With workforce challenges now a key concern, NHS leaders need to act swiftly to attract and retain staff. In the case of doctors in training, this means addressing the non-contractual issues driving low morale.
One year on from the contract dispute, the 2016 terms and conditions of service have now been implemented for the majority of doctors in training in England. However, a wide range of non-contractual issues remain to be tackled. This will need concerted effort from trusts, central bodies and the medical profession itself.
Some of these issues are complex, deep-seated and will require sustained coordinated action for example tackling rota-gaps, particularly in rural areas and improving the quality and flexibility of training.
The wheels are beginning to turn with the increased involvement of trainees in the national debate helping to identify and take early steps in the right direction.
The wheels are beginning to turn with the increased involvement of trainees in the national debate helping to identify and take early steps in the right direction.
Making progress
Earlier this year Health Education England (HEE) published a progress report on actions that it is working to address including reviewing the annual review of competence progression (ARCP) process. Many find the current process very onerous and unrewarding. NHS Improvement is now monitoring trusts adherence to the publication of rotas 6 weeks prior to start date, as delayed release has a major impact on doctors work-life balance. This should help to ensure that doctors do get their rotas in good time.
More recently, the Care Quality Commission (CQC) has asked medical royal colleges to produce standards on safe workloads for junior doctors whilst the General Medical Council (GMC) has provided greater flexibility for less than full time trainees wishing to do locum work.
Other concerns are more about practicalities of the working environment – things that provider trusts can address. Working with the medical royal colleges and the British Medical Association (BMA), doctors have recommended actions that can be taken to improve these issues.
If the NHS is to develop the medical workforce that it needs to meet its future demands, then trusts must show junior doctors that they are valued and empower them to do the job they love.
If the NHS is to develop the medical workforce that it needs to meet its future demands, then trusts must show junior doctors that they are valued and empower them to do the job they love.
Practical actions
In response to the views of junior doctors, NHS Providers, The Faculty of Medical Leadership and Management, and NHS Improvement have worked with trusts to discuss what practical things can be done immediately. The outcome of these discussions is Eight high impact actions to improve the working environment for junior doctors.
It draws on the Royal College of Physicians’ ‘Being a junior doctor’ and ‘Keeping medicine brilliant’ reports, the Royal College of Psychiatry’s ‘Supported and valued’ report and the latest research on issues such as wellbeing and sleep. Input was provided by the BMA Junior Doctor Committee and the Emergency Medicine Trainees Association and actions have also been tested with frontline organisations.
The eight practical actions – each accompanied by potential solutions – are:
o Tackling work pressure
o Promoting rest breaks and safe travel home
o Improved access to food and drink 24/7
o Better engagement between trainees and the board
o Clearer communication between trainees and managers
o Rotas that promote work-life balance
o Rewarding excellence
o Wellbeing, support and mentoring
Whilst these actions may seem obvious to many, the unfortunate reality is that they are not delivered ubiquitously and, even worse, there are junior doctors that would not expect them.
This cannot go on – which is why it’s hugely encouraging that the new resource has wide support – from the Academy of Medical Royal Colleges, HEE, BMA, CQC, GMC, and NHS Employers.
We’re delighted to have worked together with others to identify the most impactful, short-term actions that trusts – who want to make real progress on this – can take.
A worthwhile return
Of course, meaningful improvements will require much more: engagement locally between trusts and junior doctors, with support from senior clinicians and, in some instances, investment of resources. However, the benefits to staff engagement, performance and most importantly, patient care and reduction of harm will provide a worthwhile return.
The benefits to staff engagement, performance and most importantly, patient care and reduction of harm will provide a worthwhile return.
This new resource adds to the existing case studies of action taken by trusts to improve engagement with junior doctors. What is reassuring about both of these resources is the many examples nationwide of senior clinicians and managers empowering junior doctors to drive change, delivering positive results.
So yes, the wheels are slowly beginning to turn. Yes, we still have some way to go to in addressing issues at a national level. Yes, we will need to continue to engage with and lobby system leaders through the royal colleges and the BMA. Yes, it is likely to be some time before we see meaningful results.
But in the meantime, for trust leaders and junior doctors who want to work together at a local level to improve working environments – here’s a starter for eight.
This blog was co-authored by Sumeet Hindocha, clinical oncology registrar and former Faculty of Medical Leadership and Management national medical director’s clinical fellow at NHS Improvement, and Dame Gill Morgan, chair of NHS Providers.
Read our the full report - Eight high impact actions to improve the working environment for junior doctors.
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