The general public will not be aware of how difficult it will have been for the reporter to persuade doctors to talk, and e named, but over the last few years their natural reluctance to “let their Health Service” down has been eroded. The “truth” needs to be heard and they appreciate this, but there are still far too few of them willing to speak out. If only the directors, CEOs and Chairmen would have the same courage and honesty.. It is most unfortunate that there is no plan… and for the new consultants contract: inactivity and stalemate. A gradual decline in state standards seems inevitable, in contrast to private .. And of course we are going to Reduce NHS reliance on migrants.
Emma Thelwell reports for BBC news on the views of 5 doctors questioning their professional direction and altruism.
‘I can’t imagine being a doctor for five more years’
Should patients be worried that poor morale among doctors is putting them at risk?
The General Medical Council has taken unprecedented steps to warn there was “a state of unease within the medical profession across the UK that risks affecting patients as well as doctors”.
Five doctors speak about their experiences.
Worried I’ll miss something: London GP Dr Eloise Elphinstone, 31, says she feels “very demoralised and pressured in the current climate”.
“I work incredibly long hours to ensure patients get the treatment they deserve, but sometimes to the detriment of my own health.
“I worry that I may miss something, being so tired by the end of a 12 hour day. I feel it’s such a shame as it is an incredibly rewarding job on a good day.
“However, even over the last year the pressures are getting greater and greater and I feel we can provide a less good service.
“It has even got to the point that I have private health insurance for myself and my family as I worry that the NHS can not provide a timely service anymore with the pressures.
“I’ve also started looking to work in other environments – with the military or privately – where you get longer appointments with patients and the pressure is less…
“I also feel ashamed to say that a relative is thinking of training as a doctor, and I have been very reluctant to encourage this.”
Extremely Disheartening: Dr Kalpa de Silva, 35, a final year cardiology registrar from London, says the “unstinting” belief in the NHS he had when he left medical school “has been whittled away”.
A slew of government interventions have seen the training system “eroded”, and most proposals under Health Secretary Jeremy Hunt – leading to recent strikes by junior doctors in England – have “degraded morale even further,” he said.
“The way the whole saga has been portrayed by the government and, more worryingly by the media, has been extremely disheartening,” he said.
“I work days, and nights, seven days a week, on a rota, as do all of my colleagues, and many hospital specialties do the same…
“Whilst I do not ask for a pay rise, I am frustrated that I will be financially less secure despite the number of years I have worked and trained for.”
He added: “As cliched as it sounds, I work for my patients… no matter what happens I will do my utmost to deliver the best care that is possible.”
“I do however, think that overtime, a workforce that is disenchanted and disillusioned will inevitably be less inclined to work the extra hours, and go the extra mile…which would be a sad thing to see.”
Taking Breaks from Work: Dr Andrew Bull, from Bristol who qualified nine years ago, says he has had to take breaks from work due to low morale.
A GP for just two years, he says: “Gradually I am enjoying my career less and less. I originally thought I would be a doctor for 40 years but now I struggle to imagine being a doctor beyond five more years.
“The low morale has complex causes but most doctors chose this job for the satisfaction it gives rather than for the money. Take away the satisfaction and we are not left with much from our career.
“I’ve had a couple of breaks from work to help get my enthusiasm back. It worked – it’s useful to have a break, some people have enough and retire early.
“I’ve worked in Australia – it’s another health system, you realise the NHS isn’t as bad as everyone makes out. Outside the UK, many countries are jealous of the NHS. There are so many things it can do that the rest of the world can’t.
“I’m thinking of working abroad again, maybe next year as things can get a bit stale. It’ll be short term to begin with – maybe a year, like I did in Australia. I’m not planning on leaving forever. My plan would be to come back.”
The Last Straw: Dr Stefan Cembrowicz, 69, former Senior Partner at Montpelier Health Centre in Bristol, said that the current generation of doctors face fresh challenges.
In the mid-1990s, he interviewed 20 of his registrars at Montpelier about a number of staff conditions, including morale.
He said: “They all had surprisingly high morale – they nearly all said their morale was eight out of 10. Why? Well they were a capable, high calibre bunch, but it was because they were looking forward to a good career.”
Twenty years later, there is “a state of unease within the medical profession”, the GMC has warned.
Dr Cembrowicz said: “As I understand it, the junior doctors’ problem isn’t money, it’s the rota. What you have is a very hard pressed workforce already filling in the cracks, and being asked to fill in even more gaps on the rota is the last straw.
He added: “We must cherish them because they are the brightest and motivated people in the country.”
Dr Cembrowicz pointed out that his generations of doctors were almost entirely male and did not have the shared childcare duties that they face today.
“If you change have to ask people to change their child care for rotas all the time, the sky will fall – it costs money and what’s worse is all the organising”.
An Exhausting Privilage: Dr Matt Piccaver, 38, a GP from Suffolk, maintains doctors will take the pressure first, before it hits the patients.
“Doctors just put more hours in – there aren’t really corners you can cut. You can tell them to keep their coat and shoes on to save time, that’s about it. To do the job properly you have to do all the right checks and you can’t cut corners with those.
“You keep on absorbing until you personally suffer. I’ve been a GP for 11 years and it’s an exhausting privilege – I’m knackered but I love the job”.
With morale remaining low in the aftermath of the junior doctors’ strikes, he said: “I think patients are still on our side, but in the media it’s like we are the bad guys. We seem to be vilified in the press – it’s reduced the perception of it being an attractive career.
“No one wants to be a GP anymore, no one wants to work – unbelievably – in paediatrics, or A&E.
He said the NHS was being “set up to fail” by the government, which is not giving it enough money in the face of rising patient numbers.
“The government needs to shape society around a world where one in three of us is elderly. They need to invest in social and community care – and give us adequate funding for the job, we need to attract people to it and get away from this toxic, awful feeling”.
Andy Cowper reports – A view to a plan? ( BMJ 2016;355:i5583 )
The Care Quality Commission has warned that the NHS is on the verge of a “tipping point.” But one of the key rescue plans for providers may be undeliverable, finds Andy Cowper
For almost all the wrong reasons, NHS performance is scarcely out of national news headlines. The State of Care report just published by the Care Quality Commission (CQC) outlines a system having to deal with a record 23 million emergency department attendances and six million hospital admissions in 2015-16. 1
The CQC chief executive, David Behan, identifies falling and failing social care provision and pressures in primary care as key contributors to problems with NHS performance. “[They] are now beginning to impact both on the people who rely on these services and on the performance of secondary care. The evidence suggests we may be approaching a tipping point,” he said……
Hugh Pym reports for BBC 27th October 2016: Doctors, the BMA and ministers – the state of play
The Evening Standard: Harley Street gets a new proton beam cancer unit splitting investors
Reduce NHS reliance on migrants, HEE told – Abi Rimmer in BMJ Careers 14th October 2016 but Wales has differing ideas. They began in 2002, and have continued to fail. In 2006 – Rhodri: There’s no GP crisis looming – Wales Online – and now “financial Incentives” are needed despite refusing 9 out of 11 applicants to medical school for decades…
The Guardian 28th October: We mustn’t stop doctors in the UK giving us a dose of the truth