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Working in a system under pressure

St Marys/Hammersmith Hospitals 21-12-16
Hospital doctors in meeting with nurses SMH2016
Hospital doctors in a meeting

The NHS is regarded as one of the best health systems in the world, yet chronic underfunding and workforce shortages put quality of care and patient safety at risk. Doctors are working in a system which is under immense pressure to meet rising patient demand and is unable to recruit and retain the necessary staff required to deliver services.

Individual staff feel that they bear the brunt of these workforce pressures. Working in healthcare is demanding at the best of times. Operating in understaffed and under-resourced environments makes it more difficult for doctors to meet their professional standards. It has also left doctors over-stretched and at risk of illness and burn-out.

The BMA consistently lobbies government to address underfunding, workforce shortages and the need for proportionate regulation. We also provide support to our individual members through a range of advice and counselling services.

Given growing concern amongst our membership, we established a working group of BMA Council and committee members which met between August 2017 and January 2018 to consider these issues.

This report is a summary of their discussions. It sets out the current pressures within the healthcare system and how these affect doctors and their practice. The group also highlighted several priorities for what needs to change to address system failures and support doctors.

Read the full report (PDF)


Key facts

  • The UK population is growing and the number of people with multiple long-term conditions is set to increase.As a result, doctors are doing more complex and intense work. The BMA's tracker survey, which follows medical staff across the UK, shows that 68% of GPs and 44% of consultants now find their workload unmanageable.


  • The NHS is doing more. There have been significant increases in NHS activity across the UK. Hospitals have been getting busier and average consultation rates in general practice have increased.


  • Doctors across the profession report working longer hours than previously and face unnecessary bureaucracy. This increased workload is in the context of significant cuts to other services across the UK, such as local authority social care, public health and community mental health services.


  • The NHS is facing unprecedented financial challenges as a result of insufficient funding and unachievable efficiency savings. If the UK matched the average spend on health across other major EU countries it is predicted that total health spending would reach £227.2 billion by 2022/23 - £22.9 billion more than current spending plans.


  • Fewer students are applying to study medicine in the UK and applications to specialty training are also decreasing. There are also a worrying number of vacant medical posts across the UK that have a significant knock-on effect on doctors currently in post.


  • Forty-four percent of doctors in the BMA's quarterly survey described their morale as being low or very low and nearly two thirds said their stress levels in the workplace have increased, and half saying they have felt unwell as a result of work-related stress over the past 12 months.


What needs to change

  • Health services have been seriously challenged for the last decade by insufficient funding from UK Governments and poor management of workforce recruitment and retention. Health staff are faced with more patients needing more care than ever before and a falling share of the increasingly limited budget with which to provide it. Greater investment and better workforce recruitment and retention remain key to addressing the current problems in the health service.


  • Working environments and support services provided by employers need to be responsive to the challenges in the health service and mitigate their impact on doctors’ welfare. Rotas need to be well-planned: there should be sufficient doctors for safe working; planned time for training should not be eroded; and shifts should be organised so doctors are not forced to sacrifice rest or sleep. Doctors also need post-shift rest facilities and employers must ensure other essential welfare provisions are in place.


  • A fit for purpose occupational health service should be a priority. Under-resourced and over-stretched health services are a potential cause of ill health amongst employees. At a time when the NHS is experiencing unprecedented strain, and when doctors arguably need the most support, occupational health provision is woefully inadequate.


  • Regulation of the profession and the health service needs to be proportionate and reflect the pressurised environment in which care is provided. The mismatch between the best practice care doctors want to provide and the resources at their disposal can be a cause of significant professional and ethical tension.


How we can support you

We continue to highlight the latest NHS data and evidence directly from doctors on the current pressures being faced by the NHS.

We also provide BMA members facing overwork and fatigue with guidance and individual support:



Read the full report (PDF)