Nearly two-thirds of physicians in Wales say they feel "overwhelmed" due to excessive workloads and high staff absence rates.
A new Royal College of Physicians (RCP) membership survey found that 63% of respondents in Wales had felt overwhelmed at least once while at work in the past three weeks while one in six (17%) said they felt overwhelmed almost every day.
The RCP said high levels of staff sickness are still putting immense strain on "demoralised" clinicians who are working under the extreme pressure of Covid-19 coupled with usual winter illnesses.
With so many people off work more than half of respondents (52%) in Wales said they had been asked to cover rota gaps at short notice in the previous three weeks and almost a third (30%) had been asked three times or more.
While staff absence has been felt acutely during the pandemic the RCP said much of the pressure stems from workforce shortages that existed long before the pandemic began.
Over the last year the organisation confirmed that 59% of consultant physician posts advertised in Wales went unfilled. That’s three in every five advertised posts remaining empty. In 63% of those cases it was because there were no applicants at all.
The RCP is now calling for investment in "hospital at home" services that provide specialist medical care in the community across Wales. It claims these teams can help to reduce hospital admissions, get people home more quickly, and improve the quality of patient care.
Dr Firdaus Adenwalla, a consultant physician with Swansea Bay University Health Board, said: "Hospitals are firefighting. We have no long-term solution to look after our ageing population and pressures that once caused a winter crisis have become a year-round problem.
"We need a national approach to care for our frail older people – not a sticking-plaster exercise that is carried out every winter.
"I strongly feel that the solution to unscheduled care pressures lies in the community. GPs need support from secondary care specialists and the wider multidisciplinary team to provide the right care to the right person at the right time – but to do this ‘hospital at home’ teams need to be adequately resourced.
"The Welsh Government needs to make this a priority. It's very frustrating because there's so much rhetoric around improving care in the community but the resource does not seem to follow."
The RCP said keeping older people out of hospital and in their own home has never been more important. Experts warn that lengthy stays in hospitals can increase the risk of hospital-acquired infections.
Over the next few months physicians believe significant investment needs to be made in community resource and staffing, especially in social and intermediate care.
The RCP has called for:
- better regional collaboration and clinical networking across health boards;
- investment in training more clinicians to work in the community;
- rapid access to the right diagnostics and interventions; and
- closer working relationships with therapists, social care and palliative care teams.
Dr Olwen Williams OBE, Wales vice-president of the Royal College of Physicians (RCP), said: "There are some very difficult choices ahead to try and reduce waiting lists and put the NHS back on a sustainable footing.
"But what is clear is that a lack of workforce across all professions will continue to limit our recovery. Increased investment in the NHS cannot improve patient care if we don’t have the staff to treat patients.
"This shouldn’t be about doctors taking on more and more patients until people simply burn out.
"We need to increase the number of medical students and postgraduate trainees to prepare for an ageing population.
"This year more than half of advertised consultant posts in Wales were unfilled due to a lack of suitable applicants. These rota gaps meant that an overstretched NHS came close to breaking during the pandemic."
Professor Sam Abraham, chair of British Geriatrics Society Wales, said: "As the population of Wales ages and pressures on the healthcare workforce increase it is essential that we consider ways of providing care to older people closer to their homes and health boards look at preventative commissioning for such services.
"For many older people being admitted to hospital brings risks as well as benefits including the risk of hospital-acquired infections and de-conditioning. By providing care to older people in their own homes hospital admissions are reduced and patient care and satisfaction can be improved.
"We support the RCP’s calls for more extensive rollout of services such as virtual wards and ‘hospital at home’ across Wales."
The Welsh Government said NHS staff had worked "tirelessly" throughout the pandemic, putting their own wellbeing at risk to keep the rest of us safe and that the relentless pressure of the pandemic will have consequences.
A spokesman said it was "committed to improving access to the necessary support for doctors who are struggling with their mental health" and an extra £1m was being invested in behavioural and cognitive therapy for primary and secondary care doctors as well as other NHS staff.
He added that £262m had been invested in training and there were more places "than ever before" in a bid to boost the workforce and tackle issues raised by the pandemic.
To get the latest WalesOnline newsletters emailed to you directly for free click here.
