Caring for Doctors, Caring for Patients

This report was commissioned by General Medical Council to carry out a UK-wide review into the factors which impact on the mental health and wellbeing of medical students and doctors. GMC wanted to look into the issues about the environments in which doctors work, and the impact of systems pressures on medical practice.

The report was published in November 2019.

The report identifies a need to address the wellbeing of doctors faced with higher workloads, whose own health impacts on patient care.  The report identifies eight recommendations (under 3 broad headings) to support the wellbeing of medical students and doctors, and enable them to deliver safe, and good, patient care.

Recommendations

Autonomy/control – the need to have control over our work lives, and to act consistently with our work and life values.

  1. Voice, influence, and fairness: To introduce mechanisms for doctors in primary and secondary care to influence the culture of their healthcare organisations, and decisions about how medicine is delivered.

How: Clinical leaders and managers should consult doctors (and other healthcare staff) and gather feedback about how healthcare teams are established and maintained, how their work is organised and delivered and the response to concerns to ensure a focus on learning not blame.

  • Work conditions: To introduce UK-wide minimum standards for basic facilities in healthcare organisations.

How: All healthcare employers should provide all doctors with places and time to rest and sleep, access to nutritious food and drink, the tools needed to do their job and should implement the BMA’s Fatigue and Facilities charter.

  • Work schedule and rotas: To introduce UK-wide standards for the development and maintenance of work schedules and rotas based on realistic forecasting that supports safe shift swapping, enables breaks, takes account of fatigue and involves doctors with knowledge of the specialty to consider the demands that will be placed on them.

How: NHS England, NHS Wales, NHS Boards in Scotland, and the Department of Health (Northern Ireland) should fully implement the BMA’s and NHS Employers’ Good Rostering Guide in all healthcare environments.

Belonging – the need to be connected to, cared for, and caring of others around us in the workplace and to feel valued, respected, and supported.

  • Team working:  To develop and support effective multidisciplinary team working across the healthcare service.

How: All healthcare organisations should review team working and ensure that all doctors are working in effectively functioning and, ideally, multidisciplinary teams. The teams should have a shared purpose and clear objectives (one of which is team member wellbeing). Team members should be clear about their roles and meet regularly to review their performance, including inter-team/cross-boundary working. Quality improvement should be a core function of all teams.

  • Culture and leadership:  To implement a programme to ensure healthcare environments have nurturing cultures enabling high-quality, continually improving, and compassionate patient care and staff wellbeing.

How: All UK healthcare organisations that have not already done so, should start and implement a programme of compassionate leadership across all healthcare sectors; and they should obtain feedback from doctors and healthcare staff to evaluate its effectiveness. It should include mechanisms to ensure clinical leads and other leaders of doctors at all levels in the healthcare system are recruited, selected, developed, assessed, and supported to model compassionate and collective leadership.

Competence – the need to experience effectiveness and deliver valued outcomes, such as high-quality care.

  • Workload: To tackle the fundamental problems of excessive work demands in medicine that exceed the capacity of doctors to deliver high-quality safe care.

How: All organisations that oversee the work of doctors should undertake, in collaboration with doctors, a programme to review workload in their organisations. This will help them to use resources in the most efficient way, to ensure workloads do not exceed doctors’ ability and capacity to deliver safe, high-quality care. Initiatives are underway across the UK to increase staffing numbers and this should be supported by additional solutions including, but not restricted, to:

  • A programme to deploy and develop alternative roles to enable doctors to work at the top of their competence, supported by effective multidisciplinary team working in all areas of healthcare, and to support doctors to return to work after a break in practice.
  • A review of new technologies being used in UK healthcare systems to increase efficiency, working with the voluntary sector, and focusing on preventive care. 
  • A programme of process improvements that increase productivity especially by supporting communication in regular team meetings between healthcare staff
  • Management and supervision – to ensure all doctors have effective clinical, educational, and pastoral support and supervision to thrive in their roles.

How: All organisations that employ doctors should ensure:  

  • Each has a well-trained line manager supporting them to perform their roles effectively and ensuring their basic work needs are met. They should also obtain feedback to ensure this is in place (in primary care, this might be a peer mentor or coach).  
  • Management, support, educational and clinical supervision are included in the job plans of those in such roles, and their workloads are balanced to ensure protected time to provide these functions.
  • Training, learning and development – to ensure the systems and frameworks for learning, training, and development:  
  • Promote fair outcomes.
  • Are sufficiently flexible to enable doctors and medical students to grow and develop throughout their careers and to better manage their wider life circumstances.

How: Approach and practical solutions could include: a.  Monitoring using established (academic, peer-reviewed) measures. B.  Improvement, development, and implementation of the GMC’s NTS (National Trainee Survey) to ensure high-quality measurements across all areas.

Charlie Massey, the GMC’s Chief Executive, said:

‘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.’

Charlie Massey added:

‘Doctors need to feel they are part of a just and compassionate culture. They must receive appropriate and consistent support.

‘For patients to get the care they need doctors must work and train in safe, supportive and inclusive environments.’

Reference

  1. https://bit.ly/3gobZUj
  2. https://bit.ly/3ejGclH

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