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Caring supportive collaborative: a manifesto for change

CSC report graphic

What needs to change to improve care for patients and the working lives of doctors in the NHS?

For more than a year the BMA has sought to answer this question. As the only medical organisation that represents all doctors and medical students in the UK, we can draw on their experiences to find the answers.

Within the three key areas of workforce, structure, and culture, we have set out our priorities specifically for government.

In October, we wrote to the prime minister to ask that he commit to these priorities in his legislative agenda for the new parliamentary session.


'Radical change is clearly needed'

As the only organisation to represent all doctors working across all sectors of the UK, the BMA is uniquely placed to help find the solutions to the problems facing the NHS and to develop a positive vision for what a caring, supportive and collaborative health and care system should look like.

Across the UK, health services are struggling to cope after years of funding investment failing to match patient demand, leaving doctors treating patients in an increasingly unsafe and unsupportive environment.

Nine in 10 doctors tell us that staffing levels are not adequate and that they work in an environment in which they are fearful that systemic pressures and lack of capacity will cause them to make an error. 

Doctors tell us there is a persistent culture  of fear across the NHS, where blame stifles learning, contributing to the vicious cycle of low morale and poor rates of recruitment and retention. Doctors are leaving the profession due to a feeling of being undervalued and being hit by punitive pension taxation. All of which has a knock-on impact on the patients and their care.

Radical change is clearly needed. Our wider project sets out recommendations for governments, parliamentarians, commissioners  and those in leadership positions across the NHS. This document sets out the key issues which government must work to address to deliver a truly sustainable NHS. One which is underpinned by adequate funding and terms and conditions for doctors to relieve system pressures. One which is caring, supportive and collaborative.

BMA council chair, Chaand Nagpaul


A supportive culture

An environment that supports doctors’ wellbeing, promotes learning and encourages the development of systems to improve safety and quality of care – and where diversity is celebrated and there is equal opportunity and reward.

It is vital that doctors and clinical staff are given adequate time and facilities to be able to reflect on their experiences. They must also be freed from the pressure of a regulatory system which seeks to blame, not learn. 

Review the CQC with the intention of introducing reforms which will deliver a truly proportionate regulatory system.

Introduce amendments to the Medical Act to allow the GMC to streamline its fitness-to-practise processes which are inflexible, heavy handed and place great stress on doctors.

Introduce a regulatory mechanism for NHS management which will ensure core skills and attributes are maintained alongside clear individual accountability and responsibility.


A valued workforce

Where everyone who works in the NHS feels part of a properly resourced team working in harmony and with  the right mix of skills to do the job.

Scrap the punitive tax and pension regulations which are driving senior doctors out of the workforce. Without action the staffing of services will be left in jeopardy.

Safe staffing
Introduce legislation in England to ensure system-level accountability for staffing levels, which will make sure that individual clinicians are not blamed when the system places them under unmanageable pressure.

Deliver pay increases which truly value our medical workforce and help to retain staff. Commit to introducing a mechanism to address historic underpayments to doctors.


A collaborative structure

Where doctors and all NHS staff are empowered to work together across traditional organisational divides, so that patients receive seamless care.

NHS funding
Address the funding gap by increasing spending across the UK by at least 4.1% per year to put the NHS on a sustainable longterm footing. This equates to an extra £9.5bn by 2023/24.

End wasteful competition
Deliver on the NHS’ desire to revoke legislation in England which has led to wasteful and detrimental competition in the NHS and restore the NHS as the preferred provider of services. This must be comprehensive and transparent and truly rid the NHS of enforced competition.

Invest in a comprehensive IT programme so the NHS has access to the right IT equipment and facilities to provide the best care for patients. This includes basic IT infrastructure and access to high-speed broadband to enable true interoperability and the full digitalisation of all patient records.


Get in touch

For more information on issues raised here, please contact the BMA public affairs team on [email protected].