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Target driven, fearful and under pressure – a snapshot of working in the NHS

MORRISON: Urgent action is needed to reform the system and make doctors feel more valued

A survey of BMA members in Scotland reveals a medical profession that is under pressure, fearful of making errors, and one that believes that finance and targets are given more priority than patient care.

The survey also shows that 91 per cent of doctors are working over their allotted hours, almost four in 10 say bullying and harassment is an issue in their workplace, and that almost half don’t feel confident about raising concerns about patient care.

BMA Scottish council chair Lewis Morrison called the survey results worrying – and said urgent action was needed, to reform the system and to make doctors feel more valued.

‘Our survey provides clear and worrying evidence that doctors in Scotland believe national targets and finances are prioritised above the quality of patient care,’ Dr Morrison said.

‘This would indicate that the way our NHS is run is skewing priorities and not always putting the patient first. That simply cannot be right – everything our health services does should be about delivering the best care possible, and not simply meeting financial or waiting times targets, which often tell us little about the actual quality of care.’

The survey of 999 members, completed during the summer, shows that 72 per cent believe that national targets are prioritised over patient care, and 68 per cent feel the same about finances.

It also reveals that 93 per cent are sometimes or often fearful of making medical errors, with 48 per cent saying this fear is worsening. In the wake of the case of Hadiza Bawa-Garba, who was struck off the Medical Register (subsequently overturned on appeal) after mistakes led to the death of a child, around half of those surveyed worried about being unfairly blamed for errors owing to system failings and pressures in the workplace.


Wary workers

As a result, more than four in 10 practise defensively, while almost three quarters (74 per cent) are wary of recording reflective practice for fear it could be used against them.

Dr Morrison said the survey findings reinforced the deep concerns repeatedly expressed by BMA members.

‘It is clear from the results that there are simply not enough doctors to deliver the quality care we all strive to provide. Doctors are fearful of making mistakes and then being blamed for them – despite being overworked and in a system under too much pressure.

‘It is also clear from this survey that bullying and harassment of doctors continues to be far too prevalent. This type of behaviour is completely unacceptable, and we need urgent steps to promote a more positive workplace across the NHS in Scotland – something the BMA is committed to working towards.’

Dr Morrison said the survey should be the start of a process to reverse the deterioration in working conditions for doctors and other healthcare workers, in Scotland.

‘I truly believe that if they are used constructively, the results will be a useful tool not just for us, but for policy makers, employers and managers at all levels,’ he added.

‘These are the challenges – making doctors truly feel valued again, ensuring Scotland better attracts and retains doctors, delivering real improvements in doctors working lives, putting services on a long-term sustainable footing and closing the gap between resources and demand.’

He also called for a more ‘nuanced’ and mature attitude towards targets and indicators and said doctors’ judgement should be valued more.

Read the survey

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