What went wrong? When I was at school in the 70s the ultimate vocations were considered to be law and medicine. Law for the ‘arts’ students and medicine for the ‘scientists’ and if you were clever and worked really hard and got good exam results, then you would be offered a place at university to study for one of these vocations and you were officially ‘set up’!
Being a junior doctor in the 80s was hard work. We worked long, long hours, we were at the beck and call of the nurses and our Consultants, we never saw our families, we were either working, sleeping, eating, or in the pub. The pay wasn’t good, there was no security as the jobs were only short term appointments and were fiercely contended and quite frankly these were the happiest days of my life!
We were proud to be doctors, we worked hard and played hard. We felt we were part of a team, a family. We spent all day and all night with the same team members, we laughed and cried together and we looked after each other.
I became a Consultant in 1993 shortly after a cap on junior doctors hours to 72 hours a week, was introduced in 1991, although this wasn’t enforced to 2000. With this new agreement, new rotations had to be quickly developed so that doctors were given more days off to compensate for unsocial hours. Juniors were hardly ever on call with their team members or their Consultants and were off for large portions of the working week. Even at that stage I became aware of an erosion of morale amongst junior doctors and the normally vibrant Drs mess’ became ghost areas.
Consultants were now being expected to cover more and more of their juniors work and in 2009 when the European Working Time Directive (EWTD) was applied to junior doctors, the hours were further reduced to a maximum of 48. There was no change in training times for juniors, so there was (and still is) huge anxiety that juniors were getting to become Consultants having only half the experience that we were getting in the 80s.
In 2005 Modernising Medical Careers was introduced which changed the emphasis from actually looking after patients, to junior doctor ‘training’ and this is what we still have now. Deaneries didn’t give a jot about patient care, the ‘training’ was the be all and end all.
Add to that changes in legislation regarding immigration in 2005 where we were expected to positively discriminate in favour of less well trained European Union doctors at the expense of highly trained Doctors from the Asian sub-continent, who had been the backbone of the NHS for many years. Many had to go home because of expiration of their visas and all of a sudden gaps started appearing in junior doctor rotas.
There simply weren’t enough junior doctors to cover all the complex rotas that had to be developed, to ensure Trusts weren’t behaving illegally in terms of making their juniors work too many hours AND also provide adequate daytime training. Of course something had to give and the extra work fell on the shoulders of the Consultants.
Then there was Harold Shipman and the Bristol Cardiac unit scandal!
Suddenly it looked like some senior doctors including GPs were behaving badly and something had to be done, so revalidation was introduced across the board.
This is a process, introduced in 2012, which provides the GMC with ‘fitness to practise’ certification for all practising doctors. It involves annual appraisals and 5 year revalidation certification and a huge amount of money is spent on it by the NHS and a huge amount of time by doctors. This is to ‘catch’ that tiny minority of Doctors who are underperforming and ironically it wouldn’t have prevented either Shipman or Bristol!
My GP colleagues feel that expectations from patients are so high and respect has all but gone. Patients demand their medications as if they were at the sweet shop, sick notes are in the ascendancy, GP hours are getting longer and longer and patients are getting older. GPs are in constant fear of being complained about and referrals to the GMC by patients is escalating. This process is in itself demoralising. It takes 6 months at least of anxiety and the vast majority of doctors are completely exonerated anyway! Morale is at rock bottom, recruitment low and the profession is on it’s hunkers.
The final twist of the knife are the political plans to extend hours for Doctors and provide 7 day working. Those in the profession look around at each other and with one voice say, ‘where are the extra doctors’?! They don’t exist.
So there we have it.
A BMA survey of GPs found that 75% of GPs had unsustaianble and unmanageable workloads and 7 out of 10 are considering leaving the profession or retiring early (http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/gp-morale-continues-to-plummet-bma-survey-reveals/20008699.article)
A shocking HCSA (Hospital Consultants and Specialists Association) survey found that over 80% of senior Hospital Consultants are considering doing the same (https://www.hcsa.com/news-views/news/2015/09/stress-survey-initial.aspx)
And now we hear that a junior doctor’s strike over the threat of a new contract is also imminent! (http://bma.org.uk/news-views-analysis/news/2015/september/pledge-to-protect-trainee-doctors)
So I fear for my family. Who is going to look after us when we are poorly? Quite frankly the guts have been drawn out of the profession. Revalidation, litigation, evisceration! Is it a wonder why so many of us are escaping the confines of the NHS? www.mywebdoctor.co.uk