Six months away from becoming a consultant, I was asked to take on extra work because the cardiology department was short of two junior doctors. I remember starting a ward round at 6.30am in order to make it on time for clinic at 9am. Some patients were asleep as I tried to acquaint myself with their problems, rewrite drug charts, order tests and fill in the myriad forms required to discharge a patient. Rota gaps in the NHS are now endemic. In my case, I was told the salary of one junior doctor had been used to pay for a much-needed specialist nurse and that the other post had not been filled due to a lack of applicants. My experience is not unique and follows a worrying downward trend in staffing levels in the NHS.
I asked Matt, a junior doctor originally from Holland, if he planned on pursuing a career in hospital medicine or general practice in the UK. He explained that he was reluctantly going to move back to Holland. He’d watched what happened to members of the Windrush generation who had lived and worked in the UK for decades – “So I worry the same will happen to people from the European Economic Area (EEA) in the future.” Many of his junior doctor colleagues were planning to take a year out to travel, and some planned to leave medicine altogether.
The past two decades have seen a seismic change in the working conditions and morale of doctors. My positive memories of working as a junior doctor in the early 2000s are not just rose-tinted nostalgia. Back then, the NHS was enjoying record investment and morale was high. In the rare case of a gap in the rota, locum doctors filled in. While junior doctors often spent a year out to work abroad or travel, they usually returned to the NHS, the consensus being that a career in medicine was fulfilling and, usually, for life.
The most alarming sign of low morale and concerns over patient safety in the NHS occurred in 2016, when junior doctors went on strike for the first time in 40 years. Jeremy Hunt, then health secretary, tried to introduce a new contract for junior doctors that meant they would have to work extra shifts to provide more “routine” care over weekends. The contract was eventually imposed and led to a significant drop in junior doctor morale. In 2018, the General Medical Council (GMC) published an independent survey of 2,602 doctors that revealed almost two-thirds are working more hours than before but with less time for continuity of care.
A survey by the British Medical Association (BMA) of more than 1,000 doctors in England revealed that 68 per cent had been asked to act up into more senior roles or to cover for more junior colleagues; 65 per cent said trainees are pressurised to work more shifts; and 80 per cent were asked to take on the workload of multiple staff.
The GMC reports that in 2017 more than 9,000 doctors left the profession entirely. A third of doctors were considering reducing their hours within the next three years, while a fifth planned to work part time and a fifth planned to leave UK practice and work abroad.
The NHS has always relied on overseas-trained doctors to boost numbers, with 7-10 per cent of its doctors coming from the EEA. A BMA survey of EEA doctors found that one in five have made plans to leave the UK because of the ongoing uncertainty over Brexit.
The GMC has issued a warning that the medical profession is “at the brink of breaking point”. To help combat the exodus of doctors from the NHS, the BMA has called for more resources, better long-term workforce planning and more training opportunities with flexible working conditions.
Ultimately, the pressures junior doctors face have a huge impact on patient safety. I tried to persuade Matt to stay in the UK, but he remained unconvinced. “We would refuse to fly if we knew that a pilot was performing the jobs of three people,” he told me. “Yet we expect the NHS to provide safe patient care with a lack of resources and, most importantly, staff.”
Nishat Siddiqi is a cardiologist based in South Wales
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This article appears in the 08 May 2019 issue of the New Statesman, Age of extremes