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Reading through the report from the GMC which was released on December 18, has been depressing, if not unsurprising. The majority of themes particularly relevant to consultants are evident in our workplaces, our colleagues and ourselves.
The GMC presents evidence that workplace pressures are associated with risks to patient care, doctors’ wellbeing and reduced supply of medical staff. We know this.
They note that many doctors are witnessing patient safety issues due to these pressures, with 39% of consultants reporting witnessing patient safety and care being compromised and 85% reporting that they have found it difficult to provide a patient with the sufficient level of care they need over the last year. We know this.
The GMC identifies wellbeing, reflected in risk of burnout, as having reduced for many doctors and acknowledges this creates further risks for patient care, as well as negatively affecting retention. We know this.
The vicious cycle of workforce shortages leading to illness, stress and burnout thereby placing further demands on those left pervades our rotas. We know this.
The pressure-induced short-termism brought about by higher patient demand on decreasing resources leads to a focus on immediate patient safety and care to the detriment of deemed less urgent tasks, CPD and those activities that support the system and service including clinical governance arrangements. Leadership activities are not appropriately recognised, leading the GMC to make the unusual call on contractual matters stating the need for ‘the realistic representation of leadership responsibilities in job plans.’ We know this.
It is unsurprising that a third of consultants have refused to take on additional workload, with a fifth reducing their hours in clinical practice as a result of pressure on workload and capacity, not just as a direct response to the iniquitous pension taxation arrangements. And increasing numbers (59%) are looking to reduce their clinical practice in the next year.
When it comes to consultants’ roles as trainers, the national training survey from earlier this year makes stark reading. 72% of trainers work beyond their contracted hours on, at least, a weekly basis compared with 45% of trainees. 68% of trainers rated the intensity of their work by day as heavy or very heavy against 39% of trainees.
The current experience of consultants is unsustainable, across the domains of being leaders, teachers, trainers, and clinical experts. We are continually being asked to do more with less, and the GMC report adds further credence to our calls on the new Government. They must prioritise our valuable NHS workforce, giving it the resources it needs, legislating for safe staffing levels and scrap the damaging pension tax rules that mean doctors are too often penalised for going to work.
See the full GMC report
Read the news story with comments from BMA council chair Chaand Nagpaul
Phil de Warren-Penny is the BMA consultants committee deputy co-chair
It is sad, the situation in which the consultants at now, unreasonable demands from managers and pressure to take on more work load squeezed on contracted hours is counterproductive, stressful, unsafe and is against good medical practice. I thought we are the only once suffering but apparently it is across the board
Solutions need to be found before we lose our senior colleagues faster than that and put patients at risk
Just a correction: I think the sentence at the top should have read but not surprisingly, meaning we are not surprised by the GMC findings
As an NHS Consultant of 29 years, and a medical practitioner of 39 years, my "clinical performance" is now assessed by "inexperienced young competency based trainees", who have little understanding of providing a clinical service which involves patient care. Their interest lies only in acquiring specific tasks/competencies so that they may be "signed off". If a trainee deigns to turn up (sickness, teaching, pottery classes, carer's leave, other business interests allowing), I now get assessed by the trainee as to whether I was "nice" to them! It is impossible to practice the medicine I was taught at medical school, as five minutes with an unknown patient, who is clothed and sitting with 20 other patients and relatives at 07:00am is completely inadequate. Surgical patients no longer get a pre-operative "surgical/medical clerking", or relevant positive/negative summary, as this is regarded as a "waste of time" by medical/surgical doctors in training. For surgical patients in the operating theatre, there is now no-one who has a complete overview of the patient anaesthetised on the operating table. I am unable to access the patient record as the "allergies" have not been reviewed and the VTE assessment has not been completed, and this is before I have even met the patient! It is of course all documented on a "time stamp" on a "tick box computer form" used for the "root cause analysis" by the Governance team, when it all goes inevitably wrong. Checklists have been introduced to replace familiarity, and It is impossible to review a patient at the bedside with the medical notes, a current/24 hour observation chart, together with a valid prescription form, as they are all kept locked in different places, as we are not allowed to know who the patient is anymore. Patient care is disjointed, non-continuous, and anonymous. We all now practise defensive crisis management. Various "scoring systems" have been introduced to flag up issues that take no account of individual patients, on a "one size fits all basis", and clinical pathways are developed which no-one has the time to read. A straightforward day-case admission for cataract surgery is now a 27 page A4 document, which needs to be completed and reviewed for a procedure that is so routine that people should "walk in and walk out" within two hours. The CQC recommendations are self fulfilling prophecies that just add unnecessary, dangerous bureaucracy in order to practice defensive medicine that is fuelling and maintaining an outdated, unreliable, unjust legal system. One only has to review the recent high profile "gross negligent manslaughter" cases to see how unjust the legal system has become.
We waste huge resources on completing crazy documents, and spend more time documenting perceived care than actually delivering it. The system is broken, clinicians are "set up to fail", from the moment they see a patient, and the consequences are harsh when the "root cause analysis" is undertaken by the governance clip board brigade that have no idea what it is like on the frontline. Further scoring systems are introduced to dictate levels of care that are not available, and therefore immediately impact on patients who still need treatment, even if the perceived/recommended resources are not available. We have been hammered by 5 yearly reorganisations, new "time based" contracts, retrospective pension changes that mean working longer hours for no remuneration, and a "free NHS" that no-one values and are happy to exploit. The GMC is run by civil servants appointed by the department of health with no first hand experience of what it is like to be a "Doctor". They are judge, jury and executioner in a system they have never experienced. My working life has been a privilege, however the majority of my year (1975-1980) from medical school have already retired at a time when the NHS needs them most. They have been "wasted" and cast aside, like many other resources in a public service that no longer values them, and is no longer "fit for purpose" in the 21st century. Time to join them and retire!
I'm very rarely off sick but two years ago when I had a nasty cold with sinusitis I took one day off because I was not fit for work. I rang my secretary in the morning to let her know that I won't be coming to work and explained why. In the afternoon when I was fast asleep with much needed sleep I was woken up by a manager who rang me to ask what the problem is. This is humiliating for someone who is never off sick and works a lot of unpaid overtime.