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Stress. Burnout. Exhaustion. Blame. Excessive workload. Rota gaps. Bullying and harassment. A lack of autonomy.
These were just some of the issues identified by the UK-wide review into the wellbeing of doctors and medical students published by the GMC last week. The emerging themes in ‘Caring for doctors, caring for patients’ will sound all too familiar for anyone working in the health service, particularly as winter starts to bite and the pressures on the NHS build.
As your representatives, members of the junior doctors committee spoke with the GMC review team to ensure the lived experiences of trainees were heard. They considered many BMA resources, including research findings, and our recent work to support mental wellbeing in the medical profession. The review team also welcomed our ‘excellent list of support services’, including the new directory of wellbeing services around the UK, specifically for those looking for local support.
There are eight recommendations, set out in an ‘ABC’ of doctors’ core needs: Autonomy/control, Belonging, Competence.
With Autonomy there is a focus on voice, influence, fairness and moving away from a blame culture. Implementing the BMA’s fatigue and facilities charter ‘in all working environments’ is at the heart of the recommendation to improve working conditions; the BMA and NHS Employers Good Rostering Guide and exception reporting are also identified as key for work schedules and rotas.
Strength of community and inclusive culture are noted in Belonging, as is compassionate and collective leadership.
Competence acknowledges that burnout is partly caused when doctors cannot do their best for their patients, due to workload and the pressures that we’ve repeatedly raised concerns about. The GMC recommends reducing workload through a mix of delegation, tech and preventative care.
They also highlight the importance of good educational supervision and coaching, though this is currently under threat due to the issues with pensions that mean many trainers are forced to give up their education PAs. We welcomed the suggested solution for the tension between training and service provision for junior doctors: step-on step-off training is something we have been lobbying for. Our work with Health Education England and others aims to end the administrative burden on junior doctors.
The issues and suggested approaches identified in ‘Caring for doctors, caring for patients’ will sound like common sense to most of us, and this review is the latest of many in recent years from various organisations that have aimed to tackle the problem of morale and wellbeing in the medical workforce. This work is laudable and the increased focus on this area in recent years is welcome.
It is now crucial, however, that we move from defining the problems and considering solutions, to real and tangible action.
The onus is now on NHS managers across the UK to respond to the challenge the GMC has set and enact all its recommendations. Safeguarding staff wellbeing will improve retention and, ultimately, patient care. As your junior doctors committee, we will continue to work with all relevant groups to drive this necessary change.
Sarah Hallett is chair of the BMA junior doctors committee
Very welcome initiative, my solution to all of the above is taking out one or two of the clinical sessions of a 10 session consultant to be dedicated to teaching mentoring and support, otherwise known going to the pub with your team, ok fine the coffee shop then, that would go a long way to restoring the firm by allowing the Doctors a time to get together and know each other better instead of just firing along with tasks and shop floor work. Better still give every hospital a proper Doctors mess with sofas, TV, kitchen so that these get togethers can happen in confidence and allow real emotion to be explored.
Bring back the firm...
I have seen to many junior Doctors in tears unable to cope with pressure from senior doctors just crying in my arms .
So many issues but for a big cause of low morale and resentment look at the can't do dogma of things like the interdeanery transfer process for trainees. It is almost impossible to be eligible for a transfer which locks trainees in jobs they hate. Look at the way training programmes farm trainees out around the country putting massive strain on their families and relationships (thanks to the Nobel prize winning matching algorithm by Gale and Shapely which leaves no one happy). Look at how once they are farmed out into training programmes they are locked in by the rules, e.g. if you ever leave a certain programme you can never re-enter training in that specialty again, or how you quickly become overqualified to apply for training programmes by just a few years of training and it is almost impossible to move sideways into another programme. Trainee doctors are trapped by a rigid system which treats them as a number not a human. Trainers receive random trainees who never wanted to work with them and who they get stuck with even if they do not have a good relationship. It's actually a patient safety issue, like forcing an aviation industry worker to be miserable and to make no allowance for human relationships within the team. A doctor who lost a marriage moving for specialty training then ends up in a bad training post in a random corner of the country which they cannot leave is likely to underperform or worse.
Read the book by Caroline Elton, 'Only Human', for a detailed and professional look at these issues.
As the parent of a trainee surgeon in an extremely competitive speciality, I have had to watch his enthusiasm being eroded by constant overwork which leaves him unable to spend time with patients, bullying from senior colleagues and the feeling of just being a cog in a wheel. The inability to transfer deaneries is ridiculous. Who in their right mind would accept a job for 8 years without knowing the team, workplace environment or city in which they would work. Add to that no let-out clause unless you gave up everything you had worked for. Indentured servitude was not dissimilar.
Net result? Another country is benefiting frim a great, empathetic person with a fine brain and a set of skills funded by the UK taxpayer. And our family divided by several thousands of miles.
As a non medical person it has long been a surprise to me how slow the NHS has been to focus on what most large organisations have for many years accepted as a managerial truth - namely that it is the people and their ability to work together that matter most, and frequently far more than anything else. Where organisations are either succeeding or failing it is often down the 'chemistry' or lack of it between personalities or groups of individuals. The human resources function often has this as one of it's highest priorities. I hope this initiative means that will become the case for the NHS as well.