Disregarding staff wellbeing will compound NHS workforce pressures
Fatigue and burnout are amplifying workforce pressures across the NHS, addressing this will require compassionate NHS leadership that prioritises wellbeing.
In 2019, the General Medical Council penned a report entitled Caring for Doctors, Caring for Patients. The report provided detailed guidance and protocols designed to guide health service leaders with a roadmap, allowing them to support clinicians by prioritising wellbeing, thus enabling them to provide the highest quality patient care.
Despite the unquestionable importance of its findings, this report is largely unread, unacknowledged and certainly not implemented. This lack of engagement raises issues that stretch far beyond individual emotional wellbeing and are likely, in fact, to affect clinicians’ abilities to deliver the safe care demanded and expected of them.
How can we be sure that our surgeons can deliver the best, and safest, level of care when they are suffering with fatigue, with no place to rest even when on-call? A recent survey by Confederation of British Surgery — the UK’s only trade union representing surgeons and anaesthetists across all specialities — revealed significant oversights by trusts that have neglected to follow the guidance and proposals set out in the GMC’s report.
The original GMC report emphasised the need for organisations to consider doctors’ wellbeing as the cornerstone of their practice. This would help nurture compassionate leaders who promote wellbeing and increase recognition of the fact that workplace stress profoundly affects quality of care.
There is an undeniable link between stress and medical performance. Doctors with prominent stress levels are between 45 per cent and 65 per cent more likely to make a major medical error; these are statistics that simply must not be overlooked. But with fewer than one in five clinicians surveyed by Confederation of British Surgery even aware of the report’s existence, how will clinicians know what they are to be expected to ‘put up with’ and what is fundamentally flouting official guidance?
Trusts must show more leadership on mental wellbeing. Out of the hundreds of medics surveyed as part of Caring for Doctors, 91 per cent stated that their trusts do not have a programme in place that recognises overload, and 85 per cent said there was no policy or best practice guideline that addressed fatigue and its fundamental risks.
From a practical perspective, significant improvements can be made. Four out of five of the clinicians surveyed outlined that there was no place to sleep when on-call, and just 11 per cent of trusts implement the official NHS Employers Good Rostering Guide (guidance for best practice in planning shifts rotas), with a further 24 per cent responding that their trust definitely did not. Worse still, 65 per cent were not even aware if their trust adhered to best practice when allocating shifts.
Amplifying existing workforce pressures
It costs over half a million pounds to train a doctor; a profession that should be one to continue for life. And yet, according to the GMC’s report, doctors’ workloads, unsympathetic workplaces and subsequent burnout through stress are all contributing factors to increasingly poor levels of retention. From a financial perspective, surely greater priority must be placed on looking after the experienced clinicians we already have.
It is rather shocking that when a comprehensive report focusing on staff wellbeing was published over a year ago by the official regulatory body for all medics, less than one in five in our profession – to this day – even know of its existence. Crucially, the publication focused on the need for collective and compassionate leadership and practical provisions to ensure the delivery of safe care, yet very little of it (if any) appears to have been implemented.
Caring for Doctors, Caring for Patients also stresses the importance of using feedback to ensure that doctors and clinicians have effective clinical, educational and pastoral support that helps them to thrive in their roles. In primary care, this would be in the form of a peer mentor or coach, yet 86 per cent of those surveyed responded that feedback was not sought from them in terms of compassionate leadership. Further, 83 per cent of surveyed clinicians stated that trust management had not approached them for feedback regarding how concerns are tackled, and fewer than 14 per cent approached feedback on the service provision and efficiency of their unit.
A crucial recommendation in this largely ignored report from the GMC is regarding compassionate leadership. As stated in the report: “leadership and boards of health providers should introduce key performance indicators for compassionate leadership and should review feedback from doctors and other healthcare staff to assess if leadership is compassionate and collective.” The fact that only one third of clinicians surveyed agreed that leadership was encouraged to be compassionate is a damning indictment of how the NHS prioritises staff wellbeing.
As Consultant plastic surgeon and President of the Confederation of British Surgery Mark Henley said the results of this survey highlight a very real danger to patient safety. Mark asked: “How can a depleted, demoralised and overwhelmed workforce, bogged down by blame culture, possibly deliver safe care? If they are not offered the opportunity to give feedback, or even so much as a place to rest, it is clearly not humanly possible. There doesn’t seem to be much of a leadership at the helm, let alone a compassionate one.”
With this blatant disregard for guidance and protocols that should serve to ensure efficiency, safety and wellness, how are our doctors meant to thrive, let alone look after patient welfare alongside their own? Trusts need to pull together to protect clinicians, giving them opportunities for discussion and feedback to help limit the possibility of burnout, alongside implementing a support pathway, debriefing procedures and remediation where doctors are experiencing difficulties.