College calls for workplace improvements to be priority for new government

College calls for workplace improvements to be priority for new government

Latest data from doctors show that the NHS is at growing risk of losing critical senior staff unless the new government urgently prioritises action on poor working conditions and retention. 

The Royal College of Physicians of Edinburgh, Royal College of Physicians of London and Royal College of Physicians and Surgeons of Glasgow have today (11/07) released the findings of their latest UK consultant physician workforce census. It reveals overwhelming workloads, poor IT equipment that saps doctors’ time, widespread staff vacancies and plummeting job satisfaction. 

The census revealed that nearly two in five (39%) UK consultant physicians say they have an excessive workload almost all or most of the time, while almost one in a five (18%) ‘almost never’ feel in control of their workload.

Almost half of UK consultant physicians surveyed (47%) reported that enjoyment in their job had decreased over the last year – with clinical workload, poorly functioning IT equipment and staff vacancies cited as the top three reasons, followed by a lack of administrative support and lack of capacity in social care to discharge patients in a timely manner.

The three royal colleges of physicians, representing over 60,000 doctors, say the census makes clear that retention, including efforts to improve working conditions for staff, must be a key priority for the new government.

Key findings of the latest annual physician survey:

• There continue to be consultant physician vacancies: 59% of UK consultant physicians reported that they have at least one consultant vacancy in their department.
• Consultant physicians are frequently seeing gaps in the trainee rota: 62% reported daily or weekly trainee rota gaps when on acute duty over the past year.
• Consultant rota gaps are impacting patient care: 69% felt that consultant physician rota gaps were having a negative impact on patient care, with reduced access to outpatient care , increased length of stay, the care of inpatients out of hours and delays in diagnosis the most commonly cited impacts.
• Rota gaps are impacting consultant physicians’ ability to supervise and train others: when asked whether rota gaps at consultant or trainee level were having a negative impact on their ability to supervise and train others, 32% said a lot, 41% said to some extent, 16% said a little and 12% said no impact. 
• Consultant physicians continue to manage significant workloads: almost a fifth (18%) said they almost never feel in control of their workload. Only 36% said they feel in control of their workload most of the time or almost always. 
• Consultant physicians continue to work beyond their job plans, with over half of respondents (52%) saying that their job plan does not adequately reflect all of the work that they do, compared to 48% who said that it did. On average, full-time consultant physicians are contracted to work 11 programmed activities (PAs) but work 12 PAs, while those who work less than full time are contracted to work 8 PAs but work 8.5.
• Unmanageable workloads are impacting the training and supervision of doctors: The top three things that were squeezed out of a week when things get too busy were continuing professional development, quality improvement activity and education, training and supervision of doctors (of all grades, including appraisals).
• Consultant physicians feel stressed at work: 14% of UK consultant physician respondents said they were very stressed at work. 55% said they were somewhat stressed at work.
• Better IT, reduced clinical workload and a bigger workforce would most improve work satisfaction: When asked to select the top three things that would improve work satisfaction, improved IT systems, reduced clinical workload and increased workforce/fewer gaps were most commonly cited. 
• Less-than-full-time and flexible working continues to grow: just under a third (32%) of UK physician consultants said they work either flexibly or less than full time. This breaks down into 46% of female consultants and 21% of male consultants. The majority of men working less than full time are over 60 years of age.
• Most UK consultant physicians undertake educational and clinical supervision, but the time allocated is not always sufficient: 85% said they undertook educational or clinical supervision. Of those, 94% said they supervised doctors in training, 41% said they supervised doctors not in a training post and 41% said other health professional. 61% said they had time in their job plan to undertake this supervision, and while 65% of those said the time was adequate, 35% said it was not.

Commenting, Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh said:

The census highlights that the UK continues to operate with too few doctors. This puts a strain on our medical workforce, through increased workloads and rota gaps, leading to stress and burnout in many instances. 69% of consultants feel stressed at work, for example. 

A focus on the recruitment and retention of doctors is of course vital – but this means little without serious investment in public health. A strategy for health-promotion activity and the avoidance of ill-health and health inequalities is much-needed. 

During the general election, we called on the new government to introduce a range of measures, including legislating to restrict advertising on TV and online for products high in fat, salt or sugar; extending the “sugar tax” and introducing a sugar and salt reformulation tax to change the fiscal incentives in the food system to better support healthy diets; and introducing minimum unit pricing on alcohol, as Scotland and Wales have done. 

The new government should follow through on proposed new legislation making it an offence for anyone born on or after 1 January 2009 to be sold tobacco products.

Dr Mumtaz Patel, vice president of education and training at the Royal College of Physicians of London, said:  

The medical workforce is the lifeblood of the NHS. While we must train more doctors to meet demand, retaining the staff we already have is critical to getting our health service back on firm footing and delivering many of the new government’s promised commitments on the NHS.

Right now, we have dedicated staff working in a health service which simply doesn’t work for them. They are overworked, undervalued, job satisfaction is falling and many are clearly becoming disenfranchised.  Unless we urgently improve working conditions, we face losing many of our brightest and most committed.

The findings of our latest census show the new government must prioritise retention. From improving NHS IT systems and affordable childcare to embracing flexibility and getting the basics right, there is much that would make a difference. We need to urgently alleviate pressure - boost doctor numbers to close rota gaps and reduce the clinical workload to manageable levels.

The census also revealed widespread vacancies with 59% of UK consultant physicians reporting at least one consultant vacancy in their department, while 62% reported daily or weekly trainee rota gaps. Worryingly, 69% said gaps in consultant physician rotas were having a negative impact on patient care. 
It also showed that the country’s consultant physicians are over-committing in an effort to meet increasing demand. Those working full time are delivering on average one more programmed activity (PA) than contracted, such as providing direct clinical care, while those who work less than full time are contracted to work 8 PAs, but say they work 8.5.

Mike McKirdy, president of the Royal College of Physicians and Surgeons of Glasgow said: 

The NHS as we know it cannot survive without a strong workforce, we rely on the doctors working today and those who will join the health service in the near future to turn the tide on long waiting lists and backlogs. It is important that our new government reflects their value and recognise their contributions and sacrifices through workforce planning that has wellbeing at its core.  

With this, we must also ensure that the NHS is ready to welcome the influx of new doctors that will come from an expansion in medical school places. To do this we must prioritise retention.

At present, training is under significant pressure and relies on our ability to make sure experienced consultant level doctors remain in the NHS as our clinical educators and trainers. That 59% of consultant physicians reported at least one consultant vacancy shows the pressure on our ability to deliver care and prepare our next generation of doctors to move to consultant level positions. 

We strongly urge as a first action that the new government seriously address the ongoing crisis in the NHS workforce, which any reform in our health system will depend upon. However, as we learned earlier this year, the future of health is dependent on more than just the functions of our health service. More often, doctors in the NHS are seeing patients with preventable illnesses, worsening due to social harms. This government must take urgent action to tackle health inequalities, including reversing the trajectory in rising obesity cases, to improve the health of our people and communities.