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The GMC report: Caring for doctors, Caring for Patients - Dr Mark Burgin

04/12/19.This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

Dr. Mark Burgin BM BCh (oxon) MRCGP reviews the GMC report on the risks posed to patients by increasingly unwell doctors in the NHS.

Signals which suggest that the NHS is becoming dysfunctional are increases in secondary care workload, healthcare staff complaining of burnout and stalling life expectancy.

The report from the GMC looks at how burnout may cause risks to patients concludes that ‘we are seeing positive change’ but is there evidence to support this opinion?

The co-chairs of the review were an expert in the organisation of health services (and author of previous reports) and a clinical psychiatrist who had ‘engagement’ with others.

There is a lack of SMART recommendations and many suggestions are too vague to have any direct impact e.g. ‘review of new technologies’.

Are ‘neglect, incivility, blaming and harassment’ and ‘workload, bullying, poor supervision, discrimination and poor team working’ symptoms or causes of the problems?

‘Neglecting the simple basics’

The report blames the NHS working conditions for damaging the health and wellbeing of doctors and suggests that Workforce Strategies such as The People Plan by NHS England solve the problems.

The ABC of core needs are Autonomy, Belonging and Competence which the report states can be achieved by following eight recommendations.

These recommendations appear to suggest that doctors are not listened to, prevented from eating, not provided with somewhere to sleep.

Many doctors do not work in teams and are unclear about their roles, the leaders lack compassion and are interested in saving and efficiency not quality.

If these criticisms are true then the victims of this regimen should be given legal advice but they seem to have little in common with the issues in primary care where the worst problems are.

The report recognises that ‘There is also an urgent need to develop and implement a staff survey across primary care in all four countries using robust, validated and peer-reviewed measures of key workplace factors affecting doctors’ wellbeing and mental health.’

Evidence for poor performance

The review considered research papers from the US looking at associations between poor performance and increased stress in groups of doctors but not on an individual level.

Stress in eighth National GP Worklife Survey in England and being unwell in 2018 NHS Staff Survey in England are not linked with worsening performance in either study.

The apparent association between failing Primary care and increasing workload in secondary care has not been explored.

The link between patient safety and doctor’s wellbeing is plausible but there is little direct evidence despite the conclusions in the report.

The reports of increased RTAs in sleep deprived junior doctors appears to be limited to that group and may not explain broader problems with morale.

Improving the work environment

The solutions included ‘events’ where staff could be listened to, improving conditions at work, learning from mistakes and make suggestions.

Some solutions were directed at on call staff and recommends minimum standards for basic facilities and avoiding high risk shift patterns.

Solutions based upon reversing the changes that were made as a result of the European working time directive seem unlikely to be possible without large increases in staff.

One case study (17) described how GPs increased their list size by 72% without recognising that the GPs would have a worsened work environment as a result.

The effects of these interventions could not be assessed easily as they seem specific to the situation but there was a general recommendation which could be effective…

‘Establish a key performance indicator for effective team working and obtain and review feedback to assess if all doctors are part of a well-functioning team.’

Conclusions

My experience of working 100-hour weeks as a junior doctor and 60-patient days as a GP was generally positive despite encountering many of the issues raised in this report.

The report links problems that have existed since the beginning of the health service with the recent changes to doctors’ morale.

There is no logical or reasonable explanation of why these long-standing issues would be causing problems now, or explain the mechanisms causing burnout.

The focus on solutions lacks critical assessment of whether they are delivering long term improvements or only short-term relief.

Why doctors feel that the core needs are not being met and who is making the health service a bad place to work needs an analysis of the effects of systems such as the Triple Aim.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

Caring for doctors Caring for patients How to transform UK healthcare environments to support doctors and medical students to care for patients Professor Michael West and Dame Denise Coia

https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341

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