BMA to look into ‘toxic’ NHS presenteeism culture

by Ben Ireland

Doctors forced to work though sickness and burnout through ‘guilt’, ARM hears

Location: UK
Published: Wednesday 5 July 2023
bma arm 2023

‘Staying away from work when under the weather should be a given, and doctors should look after their physical and mental health without any feeling of guilt.’

Fiyinfoluwa Akinsiku, a specialty trainee 3 in psychiatry based in Worcestershire, made the case against a ‘toxic’ culture of presenteeism that the BMA has agreed is ‘prevalent’ in the NHS, and education.

‘It is not uncommon to see doctors feel genuinely guilty about the rota gap created by their absence – making it to work when they’re genuinely ill,’ Dr Akinsiku added when speaking in support of a motion at the BMA annal representative meeting on 5 July which notes that presenteeism can be ‘extremely detrimental to physical and mental health’.

The debate followed recent analysis of NHS data by the Nuffield Trust showing record levels of staff sickness in 2022, higher than during the peak of the COVID pandemic. This was put down to current pressures and short-staffing exerting a ‘psychological strain’ on NHS staff.

Dr Akinsiku told of instances where doctors were called ‘every day’ when off sick by medical staffing teams, and occasions where doctors were pestered to come back to work while recovering from major surgery, with staffing teams ‘caring only about the rota’.


Error risk

She said many international medical graduates in particular often ‘fall for this abhorrent and sickening behaviour’ when they start working in the NHS.

‘If you’re at work when you’re supposed to be off sick and a mistake happens, we all know it could spell doom for a doctor’s career,’ said Dr Akinsiku. ‘Particularly if that doctor is BAME.’

She said that ‘if people make culture, then the same people can unmake culture’ and urged the BMA to help doctors ‘tackle this scourge’.

Aisia Lea, a third-year medical student in the East Midlands – who sits on the student wellbeing advisory board at her university – agreed.

She called out the ‘work hard play hard’ culture within medicine and the ethos of ‘take a break, fall behind’.


'Take a break'

Noting instances in which sick doctors and medical student have been asked to come in for half days because 'these patients need you', she said: ‘Our profession does not practice what it preaches. “Get some rest”, “take a break”, “I think you need some time to recover”. Do these phrases sound familiar? Are they something that you’ve said to your patients countless times? Probably.

‘But is it something that you’ve had said to you? Is it something that you’ve said to yourself?’

Ms Lea said: ‘Staffing shortages and a crumbling NHS instils guilt in our doctors for missing a day. This needs to change because a sick doctor spreads, an overworked doctor burns out and their physical and mental health crumble.

‘As a student on clinical placement I fear taking a day off. What I miss will need to be made up, and that might require me missing something else and having to make that up – it’s a vicious cycle.

‘We need to move away from “work no matter what”. We need to take the advice that we share with our patients. We need to support each other to take the time that’s needed, no questions asked.

‘Do not allow presenteeism to be an added straw to the camel’s back of the NHS. Do not let it break.’



GP registrar Lucy-Jane Davis, chair of the BMA’s South West Regional Council, introduced the motion.

She said the ethos of ‘ploughing on through when you’d be better resting and recovering’ was ‘built-in’ to medicine because ‘we all want to be there, we all want to make a difference’.

‘Medics tend to be the very people who will turn up to work looking what I call “peaky”,’ she said. ‘And I suspect all of us here have probably sent somebody home because they just don’t look very well.

‘We know our members are at a fairly unprecedented level of exhaustion and burnout – and wellbeing and yoga at lunchtime just doesn’t touch the sides. Addressing the cumulative effects of presenteeism will.

‘Making sure our members are protected in the workplace and doing the background work that explores this gives us the evidence and the power to really do something.’


Learning scenarios

Dr Davis said it was important for the BMA to have policy to support doctors faced with a culture of presenteeism, but also within education as well.

Schools, she said, were often mandating children to go in when they’re physically or mentally unwell and award 100 per cent attendance.

‘I’ve seen so many children, as young as primary age, who are struggling’, she told ARM. ‘They find school overwhelming and hard to cope with.’

She said she’s written to headteachers asking for part-time timetables for some children because ‘some school is better than no school’ but has ‘been told it’s not possible’.

‘I’m strongly in support of enabling children to be present at school, but we must take a holistic approach which is child-centred, not imposed on a one-size-fits-all approach,’ added Dr Davis.

‘There’s nothing like sitting with a teenager who’s telling you school is making them so unhappy and they are seriously considering suicide. It’s just awful, and we have to change the narrative.’

The motion passed with 91 per cent of the BMA’s representative body in favour. It calls on the BMA Board of Science and Committee on Community Care to explore the issue of presenteeism.