The state of medical education and practice in the UK: workplace experiences 2023

Executive summary

The executive summary outlines the findings in this year’s report. It shows how we’ll work with healthcare organisations to maintain high standards of patient care in the face of ongoing pressures. 

Foreword

This is a time of unparalleled pressure in the healthcare sector.

The testimony we’ve heard from doctors is stark. Workloads are up, stress-related absence and risk of burnout have increased, and large numbers of doctors feel unable to cope. This not only has a damaging impact on clinicians, but also on the patients in their care. In 2022, 44% of doctors found it difficult to provide patient care at least once a week, compared to 25% in 2021.

It’s not surprising, then, that more doctors told us they had taken steps to leave UK practice. As clinicians vote with their feet, the gap they leave behind compounds workload pressures, feeding into a vicious cycle.

The coronavirus pandemic was hugely challenging and left those who worked through it with deep-seated and painful memories, which mark them to this day. But, in many places, it also disrupted the vicious cycle and showed that things could be done differently. In 2021, 60% of doctors reported that the pandemic had had a positive impact on teamwork. 40% felt there had been a positive impact on the visibility of senior leadership. Since then, the long-term problems and pressures we observed in 2019 have returned in full force, alongside the additional demands of the treatment backlog.

Long-term actions are needed to address structural challenges in the service. Steps to better understand future workforce needs, and increase training numbers for doctors and other professionals, are long overdue and welcome. But, in the short term, our focus must be on retaining and better supporting the medical staff we already have. Without urgent changes now, the vicious cycle will intensify, patients will suffer and doctors increasingly risk burnout, fatigue, and moral injury.

We know that being part of a supportive team and having a strong sense of belonging lead to higher satisfaction and better patient safety. These protective factors must be treated as a priority now, with good practice being shared and scaled up.

While the root causes of inadequate staffing, waiting lists, and unprecedented demand are tackled on a larger scale, local changes can be made today to improve doctors’ working lives and make them feel that they belong and are valued. Improvements in areas such as fair and timely rota design, facilities for rest breaks, and provision of food and drink could make a huge difference to staff on the ground. They could also be instrumental in creating more virtuous cycles and helping us retain the healthcare professionals that we need to provide safe patient care.

While there are difficulties across the board, our research shows that certain groups report worse workplace experiences and require targeted support. Crucially, trainers face added pressures compared to non-trainers, being more likely to work beyond their rostered hours and more likely to describe their days as high intensity. It will not be possible to deliver the much-needed expansion of training capacity without both an increase in trainer numbers and concrete steps to support their specific needs. Investment in this area must be a priority as governments across the UK define plans to address longer-term workforce challenges.

Addressing these concerns requires concerted action across the UK healthcare systems. Improving doctors’ wellbeing must lie at the heart of shared efforts to bridge the gap until long-term solutions are implemented. This is crucial not only to their satisfaction and desire to remain in the service, but also to the safety of those in their care.

We are committed to playing our part in that endeavour. Whether it’s our induction programme for overseas doctors to help them thrive in UK practice, our targets to eliminate disproportionate referrals and differential attainment, or our work with employers to improve local resolution of concerns, we’re committed to improving doctors’ working lives, so they can give the best possible patient care.

Patient safety is protected when doctors feel supported. In an increasingly pressurised environment, a sustained focus on compassionate leadership and culture must be centre stage, as we navigate the challenges ahead.

Chapter 1: Doctors’ workplace experiences in 2022

Our evidence shows the resurgence of a vicious cycle of workplace pressures, with increased workloads, lower levels of satisfaction, higher risk of burnout, and more doctors taking steps to leave the UK profession, ultimately putting patient safety in jeopardy:

This has a negative impact on patients. 44% of doctors reported finding it difficult to provide a sufficient level of patient care at least once a week in 2022, up from 25% in 2021. Perceived inability to provide adequate care and ensure patient safety puts doctors at risk of moral injury. 

• GPs reported worse workplace experiences in a range of areas and only 38% of GPs’ were satisfied in their work, compared with 50% of all doctors.
• Half (49%) of trainers described at least three-quarters of their days as high-intensity, compared with 40% of non-trainers.
• 47% of disabled doctors were categorised as struggling with their workload, compared with 37% of non-disabled doctors.
• Fewer non-UK graduate doctors (65%) said they were part of a supportive team than UK graduates (78%).

Chapter 2 – Breaking the cycle in the short term 

This chapter considers how the vicious cycle of pressure can be broken, and the practical steps this might involve.

The first part of the chapter looks at how vicious cycles can be challenged through creating positively reinforcing ‘virtuous cycles’, such as by helping doctors feel better supported and more valued, and have a strong sense of belonging within their workplaces.

• The development of virtuous cycles could result in higher satisfaction, lower risk of burnout, improved retention of doctors, and ultimately better patient safety and care.

The second part looks at practical short-term steps that could help implement the virtuous cycles and potentially improve staff wellbeing, retention, and patient safety and care. These steps include:

• Evolving and developing what it means to be a leader and enabling compassionate leadership, to ensure that leaders can support and encourage teams, building a stronger sense of belonging.
• Building strong teams that work effectively together and have a strong sense of belonging and cohesion, for example by ensuring effective inductions.
• Focussing on groups that currently have worse experiences in specific areas regarding support, including in particular disabled doctors and non-UK graduates.
• Improving working conditions, including by developing fair and flexible rotas and making sure that there are sufficient facilities in place for all staff.

Chapter 3 – Looking ahead – reflections for the health sector to consider when looking to the future

To maintain patient safety and the wellbeing of the workforce, there are several long-term strategic needs which the wider system may wish to consider in view of our new evidence.

Long-term strategic plans must include developments that will fundamentally reduce the degree to which high – and still increasing – work intensities are impacting the wellbeing of health workers wellbeing and patient safety.

Improving trainers’ experiences will better support any future growth in the UK training of healthcare staff. 

Trainees must be better supported to develop their competencies and confidence, otherwise healthcare capacity in the long term will be negatively affected. 

Primary care needs better support given general practitioners (GPs) reported the highest levels of work intensity and burnout. This could include encouraging more doctors to choose GP training routes and developing more multi-professional roles that support GPs.

Conclusion

Our research and analysis about the challenges facing the UK’s medical profession paint a stark picture. What we have learnt from doctors and senior stakeholders across the UK health sectors should bolster resolve to tackle both the immediate and longer-term challenges the profession and health system face. We have outlined the challenges and suggested approaches to begin to address them in this report.

We are facing the highest levels of doctor burnout and dissatisfaction we have ever recorded since starting the Barometer survey in 2019. 15% of the workforce have indicated that they are taking hard steps to leave UK practice.

These are all consequences of the current working conditions that doctors are facing, including mounting workloads, increased work intensities, and backlogs from the pandemic.

As doctors consider leaving the UK workforce, or reducing their hours, these pressures will be compounded, fuelling the vicious cycle of increasing workloads affecting good, safe patient care. Chapter 1 maps out the scale and nature of some of the challenges inherent in this vicious cycle.

However, the evidence presented in this report also suggests ways in which employers, policy makers, and regulators can make changes that might help slow the vicious cycle that we have described.

Understanding the positive effect that feeling supported, valued, and having a sense of belonging can have on satisfaction, retention, and patient safety, highlights specific areas of workplace conditions that can be targeted for improvement. The vicious cycle can be replaced by building and reinforcing a virtuous cycle of increased support, better workplace conditions, increased retention, and improved patient safety. Some of the specific elements of such a virtuous cycle are covered in chapter 2.

In chapter 2, we also identify groups of doctors who need specific support, and this can help employers prioritise and target interventions.

Short-term solutions can be started on immediately—bolstering support and leadership, and improving working conditions and environments—which we discuss in detail in chapter 2. At the same time, it is vital that all parties in the UK health systems start planning and developing longer-term solutions, of which many can be started now. These solutions will include making training in the UK more sustainable. Training roles will need to become more attractive through protecting time to perform the role, and by giving trainees the space and time to develop their confidence and competence. We cover the ways that longer-term issues could be addressed in chapter 3.

We will continue to track and monitor the experiences of doctors in the UK health systems, as we all continue to work together towards developing and providing constructive solutions to the challenges the health systems are facing.

As part of this, we are working to eliminate disproportionality in doctors being referred to us, and to secure fairer training pathways. Our outreach teams will continue to work with employers and doctors to develop and encourage professional working behaviours and good teamworking, while Good medical practice undergoes a thorough review to ensure that it is clear about the behaviours expected of all medical professionals in working with colleagues and in promoting fairness and inclusion.

We will continue to work to better understand and accurately report on the state of medical education and practice in the UK by seeking ongoing input and dialogue from and with doctors, patients, and our partners.