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Doctors’ wellbeing still not being taken seriously enough, says GMC

Good practice is out there, but inconsistently applied; and in a system under so much pressure, critical that more is done for sake of recruitment and retention

Caroline White

Friday, 15 November 2019

Existing good practice on doctors’ wellbeing is still not being applied widely enough, to the detriment of their own health and patient care, finds a report* from the professional regulator, published today.

It is the third major report looking at how doctors can be better supported in delivering patient care in the UK’s pressured health systems, the General Medical Council (GMC) has commissioned.

The latest NHS staff survey found that stress levels were at a five-year high, with 40% of respondents reporting work-related stress within the past 12 months.

For this report, the GMC asked organisational psychologist Professor Michael West and clinical psychiatrist and leader in mental health Dame Denise Coia to look at the root causes of poor wellbeing, and how this is being addressed in both primary and secondary care.

They heard evidence from clinicians working across a range of disciplines around the UK.

Many individual employers and clinical teams have already taken on board the importance of doctors’ health and wellbeing, the evidence shows.  

But Professor West and Dr Coia believe that the UK health service could become a world leader in creating workplace cultures that support doctors’ core work needs if these solutions were more consistently applied.

They recommend ‘compassionate leadership’ approaches, which give doctors more say over the culture of their workplaces; adopting minimum standards of food and rest facilities; and standardising rota designs which take account of workload and available staff.

The report also makes a series of recommendations for health service leaders to improve team-working, culture and leadership, and workloads.

The GMC has accepted the recommendations made and pledged to work with other leaders to help introduce them.

“We can’t simply go on the way we are, loading more responsibility onto doctors already struggling to cope. Where workloads are excessive, patient care suffers,” emphasised Professor West.

“We heard some astonishing stories, of doctors being denied leave for a relative’s funeral and sleeping in their car, too exhausted to drive home from a shift,” he said.

“But we also saw examples of good practice and compassionate leadership; places where staff engagement works well, and ideas are listened to and acted on. It’s these that should be shared and replicated more widely,” he insisted.

The report authors found that creating supportive, safe and inclusive working environments was key, and that doctors – in common with all workers – have an ‘ABC of core needs’ if they are to remain well and stay motivated while at work.

These are: autonomy/control over work lives and the need to act consistently with work and life values; belonging – the need to be connected to, cared for and care for others in the workplace ─ and to feel valued, respected and supported; competence – the need to experience effectiveness and deliver valued outcomes, such as high-quality care.

Charlie Massey, the GMC’s chief executive, commented: “Medicine has always been a high-pressure career, but doctors are telling us that the demands on them are now so great they risk becoming unmanageable. As a result, their own health suffers, and patient care is compromised.

“Solutions are not easy, but this report shows that there are already many examples of great practice to build from. As a regulator, we will use all our influence and powers to support doctors and medical students.”

He added: “Doctors need to feel they are part of a just and compassionate culture. They must receive appropriate and consistent support.”

Suzie Bailey, director of leadership and organisational development at health think tank, The King’s Fund, said that it was a “sad irony” that working for the health service can be bad for the health of its own employees. Many of the conclusions could apply to any staff group working in the NHS, she added.

“Health and care services are facing a workforce crisis with 100,000 vacancies in English NHS trusts alone. As well as recruiting more staff, it is crucial that services hold on to and develop the staff they already employ.

“Improving staff health and wellbeing will require action at all levels, starting with the basics. It is clearly unacceptable for staff to be working shifts where they can’t access food or water, or go to the toilet.”

“As well as managers and leaders of organisations creating more supportive cultures, NHS national bodies need to model the compassionate and inclusive behaviours needed to support the at least 1.5 million people working in the NHS across the UK.”

British Medical Association (BMA) council chair Dr. Chaand Nagpaul said that years of underinvestment, a perpetual lack of resources, and a workforce crisis had taken their toll on the mental health of doctors.

“There is a worrying cycle at play as the mental health crisis among the workforce, and resulting absenteeism, places further pressure on the system and staff - patient care and performance inevitably suffer,” he added.

“Employers have a duty of care to ensure a healthy work environment and we would like to see the swift implementation of the BMA Mental Wellbeing Charter across the country to ensure a caring and supportive environment,” he said.

“While medical schools and trusts have a key role to play, the government has a significant responsibility to invest in the NHS to alleviate the unsustainable pressure on services which is pushing doctors beyond their limit.”

*Caring for doctors, Caring for patients. A report commissioned by the General Medical Council, November 2019.

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