Exhausted, disillusioned and angry: Primary Care staff send an open letter to Health Minister

We are told that the Omicron variant of coronavirus is less lethal, that the numbers of hospital admissions and deaths are lower, as such isolation times have been reduced from 10 to 7 days and there were no new restrictions brought in for New Year and ‘Kings’.

However, as record numbers of infections continue to be set on a daily basis, pressure on primary care professionals is unrelenting. Health workers have been on the front line giving their all for almost two years and now they are exhausted, burnt out, disillusioned and angry. In an open letter to Ana Barceló, the Valencian Health Minister, SIMAP-PAS, the union which represents Public Health Professionals and Practitioners, has given an insight into the real situation of primary care in the region and what it believes needs to be done.

After consulting with primary care workers in various centres, SIMAP believes urgent measures need to be taken.

The missive to the health minister begins: “Neither barrier measures (facemasks, social distancing), nor the covid certificate, nor mass vaccination, nor individual responsibility have served to stop the tsunami of infections.

“In order to safeguard the economic structure, primary care has been sacrificed, and the big losers have been both patients, who have suffered the neglect of non-COVID conditions, and the professionals who are once again suffering a high rate of infection, added to an overload and pandemic fatigue that makes their daily work difficult. It’s important to remember that without health, there is no economy. And to allow the blocking of the health system is a more than questionable decision.”

The letter continues: “Given the lack of control of the enormous community transmission of the virus, SIMAP wants to highlight once again the situation of saturation, exhaustion and discouragement of health professionals, to which is added the incomprehension, indignation and anger at the lack of foresight, communication and contingency plans of health managers.”

The authors of the letter explain: “The current situation means that doctors, nurses and auxiliary nursing technicians (TCAES) are completely overwhelmed by the high demand. There are no substitutions. Staff do not even have time to complain to absent managers most of the time. Conflicts between professionals, due to sheer exhaustion, excessive working hours because of doubling up, covering shifts, etc., are constant.

“Reception staff, administrators and orderlies, are also overwhelmed, agendas are full, with no gaps in timetables for telephone calls or in-person appointments. Patients are legitimately angry about the great difficulties of accessibility by telephone and waiting lists for medical care. AND ALL THE STAFF ARE VERY VERY TIRED, VERY DISILLUSIONED, VERY UPSET,…

“This serious situation needed immediate emergency measures to be taken. The massive community transmission and the mildness of the cases has led to a change of strategy and, consequently, the Health Department has decided to stop mass screening of asymptomatic people, with few exceptions, to drop quarantines of asymptomatic contacts, to stop mass contact tracing, etc.”

According to SIMAP the following measures are essential and should be taken by the Health Department as a matter of urgency:

• Sharing of real information with the population by the Valencian government and the Valencian Ministry of Health. Given the magnitude of mild cases flooding the centres and the new care protocol, despite the level of uncertainty, the public must be officially provided with real information on the significance of the pandemic, the current risk, the justification for the measures being taken and those being ruled out, and the need to free up health centres in order to attend to patients who really need care in a timely manner.
• Pay attention to health professionals and take note of their specific demands and suggestions. In each department there should be an accurate record of reinforcements, extra hours worked, establishing incentives, etc. But, above all, attention must be paid to specific suggestions and demands to optimise the work these days, as those who are carrying out this work are the best qualified to detect problems, ineffective measures or measures that aggravate the problem as well as possible solutions to alleviate the situation.
• Optimise resources and carry out work online or by phone if that’s the only option.
• Decentralise covid contact tracing. Move to different locations to free up overloaded areas. Antigen testing in pharamices and diagnostic tests in private centres, to relieve pressure on Primary Care Centres.
• Increase staff in Primary Care centres, both health professionals and non-health professionals. It is NOT enough to extend temporary covid contracts: they need to be converted into permanent positions NOW.
• Establish a continuous face-to-face information system in healthcare centres to explain the current situation, so that the tension of waiting does not have repercussions on care work and is not an additional source of stress for health centre staff.
• Immediate strengethening of the means of communication by telephone, and with personnel. With trained staff to provide useful information to the public. This problem cannot remain unsolvable and make it impossible for citizens to contact their health centre, forcing them to go to the health centre in situations that would not be the most convenient.
• Recruitment of security personnel in health centres. Many conflicts are arising due to the tension that the current circumstances are causing among citizens, who are already tired and drained of emotional reserves. There has been an increase in aggressions suffered by staff and they need to be supported and safe in their working environment, without the task of resolving these conflicts falling to the staff, who do not have the necessary training to deal with these serious situations. This is a priority issue of occupational health care for workers and must be addressed immediately.

In conclusion SIMAP say: “All these measures do not address the deep-seated problem in Primary Care, but they may alleviate the situation in the coming weeks. The commitment to invest in and improve Primary Care cannot be delayed, it must go hand in hand with this current pandemic crisis and must involve its professionals.

“At the moment, the Regional Ministry of Health should focus on giving oxygen to the current situation. A sectoral crisis committee should be set up to monitor the situation with social partners and, together, save the current situation of primary care.”