We are all now learning to live with a greater level of risk in our lives as we adjust to the ongoing reality of coronavirus, or COVID-19 as it is often called. It was apparent early on quite how serious and debilitating this illness can be and the threat it posed to us all. We know that some members of our community may be more susceptible to illness, more vulnerable perhaps because of their age or existing health conditions.
However, for reasons that we do not yet understand fully, those from a BAME (black and minority ethnic) background seem to be more likely to have serious complications if they become ill with COVID-19 and are sadly more likely to die. This has unfortunately been borne out in recent months as a disproportionate number of health and care staff from these groups have lost their lives to this illness. This is indeed a worrying trend. A national study conducted earlier in the outbreak, looking at deaths among medical staff during March and April found that:
- 21% of all staff are BAME – 63% of healthcare workers who died were BAME
- 20% of nursing staff are BAME – 64% of nurses who died were BAME
- 44% of medical staff are BAME – 95% of doctors who died were BAME
There will of course be some local variation and these numbers are likely to be higher still in the more diverse areas of Greater Manchester.
As this evidence was emerging, we acted quickly in Greater Manchester to roll out risk assessments for all members of staff in our GP practices. Although prompted by compelling data on the risk to BAME groups, these one-to-one discussions can include any risk factors affecting an individual, such as age, gender, weight, pregnancy and underlying conditions, regardless of their ethnicity. We shared a best practice guide setting out how to carry out a risk assessment and signposted practices to a number of different tools to help with the process, so they could decide which would work best for them.
Risk assessments are helping practices to identify those who are high risk and agree mitigations that will reduce this risk as far as possible. This may be the installation of plastic screens at reception, increased remote working, or a reduction in patient contact. But, it’s easy to forget how important the conversation is in all of this. These are tough times for us all and taking the time to understand the concerns of the individual and what they do in their job is vital. Some members of staff have felt concerned about this process as they don’t want their role to change and worry about the possible burden this could place on colleagues. But this isn’t about stopping people from doing their job, in most cases we just need to do things in a different way to reduce the risk of infection. Practices have come a long way in recent months in developing new ways of working, including more telephone appointments and video consultations. This means we’re now in a good place to flex the way we do things – putting the needs of our staff and our patients first.
However, for some small practices the mitigations required may present a real challenge, especially for those where the majority of staff are from a BAME background. They may struggle with capacity and managing workload, but they are not alone. Support is available from clinical commissioning groups, primary care networks, and Greater Manchester colleagues, to ensure they can continue to provide the same level of care to patients.
Greater Manchester started this process several weeks earlier than other areas, ahead of national timescales. The evidence was compelling, and we knew it was important that staff members were protected as soon as possible. So why wait? In just a few weeks, over 90% of staff have now been risk assessed. I am immensely proud of how rapidly everyone has pulled together to achieve so much in such a short space of time. A true collective effort to support our workforce.
A longstanding concern is that some members of staff, often those from a BAME background, do not feel able to speak up if they feel things are not being done fairly and they could be at risk. We must ensure that all voices are heard, and everyone can share concerns and fears if they need to. That’s why we’re highlighting the role of the Freedom to Speak Up Guardians, created in the wake of the mid-staffs crisis, and making sure all members of staff know how to get in touch. Guardians can offer guidance and support if someone doesn’t feel able to go to their manager.
But we must not forget that the risk to those from BAME backgrounds extends beyond primary care. Hospital trusts and other NHS organisations are also carrying out risk assessments to protect their staff. We have got our own house in order but what about those that we care for and treat? The current coronavirus crisis has exacerbated existing health inequalities so the most disadvantaged in our communities are now at the greatest risk. This will be a critical challenge for us in the months ahead.
Wirin has recently retired as a practicing GP at the Unsworth Group Practice in Westhoughton, Bolton. He is also chair of NHS Bolton Clinical Commissioning Group and is the equalities lead for commissioners in Greater Manchester.
Wirin has worked in partnership with Dr Jaweeda Idoo, a GP at Stockport’s Alvanley Family Practice and chair of Stockport’s GP Federation Viaduct Care, along with Angela Osei, Head of Primary Care Transformation at Greater Manchester Health and Social Care Partnership, to deliver risk assessments for the primary care workforce.