Survey of hospital doctors regarding resource/office provision - final report
March 2008
Summary
- The BMA has received anecdotal reports that changes in the provision of office space for hospital doctors are impacting on working practices or patient care. A sample survey of 3,000 UK hospital doctors was undertaken to ascertain whether there have been any changes in the quantity or quality of office space allocated to hospital doctors in the UK.
- Respondents were drawn from the junior doctor, consultant and staff and associate specialist grades. A wide range of specialities were represented and the majority of respondents worked in either a large teaching trust or an acute trust.
- Respondents were asked whether they had adequate resources to support them in their role as a doctor and two in five respondents reported adequate resources to support their role as a doctor. However, more than half of respondents were of the view that they did not have adequate resources to support their role as a doctor.
- Three in five respondents who reported inadequate resources to support their role as a doctor, regarded office space as a problem. Around a half of respondents also reported a lack of secretarial support and/or IT.
- Respondents were asked about any change in the quantity and/or quality of office space. A quarter of consultants and SAS doctors were of the view that the quantity of office space had decreased in the last year and almost a third were of the same view when considering the quantity of office space in the last 2-3 years. Two-thirds of respondents regarded no change in the quantity of office space in the last year. An almost identical pattern was evident regarding the quality of office space among consultants and SAS doctors.
- Around half of junior doctors were of the view that the quantity of office space had decreased in the last year and almost three in five regarded a decrease in the quantity of office space in their last 2-3 jobs. A similar pattern was evident with regard to the quality of office space according to junior doctor respondents.
- Around half of all respondents agreed that change in either the quantity or quality of office space had impacted on their working practices. This view varied somewhat according to grade of hospital doctor, with junior doctors more likely to report the change in quantity or quality impacting on their working practices.
- Around a third of all respondents agreed that change in either the quantity or quality of office space had impacted on their ability to provide patient care. This view was fairly consistent across all grades of hospital doctor, although consultants were less likely to report an impact on patient care compared with junior or SAS doctors.
The BMA has received anecdotal reports that changes in the provision of office space for hospital doctors are impacting on working practices or patient care. In order to explore this issue in more detail, a survey was undertaken to ascertain whether there have been any changes in the quantity or quality of office space allocated to hospital doctors in the UK. The survey also aimed to gather information regarding the degree to which any changes have an impact on working practices or patient care.
Method
The BMA’s Health Policy and Economic Research Unit (HPERU) was commissioned to undertake a sample survey of hospital doctors in the UK. A questionnaire was sent to a representative sample of 3,000 hospital doctors across the UK, including junior doctors, consultants and staff and associate specialist grade doctors. The questionnaire was designed to be accessed on-line. An email (including weblink to the survey) was sent to the sample of doctors on 20th February 2008 and a further reminder email was sent to the sample on 3rd March 2008. The questionnaire received a response from 20 per cent of the sample (594/3,000). This report presents the findings from this survey.
Survey results
Characteristics of respondents
Respondents were fairly evenly divided by gender (53% males/46% females). Table 1 shows that a third of respondents were doctors in training: 16 per cent in foundation training year 1 or 2, 32 per cent in specialist training (ST 1-3), 42 per cent in SpR posts and the remainder in FTSTA or other training posts. Almost half of respondents were consultants and 14% were staff and associate specialist grade doctors. Table 2 shows the main specialties of respondents.
The majority of respondents worked in either a large teaching trust (36%) or an acute trust (39%) (table 3). Four in five (83%) respondents primarily worked in England, mainly in London, the South East and North West. 9.6% of respondents primarily worked in Scotland, 5% in Wales and 3% in Northern Ireland (table 4).
Table 1 - Current job title of respondents (%)
| Frequency | Per cent | |
| Doctor in training | 203 | 34.2 |
| Consultant | 293 | 49.3 |
| Staff grade and associate specialist | 85 | 14.3 |
| Other* | 13 | 2.2 |
| Total | 594 | 100.0 |
* Includes clinical assistants, clinical fellows and LAT posts.
Table 2 - Respondents by specialty
| Frequency | Per cent | |
| General medicine (and medical oncology) | 88 | 14.8 |
| Psychiatry | 66 | 11.1 |
| Surgery | 91 | 15.3 |
| Paediatrics | 60 | 10.1 |
| Anaesthetics | 61 | 10.3 |
| Radiology (and clinical oncology) | 16 | 2.7 |
| A&E | 28 | 4.7 |
| Obstetrics and gynaecology | 29 | 4.9 |
| Pathology | 23 | 3.9 |
| Geriatrics | 16 | 2.7 |
| Public health | 3 | 0.5 |
| Ophthalmology | 9 | 1.5 |
| General practice | 20 | 3.4 |
| Other hospital specialty | 55 | 9.3 |
| Other | 28 | 4.7 |
| Total | 593 | 100.0 |
| No reply | 1 | - |
Table 3 - Type of trust in which respondent works
| Frequency | Per cent | |
| Large teaching | 211 | 35.7 |
| Acute | 228 | 38.6 |
| Mental health | 55 | 9.3 |
| Mixed | 35 | 5.9 |
| Ambulance | 1 | 0.2 |
| Community | 4 | 0.7 |
| PCT | 21 | 3.6 |
| Specialist | 17 | 2.9 |
| Other | 19 | 3.2 |
| Total | 591 | 100.0 |
| No reply | 3 | - |
Table 4 - Distribution of respondents according to regions they primarily work in:
| Frequency | Per cent | ||
| England | 491 | 82.7 | |
| North | 35 | 5.9 | |
| Yorkshire and Humberside | 52 | 8.8 | |
| East Anglia | 38 | 6.4 | |
| East Midlands | 43 | 7.2 | |
| West Midlands | 47 | 7.9 | |
| North West | 75 | 12.6 | |
| Greater London | 85 | 14.3 | |
| Rest of South East | 56 | 9.4 | |
| South West | 60 | 10.1 | |
| Wales | 30 | 5.1 | |
| Scotland | 57 | 9.6 | |
| Northern Ireland | 16 | 2.7 | |
| Total | 594 | 100.0 |
Provision of resources
Respondents were asked whether they had adequate resources to support them in their role as a doctor. Table 5 show that two in five respondents reported adequate resources to support their role as a doctor. However, more than half of respondents (332/594) were of the view that they did not have adequate resources to support their role as a doctor. This view varied somewhat according to grade of hospital doctor, with junior doctors more likely to report adequate resources to support their role as a doctor (table 5). Table 6 shows that three in five respondents who reported inadequate resources to support their role as a doctor, regarded office space as a problem. Around a half of respondents also reported a lack of secretarial support and/or IT. Other resources perceived to be lacking by respondents included administration or management support, and healthcare staff, particularly junior doctors and nurses.
Table 5 - Whether you have adequate resources to support your role as a doctor by grade
| Junior doctor | Consultant | SAS doctor | Total respondents | |
| Yes | 66.8 | 49.8 | 42.9 | 42.1 |
| No | 33.2 | 50.2 | 57.1 | 55.9 |
| Total | 100.0 | 100.0 | 100.0 | 100.0 |
Table 6 - If resources are not adequate, what is lacking
| Frequency | Per cent of total respondents | |
| IT | 119 | 47.6 |
| Office space | 163 | 65.2 |
| Secretarial support | 137 | 53.6 |
| Other | 46 | 18.4 |
* Multiple response question (n=250).
Quantity and quality of office space
Respondents were asked about any change in the quantity and/or quality of office space. A quarter of consultants and SAS doctors were of the view that the quantity of office space had decreased in the last year and almost a third were of the same view when considering the quantity of office space in the last 2-3 years (table 7). Two-thirds of respondents regarded no change in the quantity of office space in the last year and this declined to around half regarding the quantity of office space in the last 2-3 years. An almost identical pattern was evident regarding the quality of office space among consultants and SAS doctors (table 8).
Table 7 - Whether the quantity of office space has changed: consultants and SAS doctors (%)
| In the last year | In the last 2-3 years | |
| Increased | 7.1 | 13.4 |
| Stayed the same | 65.3 | 49.1 |
| Decreased | 24.5 | 29.2 |
| Don’t know | 3.1 | 8.3 |
Table 8 - Whether the quality of office space has changed: consultants and SAS doctors (%)
| In the last year | In the last 2-3 years | |
| Increased | 9.0 | 13.0 |
| Stayed the same | 62.4 | 50.5 |
| Decreased | 25.8 | 28.0 |
| Don’t know | 2.8 | 8.5 |
Around half of junior doctors were of the view that the quantity of office space had decreased in the last year and almost three in five regarded a decrease in the quantity of office space in their last 2-3 jobs (table 9). [Junior doctors are unlikely to be in the same trust for more than a year due to their job rotations. Hence, this group of doctors were asked about the office conditions in their last 2-3 jobs instead of last 2-3 years.] A similar pattern was evident with regard to the quality of office space according to junior doctor respondents (table 10).
With regard to both quantity and quality of office space, junior doctors were more likely to report a decrease in the short (last year) and longer (2-3years/jobs) term, compared with consultants and SAS grade doctors (figure 1 and 2). Nevertheless, at least a quarter of respondents in each of the hospital grades reported a decrease in either the quantity or quality of office space in their trust.
Table 9 - Whether the quantity of office space has changed: junior doctors (%)
| In the last year | In the last 2-3 years | |
| Increased | 6.1 | 7.0 |
| Stayed the same | 32.1 | 29.6 |
| Decreased | 53.6 | 57.3 |
| Don’t know | 8.2 | 6.0 |
Table 10 - Whether the quality of office space has changed: junior doctors (%)
| In the last year | In the last 2-3 years | |
| Increased | 5.9 | 6.5 |
| Stayed the same | 37.6 | 31.7 |
| Decreased | 53.7 | 54.8 |
| Don’t know | 2.8 | 7.0 |
Several respondents reported that the reduction in the quantity or quality of office space was the direct result of a reduction in overall space to accommodate an expansion in clinical space within the trust. Increased appointment of staff, particularly junior doctors and consultants without an associated expansion in office space, was a further reason given by respondents. Many respondents reported improved equipment and IT resources, but without improved office resources in their trust. Reduced trust budgets and increased demands from NHS managers for office space were further reasons given for a decrease in the quantity or quality of office space.
Figure 1 - Whether quantity of office space changed: consultants/SAS doctors and junior doctors
Figure 2 - Whether quality of office space changed: consultants/SAS doctors and junior doctors
Table 11 shows that around half of all respondents agreed that change in either the quantity or quality of office space had impacted on their working practices. This view varied somewhat according to grade of hospital doctor, with junior doctors more likely to report the change in quantity or quality impacting on their working practices. Among those respondents who reported change in office space impacting on their working practices, specific difficulties included accessing IT equipment, dictating notes/letters/discharge summaries, completing audits, making phone calls and undertaking general administration, As a result of these difficulties, respondents argued that they are more disorganised, unable to concentrate and generally less efficient in their working practices.
Table 12 shows that around a third of all respondents agreed that change in either the quantity or quality of office space had impacted on their ability to provide patient care. This view was fairly consistent across all grades of hospital doctor, although consultants were less likely to report an impact on patient care compared with junior or SAS doctors. Among those respondents who reported the change in office space impacting on provision of patient care, the key concern was patient privacy and confidentiality. Other concerns included slower working due to increased inefficiency and the inability to quickly check patient records or test results.
Table 11 - Whether the change in either the quality or quantity of office space has impacted on your working practices by grade (%)
| Junior doctor | Consultant | SAS doctor | Total respondents | |
| Yes | 65.5 | 45.1 | 52.4 | 53.3 |
| No | 34.5 | 54.9 | 47.6 | 46.7 |
| Total | 100.0 | 100.0 | 100.0 | 100.0 |
| No reply | 9 | 16 | 3 | 29 |
Table 12 - Whether the change in either the quality or quantity of office space has impacted on your ability to provide patient care by grade (%)
| Junior doctor | Consultant | SAS doctor | Total respondents | |
| Yes | 38.3 | 32.8 | 38.6 | 35.7 |
| No | 61.7 | 67.2 | 61.4 | 64.3 |
| Total | 100.0 | 100.0 | 100.0 | 100.0 |
| No reply | 10 | 22 | 2 | 36 |