Physician Shield Thyself

We are foundation doctors who have been advised to ‘shield’ and are clinically defined as ‘extremely vulnerable’ (1). We are one of many groups within the wider population of doctors whose personal and working lives have been impacted by COVID-19. Our position has shifted from practicing doctors to ‘extremely vulnerable’ members of society.

Public Health England recommending that “all workers who cannot work from home should travel to work if their workplace is open” while people shielding must “keep themselves safe by staying at home and avoiding gatherings” (2). This strikes a difficult balance for foundation doctors, who are keen to progress with their training, but require close supervision to undertake clinical work.

The shielding period is due to end 30th June and the government states it is “regularly monitoring this position” (1). Will this be extended, or will lockdown be relaxed further? This feeling of uncertainty and guilt is one of the many challenges shared by those shielding. Wales has already made the devolved decision to extend shielding to 16th August 2020 (3).

HEE first mentioned shielding in a HEE Bulletin dated 20th May 2020 (4) stating, “we will be contacting every trainee to ask if you are currently shielding so that we can share this information with your Training Programme Director and as necessary with employers. Please look out for this shortly”. The subsequent survey was sent on 28th May 2020 with a closing date of 5th June 2020 (5).

While this survey is welcome, shielding officially began on Sunday 29th March 2020 and it has taken two months (60 days) for HEE to begin the process of identifying shielding Foundation doctors. In a country where NHS workforce planning is nationally driven, it is surprising that the unknown number of shielding foundation doctors has not been identified sooner.

The uncertainty surrounding the COVID-19 pandemic means long term planning, risk assessment and a tailored approach to training will be required, in order to best support foundation doctors. With no clear exit strategy from the government, foundation doctors require innovation, flexibility and support to ensure they can continue to progress with their careers. We have already seen temporary amendments to the Foundation Programme 2020 ARCP requirements (6).

As ARCP approaches, individual thoughts turn to progression and next year: how will an FY1 progress with appropriate supervision, whilst working from home? How will an FY2, who may have been planning an ‘FY3’ of A&E locums, earn an income after August 2020? How will foundation doctors be supported moving to lower risk areas?

Foundation doctors are well versed in changing roles every four months. Our concern is to minimise disruption to training, while maximising our ability to contribute during the pandemic. We would welcome the opportunity to discuss the impact of shielding on Foundation Year 1 and 2 doctors with national bodies, in order to address the following questions:

What national guidance will be created to guide Foundation Schools regarding redeployment and training of Foundation doctors?
What long term solutions can be offered to Foundation doctors who may need to shield beyond 30th June?
Returning to work guidance for both Foundation doctors and the teams they will be re-joining – how will this be reviewed?
Should a named shielding lead within HEE be identified, so that foundation doctors can continue to be valued members of the NHS community?

Thank you for taking the time to read these concerns. We look forward to future discussions on the training and support of Foundation doctors.

Dr Grace Swann, Foundation Year One Doctor, Bristol Royal Infirmary, Severn Deanery
Dr Christopher Smith, Foundation Year Two Doctor, Royal London Hospital, North Central and East London Deanery

No conflicts of interest

References
(1) Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID‐19. 18/05/2020 https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 [accessed 05/06/2020].
(2) Public Health England. Staying alert and safe (social distancing). 11/05/2020 https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing/staying-alert-and-safe-social-distancing [accessed 05/06/2020].
(3) Welsh Government. Written Statement: Coronavirus (COVID-19) – Shielding Update – Shielding after 15 June. 04/06/2020 https://gov.wales/written-statement-coronavirus-covid-19-shielding-update-shielding-after-15-june [accessed 05/06/2020].
(4) HEE. HEE Trainee Bulletin. Email from HET@news.hee.nhs.uk 20/05/2020 [accessed 05/06/2020].
(5) HEE. Shielding Survey. Email from HET@news.hee.nhs.uk 28/05/2020 [accessed 05/06/2020].
(6) UK Foundation Programme. Impact of COVID-19 on the UK Foundation Programme 2020. 25/03/2020 https://foundationprogramme.nhs.uk/covid-19/ [accessed 07/06/2020].

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