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Excessive stress among juniors affects mental and physical health

Gaps in rotas and poor availability of beds and diagnostics endangers patients, say junior doctors

Louise Prime

Thursday, 01 December 2016

Junior doctors are under excessive stress, most are concerned about the impact of their role on their mental and physical health, and most have very recently worked an entire shift with no meal and too little to drink, the Royal College of Physicians has revealed. In Being a junior doctor: Experiences from the front line of the NHS’, released this morning, the RCP also reported that most juniors are worried about the impact on patient safety of rota gaps and high administrative burden.

The RCP’s survey of 498 junior doctors found that the current health and wellbeing of the junior doctor workforce is at a harmful and unsustainable level, as the challenge of working in an increasingly overstretched NHS is taking its toll. It described being a junior doctor as “intense, rewarding and challenging” but added that for too long, “being a junior doctor has felt like trench warfare” – bad for patients, doctors and the NHS. But, the College said: “this urgent situation is fixable”. And despite the problems, most junior doctors said they feel valued by their consultant (94%) and by the patients they treat (96%).

The study found that four in five (80%) junior doctors regularly experience excessive stress because of their job, 61% say their job has an adverse impact on their mental health, and over half (54%) that it had a negative impact on their physical health. More than half (56%) said they had gone through at least one whole shift in the past month without eating a meal, and nearly three-quarters (74%) without drinking enough water.

Almost all (95%) junior doctors were worried about the impact of rota problems on patient safety in their place of work – 69% work on a rota with a permanent gap, and 53% said the impact of junior doctor rota gaps on patient safety is ‘serious’ or ‘extremely serious’. They were also worried about the effect of gaps elsewhere, such as in consultant and nursing rotas. Furthermore, nearly one in five junior doctors (18%) reported working at a level above their career stage.

The RCP uncovered serious concerns among junior doctors about the effect of other factors on patient safety: 41% said the burden of excessive administrative work poses a serious risk to patient safety in their hospital, 58% were worried about lack of available hospital beds, and 61% believe that poor availability of out-of-hospital care – such as primary care and social care – is having a serious or extremely serious impact on patient safety. Nearly a quarter (24%) of junior doctors said a lack of diagnostic services out-of-hours was having a serious or extremely serious impact on patient safety; only 17% were concerned about in-hours access.

Dr Carol Postlethwaite, chair of the trainees committee of the RCP, said: “For too long, being a junior doctor has felt like trench warfare. This report exposes trainees’ experiences and explains how recurring institutional failures to care about their health, welfare and training needs have damaged morale and are forcing many away from the front line. We see this in daily rota gaps where there are simply not enough doctors to provide safe patient care. This report shows what trainees on the front line think … They should be heard and listened to – because it also shows how brilliant the job can be and that this urgent situation is fixable.”

RCP president Jane Dacre added: “Poor access to even basic facilities, gaps in rotas and the constant pressures of administration, often taking them away from treating patients, is having a stark impact on the mental and physical health of our junior doctors … We need to fund our NHS and social care services so that all staff are able to provide safe and effective care, but also have the ability to thrive.”

The RCP also today published Keeping medicine brilliant’, a supportive document to provide consultants, hospitals, and trusts with in-depth guidance, and a foundation on which to create positive, practical and tangible resources to help trusts and senior NHS leadership improve the working conditions of doctors working in acute settings.

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