'Death on an industrial scale'- general practice trainees' perceptions and experiences of dying and death during covid-19: an interpretative phenomenological analysis

Context: The COVID-19 pandemic led to an increase in numbers of patients dying at home in the UK, meaning that general practitioners (GPs) were exposed to more patient death than would be pre-COVID. This project aimed to gain insight into GP trainees' experiences of patient death between March and July 2020. This insight can inform support for GPs, leading to improved wellbeing, workforce retention and ultimately, better patient-centred care.

Methods: Interpretative Phenomenological Analysis (IPA) of semi-structured interviews was used to explore GP trainees' experiences of patient death in one region of England.

Results: Seven trainees, two male and five female, participated. They were working in both rural and urban community settings and were at different stages of GP training. Group experiential themes related to heightened emotional responses to patient death, managing uncertainty and the increased salience of relationships. Most appreciated positive teamworking and solidarity, though some had felt isolated within their surgery and wider community. There were some unforeseen positive experiences of individual and organisational healthcare changes, including a perceived new appreciation for the NHS workforce equality, diversity and inclusion (EDI) by actions to identify and reduce occupational hazards to at-risk healthcare staff. There were potential effects on career choice with participants feeling that changes during COVID-19 offered new flexibility in working arrangements and opportunity to sub-specialise within GP.

Conclusion: More support to help navigate the amplified emotional responses to managing dying and death in the community is needed. Some experiences, particularly around managing uncertainty, can cause moral injury if not managed in a safe and supportive environment.