Last reviewed 15 September 2020
As the UK faces the risk of a second wave of coronavirus, mental health pressure remains acute. Managers and employers have the same duty of care to staff during the pandemic as at any other time, however, it is especially important during the crisis that staff and practice managers protect their own and staff mental wellbeing through open and honest dialogue regarding situations that have been encountered and those likely to be faced moving forward.
During the pandemic, practice staff will have faced difficult ethical decisions and may have been asked to undertake tasks or have witnessed distressing scenarios whilst dealing with additional personal challenges. It is vital to acknowledge that feelings of stress, confusion, anger or despair are all normal in day-to-day life.
General practice implemented huge scale rapid change to service delivery and working patterns to manage the Covid-19 situation. Demands for routine care also changed and necessitated a move to a total triage model. Whilst remote working and virtual consultations reduced risks of contracting or spreading Covid-19, some staff found it hard to adapt to the greatly reduced ability to physically see patients, with whom they had established close professional relationships, causing increased stress.
Staff can be supported to better cope with some of the increased stress and mental health burdens by reinforcing team working, providing regular contact to discuss difficult decisions and checking in on staff wellbeing. Some managers undertake wellbeing check-ins or mental health updates on a regular basis, which in larger organisations may link with HR departments. Consider using the following.
Contact staff in their preferred way, eg through texts, phone calls, emails, conference calls, vlogs, daily bulletins, newsletters, Skype, Zoom or similar platforms.
Use virtual support groups using WhatsApp, NHS professionals or volunteers, and wider national networks can also be useful.
Set up regular virtual coffee mornings to check in on mental health and current stressors, and don’t forget to include those who are having to self-isolate.
The World Health Organisation has published Mental health and psychosocial considerations during the Covid-19 outbreak, which provides a range of advice to protect staff from chronic stress and poor mental health during this response. Advice includes the following.
Ensuring effective communication and accurate information updates are provided to all staff.
Rotation of staff from higher-stress to lower-stress areas and functions.
Partnering of more inexperienced workers with their more experienced colleagues to enable a buddy system to provide support, monitor stress and reinforce safety procedures.
Initiate, encourage and monitor work breaks.
Implement flexible schedules for workers who are directly impacted or have a family member affected by a stressful event.
Incorporate time for colleagues to provide social support to each other.
Ensure that staff are aware of where and how they can access mental health and psychological support services, and facilitate access to such services.
Be a good role model for self-care strategies.
A “Going Home Checklist” has been developed with a simple poster encouraging staff to reflect on their day, consider something that was difficult and let it go, think of three things that went well and check in on other colleagues. It also reminds them that support is available and focuses on going home and how they plan to rest and re-charge.
NHS staff have been given free access to several wellbeing apps from now until the end of December 2020 to support mental health and wellbeing, such as the following.
Unmind: a mental health platform that aims to empower staff to proactively improve their mental wellbeing by way of tools and training individuals to measure and manage their mental health needs, including digital programmes designed to help with stress, sleep, coping, connection, fulfillment and nutrition. Staff will need an NHS email to be able to sign up at https://www.nhs.unmind.com/signup
Headspace: this offers mindfulness and meditation, providing tools and resources to help reduce stress, build resilience and aid better sleep. Access requires an NHS email address and will be available until 31 December 2020 at https://www.headspace.com/nhs
Further information can be accessed via www.nhsemployers.org
Looking After You Too service
NHS England established a psychological wellbeing service back in April 2020 for primary care staff to reflect the immense mental health challenges and pressures encountered due to the Covid-19 pandemic. It was created to “ensure all staff delivering frontline primary care services feel supported to maintain their psychological wellbeing during this time, enabling them to maintain the delivery of frontline primary care.”
The #LookingAfterYouToo individual coaching support can be accessed by those working in primary care, including non-clinical roles and those who work on a contract basis. Staff can register and book a coaching session via the website https://people.nhs.uk/lookingafteryoutoo/
Staff who book into the service receive a one-to-one coaching session with “a highly skilled and experienced coach”, during which they are able to “offload the demands of whatever you are experiencing and be supported in developing practical strategies for dealing with this.” The coach can signpost further resources and support, and individuals may receive follow-up emails providing ongoing support in maintaining wellness once coaching sessions have finished
NHS England states feedback for the service has been “overwhelmingly positive, with almost all respondents saying that they had felt listened to and that the session had enabled them to move forward.”
There are posters available to download for practices to display the service.
How should staff access more urgent support, if needed?
Staff who feel they are in need of more urgent emotional support are urged to contact the wider NHS People website which can be found at https://people.nhs.uk/help/
If staff members feel they need support from outside of their organisation, One Front Door National Helpline (0300 131 7000), supported by Samaritans, provides a national helpline for staff support and is open 7am–11pm.
Support is also available by texting Crisis Support — NHSEI and Shout. By texting NHSPH to 85258, staff will be put in touch with a trained Crisis volunteer who will communicate through text using recognised techniques.
There are a range of other resources available for additional guidance and support in the following areas.
The World Health Organisation’s poster on coping with stress can be printed and put up in break/coffee rooms to provide useful guidance around coping with stress during the Covid-19 outbreak. This can be downloaded here
NHS in Mind is a free platform containing eight easy-to-access, short interventions to help NHS staff and those in health and social care to alleviate and combat high anxiety, panic and fatigue at this time.
Once the pandemic begins to diminish, the death of many service users and potentially colleagues will take its toll and staff will need to be actively monitored, supported and, where necessary, provided with evidence-based treatments to ensure they are able to move forward with the support they need.
A bereavement support line providing confidential bereavement support is operated by Hospice UK and is free to access from 8am–8pm, seven days a week. It is manned by qualified and trained bereavement specialists to support staff with bereavement and wellbeing issues relating to loss experienced through work. They can be accessed by calling 0300 303 4434 or via email at email@example.com.
Secondary trauma recognition for key workers has been flagged as being essential, particularly with healthcare workers having to manage critical issues daily, such as lack of hospital facilities, personal protection measures and exhausting working hours. The Institution of Occupational Safety and Health (IOSH) has called for closer safeguarding of key workers’ psychological health linked to Covid-19-related secondary trauma.
Supporting shielding staff return to work
NHS Employers have outlined organisational matters to help managers plan for staff returning to the workplace after sickness absence, self-isolation, working from home and return from shielding. This incorporates training and tools to support confident conversations with examples of good practice.
Employers are advised to engage with staff who are categorised at “increased risk” and jointly consider whether adjustments to work or redeployment might be appropriate. This could include working remotely or in lower-risk areas. See https://www.nhsemployers.org/
Acas produce information for employers who have staff members in the extremely vulnerable group. They also provide tips for managers which include: the importance of looking after your own mental health and obtaining support if needed. More detail can be found at www.acas.org.uk/mental-health-resources#managers
New guidance on health and wellbeing conversations
Guidance for employers on implementing health and wellbeing conversations in their NHS organisations has been published by NHS England and NHS Improvement. The NHS People Plan, launched in July, aims to improve physical and mental health support for staff. It outlines practical support for wellbeing, such as safe spaces to rest and recuperate, wellbeing guardians and support to keep staff physically safe and healthy.
The NHS People Plan, also asks that all NHS staff have a health and wellbeing conversation, and develop a personalised plan from September 2020, and covers a range of practical steps that employers can take including:
confirming what comprises a health and wellbeing conversation
creating an evidence-based case for organisations to include them in their general health and wellbeing approach
offering implementation advice and support in light of Covid-19, recovery and winter pressures
informing about current resources and what will be available over the forthcoming months
highlighting further advice for those facilitating and participating in the process.
Further details can be found at https://www.gov.uk
Resources and support for practice managers
The NHS website offers access to leadership support circles which entail brief online interactive sessions founded on evidence-based principles for leading compassionately during Covid-19. They are multi-disciplinary, interactive spaces enabling managers at all levels to come together, share their experiences and be heard. This can be accessed at https://people.nhs.uk/support-for-leaders/
Also available on the NHS website is leadership support, Speaking candidly and compassionately, which provides related guides and short courses on: Compassionate leadership in crisis and Making decisions under pressure. The free resources can be accessed at https://people.nhs.uk/all-guides/
NHS Employers provide a range of health and wellbeing resources for employers. This includes an easy to use emotional wellbeing tool to help bridge a gap in understanding and enable managers to talk openly and regularly about emotional health. This can be accessed at https://www.nhsemployers.org/
Mental health guidance for managers, jointly developed by Mind and the CIPD, explains, when having conversations about mental health, questions should be simple, open and non-judgmental, to give the employee ample opportunity to explain the situation in their own words. This can be accessed at www.cipd.co.uk
The Health and Safety Executive (HSE) have published a “talking toolkit” on how to prevent work-related stress, which can be accessed at https://www.hse.gov.uk/
Peer support is of particular importance during the pandemic and practice managers may well have been propping up the wider team with limited support for themselves. Where possible, practice managers are advised to work in partnership, liaising with other managers. Some organisations have access to wider services and having knowledge of what exists, enables managers to engage them and signpost staff.
Participating in or establishing virtual support groups to enable networking and the opportunity to share issues, advice, experience and good practice may also be useful.