemic. This means that there will be a huge amount of patients to see, even longer waiting lists for certain services and still not enough staff to support these services. For patients, this could mean that their disease has progressed further or they may have developed other conditions, which mean they are no longer suitable for this treatment, and also that they may have to experience a lower quality of life, pain or disability for a longer amount of time until they can receive the treatment they need.

Patients will also be presenting with symptoms and diseases, for the first time at a later point than they would have, had COVID-19 not happened. You might have already heard about how the amount of patients presenting to A&E with the symptoms of a heart attack or those of a stroke has dramatically fallen during the COVID-19 pandemic. Clearly, this is not due to people suddenly not having heart attacks or strokes. This huge drop in numbers of patients presenting to A&E can probably be applied to all kinds of different illnesses. All of these patients will start presenting at a later date, and this could potentially affect the management of their condition or life expectancy for these patients. One example of this is patients who are worried that they have cancer. If a patient has delayed seeking help from their GP for a long time period, this could mean that the cancer could progress to a later stage and the treatment options could switch from being curative to palliative.

Service Adaptations

Lots of services across the NHS have been forced to switch their services to a video or phone call service. This is something which had slowly been creeping into the NHS, but had it not been for COVID-19, would have probably taken many years to become as widely used. This switch to video or phone calls can reduce work load and save time for health care professionals. Also, appointments over video or phone call can be less hassle for patients with busy schedules and lives. Reducing face to face contact and interactions will be an important part of every day life for the foreseeable future whilst we still have threat of COVID-19 and no vaccine. It will be interesting to see if as many appointments in health care settings will continue to be held over video or the phone and how this impacts patient care, satisfaction and the overall running of our health care system. The other side to remember when discussing this, is that video and phone calls can make health care less accessible. People with disabilities, or older people may struggle to access healthcare if it were to all move online or on the phone. Equally, certain appointments, such as therapy or appointments where patients are discussing difficult topics, could also suffer if services were to all move onto the phone, as patients may struggle to find somewhere private enough to be able to discuss their problems openly, and health practitioners may struggle to develop a good rapport with patients and may be unable to pick up on important body language cues.

Psychological Effects

There will also, without a doubt, be a long-term psychological impact on some of the healthcare staff currently working through this pandemic. Levels of burn out, feelings of anxiety, and symptoms of PTSD could all easily increase during and following this time period. Some staff may not feel supported, or feel unable to carry on working and may leave their professions all together. On the other hand, for some this might be an opportunity for them to rethink their career, or to do further study or training. Support groups for health professionals, and sessions run in hospitals such as M&M meetings (morbidity and mortality meetings) and Balint sessions may become more important than ever, and really provide a safe and supportive environment for health care staff to discuss important events.

The social implications of the COVID-19 pandemic will affect the public’s health and probably lead, in the long term, to increased presentation to GP with certain issues. There have been increased levels of domestic abuse during lockdown, and patients may first approach their GP seeking help if these issues have arisen or worsened. Social distancing will also be affecting the mental health of many people, as will the increasing levels of unemployment and potential recession that will follow the pandemic. These will also lead to poorer physical health. Patients suffering from the consequences of the COVID-19 pandemic will present to the GP with all of these issues and more, and it could be difficult for GPs to cope with this increased demand when services are already so stretched.

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