Junior doctor England

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Junior doctors: the blight of low morale and burnout

Junior doctors walking in hospital corridor 20673
ON THE WAY OUT: Junior doctors are increasingly looking to work abroad

The poor treatment of junior doctors – from excessive workloads to a refusal to provide tea bags at work – has affected morale so dramatically that many have already left the country to work in sunnier climes, as Peter Blackburn finds out

When Ross Farrar left his hospital after the last shift it was with a sense of relief – and excitement for the future.

After just two years working in the NHS, Dr Farrar – who had just completed his second foundation year – and a group of five other young Leeds doctors, had decided they would be better off leaving for foreign shores.

Despite only being two years out of medical school, Dr Farrar admits he ‘couldn’t imagine morale being much lower’ in the workplace he leaves behind – and it was worth the gamble that the other side of the world might just offer the work-life balance and professional appreciation he yearns for.

‘I was aware of the long hours and frontline pressure before I signed up but didn't realise how much it consumes your life,’ he says.

One of the final straws for the Leeds doctor, who has now swapped the Pennines for Queensland’s Sunshine Coast, was being left to volunteer to work extra weekends with a group of friends – just to ensure colleagues weren’t left alone on intimidatingly busy hospital wards.

He says: ‘Staying late for patient safety almost every day on some jobs gradually leads to you feeling tired and at risk of burnout. You find you have worked well over your contracted hours without realising it.

‘There are huge numbers of rota gaps across most specialties: The staff on the frontline are more thinly stretched and you end up working even more hours to help colleagues.’


Daily grind

It’s a familiar picture for junior doctors across the country.

Kishan Rees, a clinical teaching fellow in London, describes the reality of this life as the ‘blur of the daily grind’ – and says it can have a deeply worrying impact on personal life.

‘The environment now is so bad that people burn out and leave,’ he says. ‘I know lots of people in medicine who are divorced, depressed and have lots of problems such as drug addiction.

‘We need to start asking at what point this all becomes detrimental to the health of doctors. It is a vocation and we go into it because we love it and enjoy it but the risk of burnout is high and doctors are vilified too often.’

It’s not just the hours in work that seem to be causing morale to plummet but also the linked inability to get hours away from the hospital wards.

Dr Farrar says some colleagues were unable to take annual leave for their whole rotation because there was never a safe period with enough staff and regularly heard the now familiar stories of doctors being unable to make their own weddings or finding out about their working arrangements hours or days in advance.

‘The service is already too thinly stretched so getting annual leave when you like can be difficult,’ he says. ‘I feel rota coordinators spend so long trying to fill the gaps that they are facing in the upcoming week that fitting in holiday time is near impossible.’


Lack of support

Holiday requests falling on deaf ears is a familiar problem for London specialty trainee 3 in psychiatry Mohsin Khan.

‘Working for an institution such as the NHS is a wonderful privilege, but I thought I’d be supported more in giving me what I need to give top-quality care to my patients,’ he says.

‘It can be very hard to get leave, even for important events such as a wedding, or when you want to coordinate time off with someone else – that makes it difficult with trying to book holidays.

'The notice is often very short for new placements – and you can be expected to move halfway across the country to start a new job less than a day after finishing the last one.’

And basic needs for junior doctors – who are after all very much learning on the job – such as time for training and opportunities to see good work being done are decreasing, Dr Khan says.

‘There's a lot more paperwork and sometimes it feels like we don't have time to spend as much with our patients or learning, because we're too busy doing endless paperwork, just running to stay in one place.

‘I wish we had more time for training – the workload can take you away from training opportunities. I've often seen doctors not go to the teaching sessions offered because they're trying to catch up on their paperwork.’

Dr Khan’s plea on this front is simple enough: ‘Give us manageable rotas, recognise that we have lives outside work as well, and provide the support and resources we need to work those long hours, learn, and look after our patients as we'd like to.’


Toilet roll

It’s not all hours and exhaustion, however – the bug bears run through every strand of working life for many junior doctors.

A recent blog written by a junior doctor on the BMA Connecting Doctors webpage shows the problems extend from these serious day-to-day issues to those arguably much simpler to solve.

It says: ‘There’s a sign on the fridge in the staff coffee room. It reads: "Would all those willing to contribute to a kitty for tea bags, milk and sugar please sign up below?" Underneath, someone has added "and washing-up liquid". Further down, someone else has written "and toilet paper". But that bit’s a joke. I hope.’

The post continues: ‘Sickness absence rates in the NHS are about 4 per cent. The rate of vacant nursing posts is 10 per cent – in London 17 per cent. Junior doctor morale – well, let’s not go there. I’m not suggesting that these problems could be solved overnight with strategically deployed free tea bags, but surely cheap, simple steps to make staff feel valued would help.’

When North East Thames region specialty trainee 6 in trauma and orthopaedics Simon Fleming started in medicine he was captured by the camaraderie and the shared values of the staff who toiled under the NHS banner – but says some of those values are being challenged by the way staff are treated.

‘What I found was that the NHS attracts the same kind of people,’ Dr Fleming, who had started his training in North East Thames but moved up to Derby, says.

‘It was a region I didn’t know and people I didn’t know but they were like me and shared my intrinsic values. That’s not just the doctors, it’s everyone. People still wanted to fix people, to work hard and all those things – there was very much a sense of togetherness. You get resilience from that sense of community and knowing everyone is supporting everyone else.’

He adds: ‘The NHS survives on the goodwill of its staff and recent events have tarnished that goodwill – not towards each other but towards the institutions that would ask us to go above and beyond.

‘Our focus is still, and always has been, on patients. That hasn’t changed. But doctors feel undervalued, not respected, not treated like adults and there is bullying and harassment and undermining behaviour in our workplace.

‘I’ve experienced some of those difficulties and I’ve been a victim but I also regularly see other people going through it – and it’s a problem.’


Community under threat

Many of these problems have been longstanding – although the plight of the health service has clearly had an exacerbating effect – but after a bitter contract dispute junior doctors have found themselves contending with Government rhetoric, questionable claims about funding, and having their motives questioned.

The developments have angered Dr Fleming and had an impact on morale among himself and his colleagues.

‘The sense of community has taken a real beating and it’s frustrating,’ Dr Fleming says.

‘It’s frustrating to have to continuously defend the NHS especially when those of us inside it know just how great it is. The rhetoric makes it sound like it’s an unsalvageable dying beast and it’s not the case. A lot of the stuff that the Government says is clearly untrue but by the time it is shown to be untrue the damage is done.’

Dr Khan has noticed similar feelings among concerned staff in his hospital.

‘Many of my colleagues feel we're not listened to by the Government – and ministers don't even listen to the experts either,’ he says. ‘We're all trying to help them maintain a safe NHS which provides high-quality care for patients while supporting staff.’

And for Dr Farrar the shattered relationship between frontline staff and politicians was an everyday strain.

He says: ‘The level of mistrust between the medical profession and the health secretary has to be resolved. We need more staff on the frontline and not the imposition of an un-costed and unobtainable full seven-day service putting those who work for the NHS under even greater pressure.

‘We also need the politicians to stop lying to the public about the NHS and using it as a political football. Evidence suggests the Government can afford to spend more money on the NHS – it just chooses not to.’


Work all waking hours

BMA junior doctors committee chair Ellen McCourt says it is vital that ‘real solutions’ to the crisis in morale are found.

She says: ‘Junior doctors have always worked extra hours, night shifts and weekends in the name of patient safety and because they believe in the NHS.

'But those hours take their toll and these hard-working, compassionate training doctors – who aren’t only healthcare professionals but also need to be mums, dads, brothers, sisters and friends – are being forced to put up with worse working conditions, longer hours and poorer training with every passing month.

‘On top of the everyday difficulties of working life, like not being able to get the holiday you need to see your friends or family, junior doctors have been politicised by a Government, and a health secretary, unwilling to be honest with the public.

'These junior doctors give most of their waking hours just to keep services running and patients safe while politicians untruthfully claim they’re giving the NHS the funding it deserves and question the motives of the very staff saving lives in our hospitals.’

She adds: ‘My colleagues across the country have been questioned and criticised when they should be appreciated and recognised. The clear reality is that the NHS would collapse without the goodwill of its staff and just like the buildings and services of the NHS that goodwill is stretched to breaking point.

‘We often talk about morale never being lower among junior doctors but these are not just words – my colleagues are leaving the NHS.

'Some take their skills to other countries and some leave the profession, which needs their skills so much, entirely. Those who are staying have a worsening relationship with politicians and health managers and have never felt less valued at a time when they should be more valued than ever before.

‘The current state of the health service is driven not by its failings, or lack of will of staff, but by political ideology. The Government must be honest about funding and come up with real solutions otherwise Britain could lose its most treasured public service.’

If Dr Farrar’s experience after just three weeks in Australia is anything to go by these solutions can’t come fast enough.

He says: ‘What I have seen so far comfortably beats the NHS for pressures on staff, morale and quality of life.’

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