An incoming deputy medical director plans to feed back grassroots' concerns from doctors working on the ground under vast pressure. 

Throughout her career, consultant nephrologist professor Sue Carr has become accustomed to wearing a range of professional ‘hats’.

With her previous roles including director of medical education and associate medical director at the University Hospitals of Leicester, and Foundation School Director and Associate Postgraduate Dean at the East Midlands Deanery, Professor Carr this year became the inaugural appointee to the post of deputy medical director at the GMC.

‘Throughout my career I’ve always done half of something else and that has been a good way to keep [myself] interested and motivated,’ she says during our interview at the GMC’s London offices.

‘My background in education and training has always been working with junior doctors and doctors in training and supporting their development, so it’s great to have that opportunity here [the GMC] as well.’

Reality check

In addition to the demands of her new role, Prof Carr continues to practise – working two days a week as an educational supervisor, a responsibility that she feels keeps her grounded and abreast of the concerns and needs of grassroots staff.

‘I work on the [health service] front line two days a week, and it does give me a reality check and it helps me bring that reality check to the GMC,’ she says.

‘I think that by still talking to trainees and monitoring their training does give me a unique insight, and my colleagues aren’t slow to tell me where they see any deficiencies.

‘It’s really important that we bring that clinical knowledge and that experience of working on the front line into the GMC, as it does help triangulate what’s actually happening on the ground.’

While continued clinical practice will allow her to keep in touch with sentiment on the ground, the focus of her role at the GMC will clearly be of the bigger picture.

Figures from the latest State of Medical Education and Practise report show some positives such as a 4 per cent increase between 2018 and 2019 in the number of doctors in training, along with dramatic increases in the number of overseas doctors coming to the UK.

The same report also found, however, that the number of doctors aged over 55 taking early retirement is now almost three times greater than 20 years ago, while figures relating to working beyond contracted hours, feeling unable to cope and taking absence from work due to stress, remain concerning.

‘There’s no doubt we face some significant challenges at the moment,’ Prof Carr says.

‘We’re seeing a marked reduction in the number of young doctors who are choosing to go into training directly from their foundation era. Just under 60 per cent of doctors now do something other than go into specialty training, and that has huge impacts on the workforce.’

There’s no doubt we face some significant challenges at the moment.

Professor Carr

Under pressure

Prof Carr said that tackling workforce pressures was something that required ‘all the agencies working together collaboratively’, adding that that the GMC had commissioned professor Michael West to produce a report into junior doctors’ wellbeing, which she expects to be published before in November.

She said that a desire for greater flexibility in training was a significant reason for graduates delaying progression to specialty training, and that this was one of the areas she wanted to use the capacity of her role to address.

‘One of the things we’ve been working on with these other bodies is to try and get rid of the snakes and ladders effect trainees [experience],’ she says.

‘If you want to train to do one specialty such as surgery and you [then] decide you want to do something different, rather than going all the way down the ladder the things that you’ve already learnt that are transferable skills can count towards training.

‘That involves all the stakeholders working together to make that happen, and we are actively doing that.’

Physician associate advocate

With a background steeped in medical education and training, it is perhaps not unsurprising that Professor Carr is keen to use her experience contribute to education reforms around flexibility in training, regulation around physician associates.

She is a firm advocate for the latter, believing that physician associates will be integral to transforming the health service’s workforce into the multi-professional healthcare teams that will be needed in the decades ahead to meet the increasingly complex needs of the UK’s ageing population.

Earlier this year it was announced that the GMC would be taking on the role of regulator for PAs (physician associates) and anaesthesia associates. The BMA, while recognising the value of PAs, has argued that the GMC should not dilute its focus on doctors through the expansion of its regulatory responsibilities, and Prof Carr acknowledges the concerns that have been raised.

‘I am very aware and sensitive to those concerns,’ she says.

‘The GMC has said that they [PAs] will be regulated separately and doctors will not be funding the regulation of PAs. Hopefully the fact there’s one regulator means there will be that shared knowledge moving forwards, so I think it will be an advantage.

‘To deliver that vision [meeting future health needs] for the NHS we are going to need a multi-professional workforce in the right place for patients, and I envisage PAs being a part of that workforce.

‘They’ll support care of patients day-to-day, support doctors in training and I think that’s a really important point; when there’s adequate staffing that will enable doctors in training to have their training and enable [senior doctors] time to supervise them.’

I am very aware and sensitive to those concerns.

Professor Carr

Brexit effect

Trying to anticipate and plan for the future has become something of a national preoccupation thanks to Brexit and the conflict and complexity surrounding how, when and even if the UK will leave the EU.

Brexit has potentially seismic implications for medicine and the health service; not least in terms of workforce, regulation and access to medicines.

Should a withdrawal agreement between the UK and EU be reached, continued mutual recognition of professional qualifications and cross-border health services on the island of Ireland should be able to continue unaffected.

While the GMC’s own data does not show a decline in doctors from EEA (European Economic Area) countries coming to the UK since the 2016 referendum, Professor Carr insisted that contingency planning had been made in the event of a no-deal scenario.

‘The GMC has been preparing for Brexit, and the various possible outcomes, for the last 18 months to two years, so I think we can be reassured by that,’ she says.

‘If Britain leaves without a deal then the GMC has put measures in place and requested the appropriate changes in legislation so that EU doctors can continue to be recognised as they are at present.’

Junior support

As a doctor, Prof Carr says she has always been passionate about supporting junior doctors both in their training and in terms of their general wellbeing and wants to help foster a ‘just and compassionate culture’ through her work with the GMC.

The case of Hadiza Bawa-Garba -- a paediatrics trainee convicted in 2015 of gross negligence manslaughter and then removed from the Medical Register by the GMC, a decision later overturned in the court of appeal -- was one that placed significant strain on the relationship between the regulator and junior doctors.

Describing the case as one that was tragic for all concerned and acknowledging its effect on the GMC’s relationship with junior doctors, she said that the regulator had since sought to reflect and attempt to repair any breakdowns in trust between itself and the profession that had resulted from it.

This included its report into gross negligence manslaughter and the yet-to-be-published study into junior-doctor wellbeing.

‘I think there has been a lot of learning,’ she says.

‘People have reflected and learnt a lot from those incidents, so certainly the GMC has put a lot of effort into understanding those issues and looking to rebuild trust and support of the profession.

‘What the GMC wants to do is support a profession working under pressure. Doctors need to be able to speak up when there is a problem, and the GMC has done a lot about supporting doctors to speak up.’