Different support is needed in different training settings

A locum GP writes about how supernumerary flexible training benefited them, but how negative attitudes from colleagues affected their health and confidence.

Different support at different times

I started my training in anaesthetics. Having had severe Hepatitis A, I developed chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and debilitating migraines. I moved into general practice and worked as a locum and out-of-hours (OOH) GP since I qualified. Over the years I have experienced the very worst and best of care and support from colleagues in the NHS, both as a patient and as medical professional.

Some of my health issues and the resulting career disruptions could have been avoided, had my health care needs been met promptly. I’ve also faced challenges in gaining access to good confidential occupational health support, part time work and reasonable adjustments.

I have however benefitted from different support/adjustments at different times, depending on the work environment and my level of functioning. One postgraduate training organisation offered me supernumerary flexible training with high quality occupational health input, this made the biggest difference. I was able to train with a tailor-made training plan and timetable. I had excellent support by the flexible training advisor and the occupational health physician. Adjustments were readily made which also took fluctuations of my conditions into account. I was allowed to avoid longer working days and had extra breaks, I didn’t have to work full night shifts. I was also given placements with an easier commute, allowed to use a self-funded electric scooter to get around the hospital, and I used a foldable seat stick for ward rounds, to reduce fatigue from prolonged standing. This was hooked onto the medical records trolley.

As an employed OOH GP I am allowed to work shorter/split shifts, allowances are made for extra time needed, and adjustments are made as to where I work and in what role.

Not being seen as a team player

As a flexible trainee, I had predominantly positive experiences and supportive educational supervisors. I mostly had good relationships with senior and junior colleagues in hospital placements. Most teams regarded me as an asset and many colleagues learned from my experiences and feedback. As a GP locum I had very good experiences in a few practices that valued my contribution and respected my limitations. The OOH GP provider was very supportive and accommodating. 

I have however experienced discrimination, harassment and bullying during training and since qualifying. This has disrupted my health, professional confidence and undermined other resilience factors. I had to move away from my social support network to access part time training twice due to discrimination, and as a flexible trainee I was at times accused of not being a team player, just because I was working to a more regulated schedule.

In GP training I faced barriers with unhelpful attitudes by some trainers and colleagues and unfair discriminatory comments in feedback and progression panel reports. It was a challenge to find GP practices who would respect the reasonable adjustments recommended by occupational health. I also experienced discriminatory feedback following job interviews for primary care placements on more than one occasion. I have received inappropriate comments about health and disability in references, confusing health issues with performance issues.

What I would change…

• A general shift in attitudes within the NHS towards becoming more caring, compassionate and inclusive towards all members of staff.
• Improve access to competent, timely, non-prejudiced and independent medical care and occupational health support by doctors that are trained in how to look after medical professionals.
• Stop the practice of ‘undisclosed references’ and the disclosure of health issues in references.
• Find a way for disabled students and doctors to actively engage and participate in influencing policy making and policies in health care.
• For non-disabled colleagues my advice is to be more curious.
• For employers to facilitate regular reviews of adjustments.