Barriers. Obstacles. Boxes.

When I look at the systems which govern our training and working lives that is what I see. Barriers to training and development. Obstacles to work-life balance which are exhausting to overcome. Boxes trapping us in unhealthy and unnecessary ways of studying, training, progressing and working. 

In an NHS under such phenomenal pressure – which needs its doctors more than ever – this is beyond bizarre.

We have 132,000 vacancies in the NHS in England alone, we have one of the lowest ratios of doctors per population in the 38-member OECD (Organisation for Economic Cooperation and Development) and there are more than seven million people on the waiting list for secondary-care intervention. By the BMA’s estimation we would need another 46,300 doctors purely to meet the OECD average. 

The numbers are frightening. And at a time when we are so desperate for an adequate workforce – when our patients desperately need a well-staffed NHS – shouldn’t we be pulling down these barriers, getting rid of the boxes that trap us and finding solutions to the obstacles in front of us? 

Every year we have limits on the number of training programme places offered in this country. We know the numbers aren’t enough – that we can’t create the junior doctors and consultants we need using these equations. 

For those in training there are seemingly endless hoops to jump through – rules which seem far more likely to push people away from medicine than support them to thrive in this profession. Why are there limits on the amount of time it must take to navigate between the start of a training programme and the end? Why are there limits on the years taken out of training? Why is there a limit on the number of exam attempts?

Maybe these rules suit some people – those who are likely to have a more traditional, linear route from the start to the finish of their training. But that doesn’t mean they are the right rules for everyone – and it certainly doesn’t mean they are appropriate in an NHS which desperately needs to recruit to, and retain, its workforce.

Have these rules considered people who are parents, those who are carers, people with mental or physical health issues, those with disabilities, or those who have partners or children who need support? How do these rules support medical students or doctors who may have diagnoses of – or are on incredibly lengthy waiting lists for support for – a wide range of physical or mental issues which make traditional work and study difficult?  

As doctors, and as a system, we are so keen to demand evidence for what we do – evidence-based medicine is our bedrock.  But I haven’t seen any evidence for the way we do so many of these things. Who do these barriers, obstacles and boxes serve? It is hard to see how they serve doctors, the NHS or our patients.

There are countless examples across the health system. There are some 325,000 doctors on the GMC register but the NHS fails to get the most out of so many of those. For example, locally employed doctors or people pushed to take locum roles because they aren’t given the flexibility or opportunities they want elsewhere.

Nobody benefits from a lost tribe of doctors who aren’t given every possible opportunity for progression and development.

Ultimately, I think it comes down to valuing people. And, here, we need radical action – and a concerted sense of commitment for change across the system.

I challenge anyone in the rooms where decisions are made which affect doctors’ lives to ask themselves whether they are holding that value at the heart of what they are doing – at the core of the decisions they make. If you are not, perhaps it is time to ask yourself why you are putting barriers and obstacles in the way of doctors we desperately need to thrive. 

Whatever you are going through, whatever obstacles or barriers you face, whatever boxes you feel trapped in – you are not alone. Firstly, we are your trade union; contact our team if you need our help. The BMA’s free 24/7 wellbeing and counselling services are also here for you and your dependants as well as non-members.

You can email me at [email protected]

Dr Latifa Patel is chair of the BMA representative body