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Doctors believe patient care has worsened

BMA survey reveals widespread concern

Jo Carlowe

Thursday, 20 September 2018

Doctors are increasingly expected to provide patient care in unsafe environments, a new survey finds.

Moreover, doctors believe patient services have worsened and national targets are prioritised over the quality of care.

Today, the British Medical Association (BMA) has published the first phase of a major project, ‘Caring, Supportive, Collaborative,’ aimed at finding solutions to the challenges faced by the NHS.

Launched in early 2018, the project is engaging doctors across the UK in an open conversation about their daily working experiences and what they want the NHS to look like in the future.

Over recent months, almost 8,000 doctors - junior doctors to GPs and hospital doctors - have provided their accounts of working life across the NHS in a major survey conducted by ICM on behalf of the BMA.

The results are stark: they suggest poor lines of communication and organisational divisions between general practice and hospitals is undermining patient care. In addition, a lack of IT support is holding back efforts to encourage collaboration and greater innovation.

This, doctors say, is contributing to a vicious cycle of low morale, doctors leaving the NHS, an inability to recruit and widespread vacancies which go unfilled.

The project is the brainchild of BMA Chairman, Dr Chaand Nagpaul.

He said: “It is vital that the government and policymakers heed the views of all doctors who provide care at the coalface; they are in the best place to know the problems the NHS faces on a daily, hourly basis. They know the scale of impoverishment in the NHS is staggering. They are working in a culture which has improved little since the publication of the Francis and Berwick reports following the tragedies in Mid-Staffordshire five years ago.

“Doctors experience challenges of trying to provide safe patient care when there is poor staffing, gaps in rotas, lack of adequate facilities and where a persistent culture of blame stifles learning and improvement.”

The survey also reveals that 95% of doctors are fearful of making a medical error and that the level of fear has increased over the past five years. Nine out of 10 doctors say one of the main reasons for making errors is pressure and lack of capacity in the workplace.

As well as a culture of fear and blame, the survey showed that Black and Asian Minority Ethnic (BAME) doctors remain disadvantaged by the NHS. Only half of BAME doctors feel respected or culturally included in their place of work. They talked of experiencing unconscious racism in everything from job progression to training and patient interaction.

Dr Nagpaul said: “BAME doctors make up more than a third of the medical workforce and play a vital role, day in day out, delivering care to patients across the country. Yet despite their commitment they’re more likely to face referral to the General Medical Council, are more likely to have their cases investigated and are more likely to face harsh sanctions following an investigation. Only 7% of very senior managers are from BAME backgrounds.

“BAME staff in the NHS workforce as a whole are more likely to experience bullying, harassment or abuse from other staff. Differential achievement in exams and poorer career progression are another worrying factor, and with independent research showing that this is not related to any lack of ability. In the 21st Century, that is not acceptable.”

Commenting, a Department of Health and Social Care spokesperson said: “We want the NHS to be the safest healthcare system in the world and have introduced major reforms to improve patient safety including a comprehensive inspection regime so the NHS can rapidly improve care where necessary and ensuring staff are empowered to speak out about mistakes and learn from them.

“There are near record numbers of staff working in the NHS, including 39,000 more professionally qualified clinical staff on our wards since 2010. We are expanding training places for doctors by 25% and as part of our long-term plan to improve care and patient safety, are investing an extra £56 million a day into the health service by 2023/24.”

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