This is part 2 on my guide to managing burnout in your staff. I'll link part 1 at the bottom.

Today, I'll be concentrating on the hardest bit: What happens when COVID starts to recede.

The third part will cover long-term plans.

When the vacc campaign gains momentum along with other measures, COVID will recede. One day you'll get to a point your COVID appointed staff start to see patient numbers drop off, people will start to think back on what they've seen.

You must start planning for this now.

This is where management will earn their pay, this is the most dangerous point for staff mental health as people will start to find the capacity to process all the trauma and moral injury of the last year.

Here's a skeleton plan for you to shape your local version:

Rather than create something from scratch, I'm basing this on the army's post-operational plan, altered to fit the NHS.

Plan sections
- Managing the COVID tail
- Decompression
- Normalisation
- Aftercare/Support

I'll walk through the sections then give suggestions.


Eventually acute/emergency COVID will become a minority service rather than a major aim. You will start to see more long-COVID than new COVID+. Long COVID is a plan for someone else to manage, not this plan.



You must intervene here to support the staff still working on acute/urgent/emergency COVID, this is a key burnout time with busyness dropping and still seeing COVID+ patients will start to hit. You can't let these staff members feel abandoned.


Many military incidences of PTSD occur once people have a chance to think through their experiences and "what if?". For the NHS, this is likely to be enhanced as you can't take a solid break from the work. You can't skip this part of the plan.



This is where you allow people to express their frustrations. Make people attend group sessions, disguise them as mandatory debriefs if you must. Let them express their emotions, these expression must never go on permanent records or identifiable notes


This is where you support staff to return to their old roles (or new ones!) in a structured way. It allows them to return to normal while healing. Think of this stage as the crutches and physio supporting someone healing from a broken leg.



Your aim here is to process all staff through it, returning most to work normally but catching as many as possible who will need targeted care. This must be sensitively handled as too many have outdated views and see mental health issues as weakness.


Your plans must be long-term, they can't be targeted short term. Often issues will present years later. There must always be a non-judgemental help service available. This is a bit often ignored.

Important: don't forget your temp/locum staff and leavers!


You know the foundation skeleton, now build your local body of the plan. One size does not fit all. Look at your teams, their roles during the pandemic and what they'll return to post-COVID, include those on the edge of the COVID work.


What resources do you have to do this? This will shape your plan.

What in-house staff can you leverage? Must you bring in some?

Key tip: Beg, borrow or sell your soul for a good clinical psychologist (or similar) to help you at least review your plan!


Build a list of champions, senior clinical and non-clinical folk who will be your face of your plan. Go outside your chain of command and leverage both the respected mavericks and grumpy old seniors.


START NOW. This plan will take 2-3 months to get right, it'll take iteration, haggling for money, bringing in resources, getting approvals. Leverage professional bodies, unions, NHSE and others for resources, funding and comms. And... And...

Please don't leave this.


In the above 15 tweets, I've covered at extreme summary level a lot of work. You must start now, even if you're overrun with today's work. If you don't, you will have a second disaster when the consequences of the pandemic start to be processed by your staff.


Simply put, if you DON'T do this, you'll be breaching your duty of care to your staff. If you leave it until you find time, then you're already too late. Find the time to start your plan for decompressing from COVID, and don't forget to include yourself!

p.s. here's the first part that I did yesterday:

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More from @CraigNikolic

13 Jan
This is part 3 of my guide to managing burnout in your staff. I'll link parts 1&2 at the bottom.

Today, I'll be concentrating on the longer term. This is the organisationally hard part as you'll be battling both internal inertia and finances.

The first two parts were:
1. Managing burnout today
2. Managing tomorrow

Each incremented up in organisational challenge, moving from operations to crisis planning, and now to future planning to help build organisational resilience

This follows the same format as before, I'll provide a skeleton for local plans with some suggestions on ways to do that.

The aim is to create an organisation capable of minimising burnout, and to provide structure to those who need help.

Read 21 tweets
11 Jan
As promised, here’s my guide to staff burnout management during COVID. I’ll post over several days.

First though, the basics.

As a senior NHS leader, you must manage staff wellbeing. It's your primary job. If you don't do this, how on earth are you going to deliver?

Today’s thread covers the problem TODAY. Tomorrow, I’ll cover the mid-term problem

Today, you have a problem: your clinical and non-clinical staff are burning out. What tools do you have available to you?



This is a same day tool. Mandatory breaks, somewhere to go for a sandwich in peace, or with colleagues.

Walk through the working environment, where can staff go to escape for a while?

Does your lower tier management understand the importance of working day breaks?

Read 15 tweets
1 Jun 20
The NHS is trying to do many projects at speed now for all sorts of reasons, but doing them with the same processes that haven't exactly worked in the past.

Here's my 4 Tweet guide for those who manage project managers, or are clinicians on projects.
1. Show me the requirements

If you don't know what you're trying to achieve then you've failed before you start. This is the picture of what it'll look like once you finish.

This is the most often abandoned bit by those who don't really deserve to be called project manager.
2. Show me the patient impact

EVERY NHS project must show the patient, if it doesn't then you're wasting time and money.

How will this help the patient? This could be anything from reducing clinician burden (faster logins, etc.) to getting the right ratio of ITU/general beds.
Read 6 tweets
14 Feb 20
I was asked to facilitate a PCN planning session yesterday for next year's specifications and workforce. I thought I'd share the framework I used to help them work it through. Here it is, and I'll explain over a few more tweets.

1/ Image
Start bottom left with the patient experience, what are their needs, how you know and is everyone sharing this? Be brutal, keep it on patients.

This is critically important. How do you know those are the patient pain points? Have you asked them? Is that a shared PCN picture?

Then move onto the NHS people working with those patients. Be brutal, keep it on people, but keeping the patient context in mind.

Then move onto practices, what's the pain points they're suffering in this with the previous context in mind?

Then PCN, then CCG size, then up.

Read 8 tweets
25 Nov 19
Interesting but this is only half the story though. Some examples in a thread on the drivers of GP demand:
Long waiting lists in hospitals? Patients go back to their GPs for interim care. My rough rule-of-thumb is a two month wait creates a new GP contact for interim care.
Increased treatment thresholds. E.g. if the hip replacement threshold is increased, you have ill folk in serious pain who need intervention and they will need increasing GP time until they finally get over that threshold.
Read 13 tweets

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