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Junior doctors have been described as the ‘eyes and ears’ of the hospital; our frequent training rotations and varied experiences of healthcare throughout different regions and trusts provide an oft needed, fresh perspective and insight into the workplace environment and patient care on the frontline of healthcare. In the Keogh report, Sir Bruce Keogh coined the term ‘agents of change’ for junior doctors; setting an ambition that “the NHS will join the best organisations in the world by harnessing the energy and creativity of its 50,000 young doctors” and “strongly advise(d) Medical Directors to consider how they might tap into the latent energy of junior doctors, who move between organisations and are potentially our most powerful agents for change”.
However, despite the vital role that junior doctors have within our National Health Service, the GMC have highlighted a ‘dangerous level of alienation among the next generation of medical leaders’ which it is vital the system and employers address to re-engage our junior doctors.
A recent document from NHS Improvement, Eight High Impact Actions to Improve Working Lives of Junior Doctors, recommends greater “engagement… between trusts and junior doctors, with support from senior clinicians, and, in some instances, investment of resources” and “clearer communication between trainees and managers” to help combat this issue, along with recognising excellence and other focussed recommendations.
As part of its role under the Health and Social Care Act of 2008, CQC was given the general objective of ‘encouraging the improvement of health and social care services’. Engagement between junior doctors and this regulator provides a powerful opportunity to drive improvement in the quality of care delivered locally and nationally. Over the past few months CQC and BMA Junior Doctors committee have discussed how to increase the opportunities available to junior doctors to contribute to CQC’s regulatory activity, and thus drive improvement.
CQC is introducing an annual junior doctors’ focus group as part of its regulatory approach at hospital trusts. These groups will be invited to feedback on issues of staff engagement, workplace culture and morale. Where possible, they will also be facilitated by a junior doctor, and importantly, all comments will be treated with anonymity.
During the focus groups amongst other issues that will be explored, CQC may also ask whether rotational trainee doctors are given on-call rotas with six-week’s notice, as stipulated in the Code of Practice for recruitment. The Code of Practice was first agreed between the BMA, Health Education England and NHS Employers in 2016 and stipulates when you should receive notification of your jobs and your rota, and could be scrutinised as a measure of the trust performance. Late notification of rotas has a huge impact on the lives of junior doctors, but despite significant work in this area, and commitments made through the Code of Practice, it is challenging to monitor whether or not Trusts are making the deadlines.
Each trust has regular inspection of its leadership, management and culture, called the ‘well-led inspection’, which will take place approximately every year. CQC inspection teams will follow up on key issues raised during these focus groups with the trust’s senior leaders during well-led inspections, where appropriate. In order to better hear the voice of junior doctors, CQC has also introduced interviews with the trust’s guardian of safe working hours and a representative from the junior doctors’ forum as a regular component of the well-led inspection. This means that the culture surrounding exception reporting, escalation of serious issues and the relationship between the guardian of safe working hours and the board can be scrutinised, to ensure junior doctors’ hours and working conditions are safe for us and for our patients.
The CQC have made these changes to their inspections in recognition of the unique insights that junior doctors have regarding the quality of care that a hospital trust delivers, and on the approach that trust has taken to engage doctors in delivering effective and sustainable improvements.
We would encourage all junior doctors to attend the focus groups and junior doctors’ forum within your hospitals, and to use this opportunity to be agents of change, to play that vital role delivering effective and sustainable improvements in the morale and culture of our hospitals locally, and the quality of care available nationally.
Iona Thorne is a Medical Registrar and National Professional Advisor at CQC
Jeeves Wijesuriya is chair of the BMA junior doctors committee
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