NHS implosion – On current projections 250,000 staff will be needed by next year alone

By TruePublica: Amongst all the other ‘austerity’ related disasters coming to light after years of a Conservative party who are ideologically motivated to privatising everything possible – the NHS is quietly being pushed into a deliberately managed implosion. This much is evidenced by a BMA warning just 4 months ago that the shortages of trained medical staff was now having serious consequences – “These worrying figures confirm consistent warnings from frontline doctors about the deepening workforce crisis and the impact this has on their ability to guarantee safe, high-quality patient care.” 

Then, there’s Brexit. Its chilling effect on the NHS cannot be understated. Rob Harwood, BMA consultants committee chair commented that –  “Brexit is also likely to have a profoundly negative effect on the NHS workforce, with almost half of EEA doctors telling the BMA they are considering leaving the UK, 40 per cent of whom have already made plans to go.”

There are now constant reports of the toll that the stress and pressure of being an NHS doctor is now taking. Some 14% plan to decrease their hours within the next three years, 12% will move abroad to practice and 15% plan to retire early. A further 7% expect to go part-time over this time period, 3% will move to the private sector and 1% take a career break. It means 52% would no longer be in a position to help NHS patients or will only be available for fewer hours, requiring even more doctors to be recruited.

So bad has the NHS crisis got that it is now predicted that the staffing crisis in the NHS is deepening so fast that the service could be short of 350,000 key personnel by 2030, health experts have warned. The NHS in England alone is already short of over 100,000 staff, including 11,000 doctors and 40,000 nurses.

 

However, on current trends, the analysts from three separate organisations tasked with projecting the likely outcome concluded that the gap between staff needed and the number available could reach almost 250,000 by late next year.

 

“If the emerging trend of staff leaving the workforce early continues and the pipeline of newly trained staff and international recruits does not rise sufficiently, this number could be more than 350,000 by 2030,” according to the briefing by the King’s Fund, Nuffield Trust and Health Foundation.

The stress of professionally trained medical staff in the NHS is so acute that it has raised a question about those who remain – and this question is posed in an opinion piece at the British Medical Journal.

 

By Hannah C.P. Wilson and Arabella L. Simpkin – Why are so many doctors quitting the NHS?—it’s time to ask the right questions

 

A recent report by the General Medical Council (GMC) lays out, in detail, the crisis that has been unfolding for many years in our healthcare professionals—a crisis that is now seeing the workforce at breaking point. [1] As the GMC puts it, “this is the most critical juncture in the history of the NHS“, and one that deserves our utmost attention. Why are so many doctors quitting the NHS? How do we reinvigorate one of the noblest workforces on whom so many lives depend?

Despite a relatively rosy outlook at the start of the journey—medicine remains a popular career choice with a surplus of students applying for a place, and the announcement of five new medical schools in England—there is a worrying exodus that is gaining momentum. In 2017, 57.4% of Foundation Year 2 doctors did not enter higher-training posts and 9000 doctors quit the NHS entirely. [1] In 2011, when career-destination surveys were first conducted, 71.3% of FY2 doctors progressed into higher training-posts. By 2016 this had dropped to 50.4% and last year the rates had plummeted further to 42.6%. [2] The rate of decline is near exponential. Added to this is a growing culture of quitting both across the specialities and across the generations. [1]

A multitude of factors have been put forward to try to explain what is causing the exodus. [3] Changes to junior doctors’ salaries, hours-worked, reduced investment in training, inflexibility with schedules, lack of consistent teamwork, and an understaffed service all contribute. [4] But perhaps what underpins it all, driving the discontent and dissatisfaction, is a lack of feeling valued and supported. Three out of ten doctors have said they feel unsupported by management each week, and that they feel the mentoring provided to them as part of their role has decreased. [1]

 

Further, little attention has been paid to the fact that many high-achieving doctors leave their jobs in the NHS and either enter into another highly competitive and equally intensive job, or perform the same job in a different healthcare system overseas. It is often assumed that the doctors who quit have simply “burnt-out”, with burnout, the zeitgeist of the 21st century, taking blame for the exodus of junior doctors. [5]

 

Recently, however, attention has been given to the often-limited understanding that researchers have when citing burnout as a cause. [6-8] Imagine a 35-year old cardiology registrar, their medical degree from a highly-ranked redbrick UK university, first-class honours achieved at graduation, now working at the top deanery in the UK, with a collection of first-author publications and a list of international awards. One day they write to the deanery announcing their resignation—no failed exams, no failed competencies, a plethora of excellent feedback—no warning signs to the system. They pack their bags and take their well-trained brain and highly developed skills across the ocean to embark on the same intensive career overseas treating similar patients with similar healthcare needs. Is this a doctor who is burnt out? Burnt out of working in the NHS, yes; but “burnt out” and unable to utilise their talents as a doctor … perhaps not.

Surprisingly, while there is literature that discusses both the quantity of doctors that leave the NHS and the factors that may drive them, there is no literature that discusses the attributes and characteristics of doctors that leave the NHS. [1, 9, 10] To truly understand what is driving the flight, we must first ask ourselves who are the doctors that quit? Surprisingly, exit interviews are rarely held. Yet this is critical information for the healthcare system to understand if we are to develop interventions and strategies to stem the leak. What are the characteristics and attributes of those that leave? Were these high-achieving doctors or those that struggled throughout medical school? What motivates them? What did they need that was not provided? What would have made them stay? If we can begin to understand who leaves the NHS, we can begin to identify motivations, driving forces, and perceived gaps in training programs that are contributing to the quitting and therefore suggest targeted programs to bring back the joy in this esteemed profession and enhance retention.

Seventy years ago, the NHS opened its doors to treat and to serve its population. We owe it to the countless health professionals and patients who have walked through its doors to work harder to save it. The Mayday call has gone out. It is essential that we act now and stem the tide on the exodus of the next generation of physicians. They are a critical cohort of future healthcare providers, and high-value patient care undoubtedly depends on them. It is time we quit the quitting.

 

Competing interests: The authors Hannah C.P. Wilson and Arabella L. Simpkin report no declarations of interest.

References:

1. Council GM. The state of medical education and practice in the UK. 2018.
2. Programme. UF. Foundation Programme. Career destination report. 2017.
3. Teo WZW. A Closer Look at the Junior Doctor Crisis in the United Kingdom’s National Health Services: Is Emigration Justifiable? Camb Q Healthc Ethics. 2018;27(3):474-86.
4. Rich A, Viney R, Needleman S, Griffin A, Woolf K. ‘You can’t be a person and a doctor’: the work-life balance of doctors in training-a qualitative study. BMJ Open. 2016;6(12):e013897.
5. Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol. 1986;42(3):488-92.
6. Dyrbye L. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA. 2018;320(11):1114-30.
7. Rotenstein LS, Torre M, Ramos MA, Roasales RC, Guille C, Sen S, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320(11):1131-50.
8. Schwenk TL, Gold KJ. Physician burnout—A serious symptom, but of what? JAMA. 2018;320(11):1109-10.
9. Doran N, Fox F, Rodham K, Taylor G, Harris M. Lost to the NHS: a mixed methods study of why GPs leave practice early in England. Br J Gen Pract. 2016;66(643):e128-35.
10. Lambert TW, Smith F, Goldacre MJ. Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation. J R Soc Med. 2018;111(1):18-30.

 

 

 

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