On 27 July 2022, Dr Gail Milligan, a GP partner in Surrey, decided to take her own life. In a tribute online, her husband wrote that she had suffered from the “overwhelming” and “unbearable pressure of her job”. While the letter shocked and saddened many as it circulated on social media, NHS professionals across the UK have seen all too many similar tragic cases before.
Poor mental health is endemic within the NHS. The British Medical Association (BMA) has reported that nearly two-thirds of doctors have anxiety or depression.
“There’s still a feeling that we’re somehow immune to stress, burnout and depression,” says Dr Will Hunter, who decided not to pursue specialist training after his foundation years. In reality, however, the suicide rate among doctors is an estimated two to five times higher than for the general population.
Many doctors are concerned with the levels of stress that are now accepted as a normal part of doing the job, with nearly half of junior doctors are considering leaving the profession altogether. Dr Janani Anbarasan, who recently finished her first foundation year, says that feeling overwhelmed at work is part of the daily experience. “A new set of doctors have just started and they’re all talking about how they cried on their first shift,” she says. “And all of our responses were that we cried so many times over [our first] year. I don’t think that should be acceptable, but it’s the norm.”
It is not surprising that medical professionals are under such emotional strain when the NHS is suffering from severe staff shortages. Dr Bethan John, a GP trainee in Liverpool, says the atmosphere of her workplace is one of desperation. “I’ve never been on a fully staffed rota,” she says. “I often get emails, texts and Whatsapp messages on the day saying, ‘Can someone pick up the evening shift tonight?’”
This staff scarcity also means that junior doctors often aren’t receiving adequate training as they try to fill the gaps. “It’s quite common to be the only person looking after a whole set of wards,” says Anbarasan. “Over the last year, there have been maybe three senior doctors who have openly welcomed me learning a new skill.”
Like many doctors, Anbarasan has made significant sacrifices for her career. Recently, she couldn’t attend her sister’s graduation as she was placed on call and no one could replace her, despite giving her NHS trust the required annual leave notice of six weeks.
Likewise, Hunter recalls similar instances of rota mismanagement. One of his colleagues “ended up on [call] the weekend of her wedding”, he says, and had to “pull favours” to find a replacement, despite alerting rota coordinators six months in advance.
Many junior doctors find their ability to provide the best care for their patients is being compromised. In Hunter’s hospital, patients who could be discharged are kept as in-patients, due to a lack of social care provision. He even says that patients with serious infections and surgical problems have been treated in waiting rooms, due to a lack of beds. “This is just not safe for anyone involved,” he says.
Sarinda Wijetunge says he resigned from being a junior doctor due to unsafe working conditions and a lack of emotional support. Doctors have to cross a significant number of “bureaucratic hurdles”, he says, which takes away from caring for the patient: “It goes against everything we stand for as doctors.” A “culture of blame” also means that healthcare workers are often pressured into performing unnecessary investigations to “mitigate the risk of missing something” rather than just doing what is necessary.
This culture of fear has been exacerbated by experiences of intimidation. Junior doctors report finding it very difficult to voice concerns to senior staff, such as consultants. The 2021 NHS Staff Survey showed that nearly a fifth – 18.7 per cent – of staff reported bullying and harassment from colleagues.
Professor Subodh Dave, dean of the Royal College of Psychiatrists, says that the communication disconnect within the NHS is not conducive to providing the best possible patient care. “We have a culture that has made [doctors] very fearful that any inadvertent slip, however minor, will be punished really severely,” he says, which prevents “safe spaces for learning”.
Doctors are also not immune to the issues facing many public and private sector workers as the cost of living continues to rise. Since 2008, junior doctors have faced an approximate 30 per cent cut in real-terms pay. Medical professionals are also expected to pay out of their own pocket on an annual basis to keep their licence to practice under the General Medical Council (GMC), and for training and exams. This month, the BMA’s Junior Doctor Committee sent a letter to Health and Social Care Secretary Steve Barclay announcing their intention to “ballot junior doctor members in England for industrial action if the government does not commit to full restoration of junior doctors’ pay to levels equivalent to 2008/09” by the end of this September.
Clearly, government intervention and funding are going to be necessary to tackle some of the systemic issues facing the NHS. Suzie Bailey, director of leadership and organisational development at health think tank The King’s Fund, emphasises the need for proper investment into staff retention, and a “national-funded workforce plan” to tackle “chronic, excessive workloads”.
The Department of Health and Social Care (DHSC) says that it is investing £45m over the next year into staff well-being, which will go towards 40 mental health hubs and other support services. It has also commissioned NHS England to develop a long-term workforce plan, and says it is tackling the doctors’ shortage, having made 1,300 more GP training places available last year and increasing the number of funded medical school places by 25 per cent between 2017 and 2020, which it hopes to see reflected in the workforce this year.
A DHSC spokesperson told Spotlight: “The health and well-being of everybody working in our healthcare system is of paramount importance, and frontline staff can get rapid access to mental health services through 40 nationwide mental health and well-being hubs.
“We are working to ease the broader pressures of all healthcare staff by tackling the Covid backlogs and growing the workforce – with 4,300 more doctors and 10,200 more nurses working in hospitals compared to last year.
“The NHS has set out further measures to rapidly boost capacity and resilience ahead of this winter, such as creating the equivalent of at least 7,000 more beds, including through innovative virtual wards.”
It is clear that if drastic changes are not made soon, the NHS staff exodus looks set to continue, says Anbarasan: “There are very few people I know that love it and want to stay in [the NHS] if it remains the way it is.”
If you are a healthcare professional living with mental health issues, you can contact Doctors in Distress, a charity dedicated to protecting mental health and stopping suicide in health workers. It is not a therapy or crisis service. Email them at: contact@doctors-in-distress.org.uk.
Also read:
Generation Burnout: how Covid-19 pushed NHS staff to the brink
Jeremy Hunt: End the “terrible blame culture” in the NHS
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