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When a doctor makes a mistake, they can find themselves in the loneliest place. For all the sympathy of friends and colleagues, they’re on their own. There will only be one person’s face on the front of the newspapers, or in the dock.
The causes of that mistake may well have been systemic - but all too often the consequences are borne by individuals – the patient suffering an adverse outcome, and the doctor facing the consequences of the GMC, the courts and the media.
That doctor’s colleagues are left thinking ‘There but for the grace…’ They are shaken, more likely to give up their jobs, more likely to practise defensively. And yet the system and the pressures that it imposes remain unyielding.
I was asked by Anthea Mowat, the chair of the BMA representative body, to set up a BMA council working group to look at the causes and impacts of these pressures, and consider how we can best support the doctors who are bearing the brunt.
The source of the intense pressure we are all facing is that of a service having to do more for less.
The population is growing, as is the number of patients with multiple long-term conditions, and so our work is becoming more complex and intense. Emergency, elective and outpatient admissions are all significantly up, and the demands upon woefully short GP consultations even greater.
The NHS has been forced to make unsustainable ‘efficiency’ savings, in a system already spending a significantly lower share of its GDP on health than our European neighbours. Meanwhile, there have been significant cuts to public health, mental health and social care.
The government has completely failed to match investment to demand. On the current projections, NHS spending will increase by less than 1 per cent per year up to 2020/21. The historic growth rate is around 4 per cent.
Fewer students are applying to medicine, and applications to specialty training are also decreasing, while vacancies are on the rise.
These are not mere statistics. Every hospital filled beyond recommended capacity, every rushed consultation, every job vacancy has a direct impact on the wellbeing of our members. It is also a clear risk to patient safety.
There is evidence, for example, that NHS pressures are impacting on thousands of doctors’ health. Forty-four per cent of senior doctors report an adverse effect on their health while more than eight out of 10 GPs believe their current workload is excessive or unmanageable. Patients should not have to be treated by doctors who are stressed, anxious and sleep-deprived.
Our patients are simply not getting the care they need, deserve and should expect in one of world’s wealthiest countries. In England alone, over the next 12 months, we expect almost 3 million people to be waiting more than four hours in emergency departments, while fewer will be treated within the 18-week target. Without major intervention, the situation will only get worse.
And patients don’t just face longer waits, they may often be treated on wards and in GP surgeries which are severely under-staffed. Patient safety expert Don Berwick, writing in the wake of the Francis report, said ‘healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well supported’. This call is simply not being heard.
Part of the solution has to be the belated investment which the NHS desperately needs to start addressing the damage of recent years. This must be accompanied by a renewed commitment to workforce recruitment and retention.
Regulation must be proportionate and properly reflect and understand the pressurised environment in which care is provided. The GMC appeared to ‘get’ this when in successive annual reports it acknowledged the significant pressures on the profession, but the recent case of Hadiza Bawa-Garba has reinforced a perception that doctors will be held personally accountable for failings in the system.
We need a fit-for-purpose occupational health service. The health service does not adequately care for those who care.
Working environments can seem ‘callous’, in the words of a junior doctor who waited months for her wedding leave to be approved. Rest facilities can be hopelessly inadequate.
It cannot be right that individual doctors are blamed and being made ill, while their patients’ care suffers, by systemic failings entirely outside their power to control. Tackling these intolerable pressures is a fundamental matter of justice.
Helena McKeown is deputy chair of the BMA representative body
Read the BMA report on working in a system under pressure
Is the gmc listening?
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