Doctors under strain need more support if they are to perform well

Professor Dame Carrie MacEwen's keynote speech at GMC Symposium, held in London on 22 November 2023.

I’m absolutely delighted to be here and to be opening this symposium today. I would like to say how pleased I am to see you all here, it’s so encouraging to have such strong attendance. Many of you will have been to our previous GMC conferences, but we obviously have a different agenda this year. Instead of dividing for breakout workshops we will all be here in one room for the three plenary sessions. Nobody will miss out on any of the discussions which is useful when the challenges we face in our health service all require collaboration, collective action and collective leadership. I believe that with the combined experience in this room we can look forward to some important thinking taking place today, and no doubt afterwards as we all reflect on what we have heard and discussed and translate it into action.

At the heart of our discussions today is Good medical practice. Our professional standards provide a guide for doctors throughout their career, a supportive framework that allows them to understand what is expected of them in their interactions with their colleagues, with other professionals, and with patients.

Good medical practice is the most important document we publish. Doctors have an annual appraisal against its four domains. It feeds into Outcomes for Graduates as used by medical schools.

We launched an updated version of Good medical practice in August, which will come into effect on 30 January. We’ve made a number of changes that make it easier to navigate and understand, and hopefully interpret. And we’ve made changes that increase the emphasis on professional behaviours at work, bringing a greater focus on building fair, respectful and inclusive workplace cultures.

This is in direct response to our extensive consultation. We heard from thousands of medical professionals and patients that they would welcome greater emphasis on this within Good medical practice. The changes are representative of a strong consensus.

We are working hard to make sure that all doctors are aware of the changes, and are familiarising themselves in time for the change. Today, we are asking you all to work together to identify how the new professional standards can be best embraced and embedded across the health service.

We are, of course, acutely aware that the system is currently under strain. The pressure is only going to increase as we move into winter. In some ways it is a difficult time to be making a call for cultural change. But in reality, these pressures make this more important. Doctors under strain need more support if they are to perform well. There is no expectation of quick cultural fixes, but there is an urgent need to acknowledge across the board that good culture provides the foundation for good, safe patient care.

This year we’ve published our twin The state of medical education and practice in the UK reports. We published the Workplace experiences 2023 report in the summer, and the Workforce 2023 report was published just last week.

The two reports work well together to give a clear picture of the challenges we face. This year, we had to report another jump in the number of doctors at high risk of burnout, and, worryingly, in the number of doctors who say they regularly find it hard to provide sufficient care to patients.

Commitments in the Long Term Workforce Plan and plans in Scotland, Wales and Northern Ireland to increase the overall size of the workforce are most welcome of course but as we are not likely to see the impact of increasing numbers for a decade we need to ease pressures on the doctors working here now.

We have known for some time how important it is to create the right working culture for doctors. There is an abundance of evidence directly linking doctors’ wellbeing to patient care, and in our 2018 report, ‘Caring for doctors, caring for patients’ we highlighted this and called for compassionate workplaces and compassionate leadership.

I’m very conscious that it is almost a year since my colleague and friend Clare Marx, who was my predecessor as Chair of the GMC, very sadly died. Clare was absolutely committed to raising awareness of the value of compassionate culture. She firmly believed it provided the key to unlocking staff wellbeing, team functionality, and fundamentally, patient care. I am immensely grateful for the energy and drive she put into raising this issue up the agenda. I’m sure she would be delighted to see that we’ve had such an excellent response to Good medical practice 2024. The positive reception, and the widening consensus that good workplace culture really matters, is, I believe, part of her legacy.

To make changes in culture you need good leaders, and leadership is the focus of our first plenary session today. We are going to hear from the panel about some of the barriers faced in establishing the type of good, compassionate workplace cultures that Good medical practice aims to promote, and of course some suggestions for how to overcome them.

Leaders must demonstrate and promote a professional skill set and cultural competence. The value of clinical knowledge and technical skill is diminished if it is not accompanied by courtesy, empathy and respect.

Good leaders create environments where open, and sometimes challenging, conversations can take place. In a medical workplace it’s vital that everybody feels able to raise questions and highlight issues. Not only that, everyone should be confident that their voice will be heard, and that any concerns they have will be acted upon appropriately.

Leaders need to make sure that the working environment feels comfortable for everybody. Inclusion is the focus of our second session today and I’m looking forward to understanding more about the perspectives on this amongst this experienced group.

We are fortunate to have an increasingly ethnically diverse workforce. However, we know that some doctors experience discrimination based on their race in the workplace. That’s wholly unacceptable, as is discrimination based on any personal characteristic, including but also beyond those protected by legislation. We know that sexual misconduct in medical workplaces is a significant problem, and we have been robust in our position here. I hope that the clarity we have provided in the updated version of Good medical practice will be useful here in setting out everybody’s responsibilities to tackle these deep-rooted problems.

Efforts to eliminate direct discrimination, bullying and harassment are obviously one of the fundamentals of running a good workplace. But inclusivity goes further. At its core is the need to create an environment where everybody feels a sense of belonging, feels comfortable and able to participate fully. In an inclusive environment all doctors feel supported, valued, and respected. Nobody should feel they are an outsider.

As our workforce continues to diversify inclusion becomes more and more important. And it’s critical that we stretch our thinking and recognise that diversity comes in many forms, including professional diversity.

We need to think about different groups of doctors. Numbers of locally employed doctors are climbing rapidly, yet they tell us they feel unsupported, and unable to access development opportunities. As with SAS doctors, outdated notions about the proper career path a doctor should take can be responsible for unhelpful, non-inclusive behaviours. A lot of the growth in numbers is driven by international medical graduates so there are intersecting issues here which make this more difficult.

And of course, the current environment for medical associate professionals is clearly very challenging. Multi-disciplinary respect and courtesy is fundamental within our professional standards but there are going to be situations and times when that is challenging to deliver. Leaders have a significant responsibility to establish a culture where this is expected, even in the face of a tough external environment, and where all doctors hold each other to high standards on inclusivity.

I am pleased that our third session today is focused on training and induction.

There is a real danger that in times of pressure the onboarding process is neglected, but it is essential in terms of establishing expectations around professional behaviours in the workplace.

For example, for joiners from abroad, onboarding is invaluable to help them settle and integrate. Our Welcome to UK practice workshops are now in their tenth year and are hugely successful, but ideally they should be backed up by high quality local inductions.

It is not just for international medical graduates that this is important, health services cannot afford to cut corners on training and inductions anywhere, for any doctors, if they are to ensure best patient care. There is a small window of opportunity to demonstrate compassionate leadership, and to highlight inclusive organisational values. This is the time to outline expectations around team working, including multidisciplinary approaches, respect, empathy, mutual support and compassion. At an induction, a joining doctor can learn that their organisation will listen if they speak up to raise a concern about patient care, or to highlight that colleagues are being treated unfairly or inappropriately, even if their concern involves somebody in a position of power.

Getting this bit right is so important. Training and induction form the bedrock of good workplace culture - appropriate prioritisation and implementation can help us break the vicious cycles that hold us back.

Of course, these changes will not fix everything in the health service. Good workplace culture is not a cure-all. But it can make a substantial difference, even in extremely challenging times. Certainly, its absence will compound harms, to doctors and to the patients they care for.

We’re delighted that the changes we’ve made to Good medical practice have been so well received, and we will continue our work to raise awareness. But now we ask you to help us with its implementation.

We are asking you all today to call on your experience, listen to your colleagues, share ideas and be open to provocation and inspiration. With collective leadership significant change can be achieved even in these very challenging times.

Thank you for listening. Enjoy the day.