Staff wellbeing is more important than ever

The acute phase of the covid-19 pandemic might be over, but its shadow continues to loom large. The cumulative effect of covid on health services, including treatment backlogs, means that staff wellbeing is more important than ever. If you were able to grab some respite in a wellbeing “lounge” at work during the pandemic, chances are that those free hot drinks and snacks have now dried up, although the risks of acute and chronic fatigue have not receded (doi:10.1136/bmj.p2676).1

Adequate rest breaks, shifts that give appropriate time to recover, and hot food available out of hours should be standard, say Peter Brennan and colleagues, and senior staff should be better at modelling a good work-life balance. Getting vaccinated also helps staff and patients stay well: impressive findings from a cohort study find the incidence of long covid is substantially reduced among vaccinated adults (doi:10.1136/bmj-2023-076990 doi:10.1136/bmj.p2633).23 These findings are similar to the cumulative protective effect of vaccines against outcomes of acute infection, such as severity of illness and death.

Vaccines have saved millions of lives during the pandemic. But excess mortality has not fallen to pre-pandemic levels, and socioeconomic factors, made worse by the cost of living crisis, are a public health challenge in themselves (doi:10.1136/bmj.p2612).4 We see this in alcohol and drug use (doi:10.1136/bmj-2023-078472 doi:10.1136/bmj.p2684),56 with global progress on alcohol particularly dismal.

In dealing with these pressures, could a renewed focus on continuity of care in general practice help doi:10.1136/bmj-2022-074584)?7 Evidence shows the benefits for both patients and GPs. But continuity—when a patient sees the same GP repeatedly—has fallen dramatically in recent years. The national focus on access times, made worse by the pandemic, has drawn attention away from providing continuity. Can fast access and continuity ever be compatible? Denis Pereira Gray and colleagues present a strong argument that they can, despite all the pressures on general practice, and call for an end to the “any GP will do” mentality.

There are plenty of international examples of continuity of GP care, they say, including in Canada and Belgium. There are some UK beacons too, such as a practice in a deprived area of Bristol, with several part time GPs who still achieve a continuity score of 55%. Personal lists, where the practice list is divided between GPs so that every patient has a named doctor, seem to point the way ahead.

As more patients live longer with multiple, complex chronic conditions, continuity of care helps doctors build strong therapeutic relationships. These are conditions in which polypharmacy, for example, can be tackled (doi:10.1136/bmj.p1708).8 Deprescribing is difficult, and clinicians have to tailor explanations to individual patients about their medicines, possibly working beyond guidelines and managing uncertainty—a challenge, given the time pressures facing overstretched staff.

And, let’s face it, making working conditions better for women would make a crucial difference in the workplace. This week brings yet more news about sexism in medicine (doi:10.1136/bmj.p2744).9 Doctors have described how their experiences led to discrimination in maternity and reproductive rights, reduced pay, and lost career opportunities. That must change.