Impact of COVID-19 on Surgical Service Provision, Medical Staffing and Training at a Large Acute NHS Trust in the United Kingdom

Document Type : Research Paper


Barking, Havering and Redbridge University Hospitals NHS Trust, United Kingdom.


The COVID-19 Pandemic has been widely accepted as a challenging period for the medical community. The impact of the virus posed challenges on the surgical service provisions in the General Surgery department at a large acute NHS trust. The department learnt to adapt to the challenges and changes in the system which can be summarised into 4 phases, ‘Alarm’, ‘Resuscitation’, ‘Stabilisation’ and ‘Adaption’.
Materials and Methods:
The General Surgical department implemented a ‘Gold Command’, ‘Silver Command’ and ‘Platinum Command’ hierarchal system as a systematic method to make decisions to implement change. To assess the outcomes, electronic records were reviewed for number of NCEPOD cases, emergency laparotomies, elective surgeries that took place over the trust and these were compared at each phase.
Between 26/03/20-30/09/20 a total of 1578 surgeries took place, of which 869(55.1%) were emergency operations, from that 152(17.5%) were emergency laparotomies. 709(45.9%) were elective operations, 197(27.8%) performed at the satellite hospitals, 468(66.0%) performed at King George’s hospital and 44(6.2%) at Queen’s Hospital. 
The BHRUT General Surgery Department has successfully implemented a system to work through the pandemic to minimise its effects on surgical provisions. This template can act as a guide to nationwide hospitals if ever faced again with a similar challenge.


  1. References

    1. Chambers T, Hospitals BHR. (n.d.). No Going Back. June 2020 [Internet] BHR Hospitals. Available at: https://www. bhrhospitals.nhs. uk/no-going-back [Accessed 6 Aug. 2020].
    2. (n.d.). Coronavirus » Deploying the clinical and non-clinical optical workforce to support the NHS clinical delivery plan for COVID-19. April 2020 Version 1: Page 3 [Internet] Available at: https://www.england. deploying-the-clinical-and-non-clinical-optical- workforce-to-support-the- nhs- clinical- delivery-plan-for-covid-19/.
    3. Baker T, Schell CO, Petersen DB, Sawe H, Khalid K, Mndolo S, et al. (2020). Essential care of critical illness must not be forgotten in the COVID-19 pandemic. The Lancet, April 2020 [Internet] Line.1253–1254. Available at: https://www.
    4. COVID-19 and Trainee Progression in 2020 (update VI) – 1 October 2020. (2020). [Internet], JCST, p.9. Available at: https://www. [Accessed 1 Dec. 2020].
    5. Hospitals, B.H.R. (n.d.). Our services during Covid-19. January 2020 [Internet] BHR Hospitals. Available at: https://www. bhrhospitals. [Accessed 6 Dec. 2020].
    6. Mehlmann-Wicks J. (n.d.). Junior doctor contract in England. [online] The British Medical Association is the trade union and professional body for doctors in the UK. April 2021 Version 9: Pages 24-32 Available at: https://www.bma. contracts/ junior-doctor-contract/ junior- doctor- contract-in-england.
    7. Clinical Guide to Surgical Prioritisation During the Coronavirus Pandemic. (n.d.). May 2021 Version 3: Page 3 [Internet] Available at: userfiles/pages/files/ covid19/prioritisation_ master_ 240820. pdf.
    8. 2020. Bluespier. United Kingdom. Theatre management software used by BHRUT
    9. Al-Jabir, A., Kerwan, A., Nicola, M., Alsafi, Z., Khan, M., Sohrabi, C., O’Neill, N., Iosifidis, C., Griffin, M., Mathew, G. and Agha, R. (2020). Impact of the coronavirus (COVID-19) pandemic on surgical practice - Part 2 (surgical prioritisation). International Journal of Surgery 2020 Jul; 9:233-248.
    10. (n.d.). Overview | COVID-19 rapid guideline: arranging planned care in hospitals and diagnostic services | Guidance | NICE. Nice Guidelines [NG179] July 2020 [Internet] Available.