Charlie Massey GMC Conference keynote speech 2 December 2020
In the year since our last conference, life as we know it has changed dramatically.
I didn’t expect then that only 12 months later I’d be speaking to you virtually, with much of the UK still in lockdown. And with exciting news about vaccines dominating the headlines.
I want to start today by thanking doctors and other healthcare professionals for their extraordinary efforts, commitment and compassion during this unprecedented time.
Coronavirus has put our healthcare services under extreme strain. But before it emerged, we were already talking about how to ensure the NHS has the workforce it needs to meet current and future demand, and how it could deploy that workforce to best effect.
Coronavirus has showed us how adaptable the healthcare system can be.
Our task now is to build on that foundation, taking the chance not just for recovery, but for renewal.
The question of how to cater for growing demand has long dominated conversations around healthcare. This is why one of the four ambitions in our new strategy for 2021 to 2025 is to play a key role in ‘developing a sustainable medical workforce’.
So what do we need to do?
The first lever we often reach for is recruitment.
This is an area where the UK has historically been pretty successful, with large numbers of overseas doctors joining the register alongside those graduating from UK medical schools.
Our data show that over 10,000 international medical graduates (IMGs) joined the UK workforce this year, more than UK and EEA graduates combined.
These doctors do a fantastic job and have become an indispensable part of our medical workforce. That’s why we worked hard through the pandemic to restart our PLAB tests as soon as we could, to allow overseas doctors to take the exams they need to practise in the UK.
But while those numbers have held up this year, the impact of Covid across the world makes this a less certain route for the longer term.
I do not think we can presume that these numbers will continue to grow as they have done. So, for workforce planning, we should not rely on these doctors to meet growing demand.
The other major route to recruitment is through UK medical schools. And while the supply of international doctors may dip, this year we saw an expansion in medical school places as a result of the exceptional A Level situation.
Whether this is maintained is a matter for Government. But the events of this year do give us a chance to demonstrate that medical schools and the NHS infrastructure can absorb a longer-term increase in medical school places. Government will then be able to make informed spending decisions about whether and how to sustain those increases in the future.
Adding doctors to the workforce is one thing, keeping them there is another.
So the second area for addressing our workforce needs is around retention. This has been an area of particular challenge over the last few years.
Significant and growing numbers of doctors have been choosing to reduce their hours or step out of UK practice in recent years. In this year’s GMC Barometer survey, a third of doctors said they were considering reducing their clinical hours, while one in ten said they were considering leaving permanently.
Research we undertook at the start of the year points to the reasons why.
More than financial considerations, pension concerns or visa issues, doctors cite dissatisfaction with their working environment as the primary driver. Over one in three said it was one of the key reasons they left, and one in four said it was a reason they wouldn’t return. Data we published last year show how lack of a supportive environment is linked to frustration and higher risk of burnout.
All of which suggests that without a concerted effort to improve the environments in which doctors practise, efforts to retain the doctors we need are likely to fail.
Though we have seen encouraging signs of change in this area during the pandemic.
Many doctors reported positive experiences around teamwork, support and feeling valued in our National training survey. Around four-fifths of trainees, and three quarters of trainers, felt that their workplace encouraged a culture of teamwork between all healthcare professionals.
This was mirrored in last week’s publication of The state of medical education and practice in the UK (SoMEP). Many doctors reported positive changes, particularly in relation to teamwork and knowledge sharing, which they felt could be sustained beyond the pandemic.
But if doctors are going to stay in practice for the long term, more must be done to make this the norm. And that requires concerted and joined up efforts by all of us – professional and system regulators, governments, NHS bodies, and employers.
The emergency register
Another opportunity that was borne out of the pandemic was the fact that so many healthcare professionals made themselves available to support the pandemic response.
Back in March, we gave around 30,000 doctors who had left the profession temporary emergency registration.
Our recent survey of this cohort, which has an average age of 57, showed that there remains significant interest in helping out the service. The results show that there are at least 3,000 doctors who are prepared to come back in to practice to support the NHS during this emergency. And over 1,800 told us that they would consider returning to permanent registration.
Given the continuing challenges across our healthcare services, this creates a real opportunity to provide much needed resource both for the short and longer term. We are now sharing these insights and working with partners across the UK, so we can harness this willingness, and help enable more doctors to return.
This brings me to the third part of the workforce equation – how do we support doctors so they are as productive as possible and perform at their best?
One important element is to ensure that doctors work alongside the other healthcare professionals that allow them to do the things that only doctors can do. We are delighted that the Government has committed to legislate to enable us to take on the regulation of physicians associates (PAs) and anaesthesia associates (AAs). These roles have become more important, and could grow much further once they are brought within regulation.
To ensure that these associate roles maximise their contribution, it’s crucial that the legislation brought in around regulation is flexible and futureproofed. We’re talking to the Government about how to ensure that the law will accommodate the development of these roles, so they can respond to the changing needs of the workforce and wider public.
Another growing part of the workforce is specialty and associate specialist (SAS) and locally employed (LE) doctors.
Many SAS and locally employed doctors choose these positions because of the flexibility they offer. But doctors in these roles can face very specific challenges.
Our recent survey found that 30% of SAS doctors and 23% of locally employed doctors had been bullied, undermined or harassed at work.
It also shone a light on other concerns like access to learning and development, and the potential to make the transition into consultant roles.
Here, again, more flexible legislation has a crucial role to play.
A large proportion of SAS doctors are international medical graduates. Because of the prescriptive nature of current legislation, they have to overcome a series of bureaucratic hurdles in order to get on to the specialist register. This can mean assembling up to 2,000 pages of information and spending 9 months gathering evidence.
We’ve been pushing for changes around this. So I was really pleased to hear Matt Hancock last week commit to legislative reform to give us more discretion in setting the rules around this process.
Doing so will ensure that legislation does not create a glass ceiling, preventing doctors from progressing and fulfilling their potential.
Another drain on productivity is unhealthy culture and what that can mean for our very diverse medical workforce.
Too often, doctors work in environments where collaboration is absent, tribalism predominates and people are side-lined. Not only do these factors prevent doctors from performing at their best, they also create bad outcomes for patients.
As Michael West and Denise Coia highlighted in their Caring for doctors, Caring for patients report, the wellbeing of doctors is vital because workplace stress affects quality of care for patients. Researchers found that doctors with high levels of burnout were 45% to 63% more likely to make a major medical error.
This is particularly important as the composition of the workforce continues to change.
As Clare Marx told us on Monday, this year 61% of those joining the medical workforce are from BME backgrounds compared to 44% in 2017.
And yet we know that these doctors will often have a very different experience of medicine than their white colleagues.
Our research tells us that BME doctors are twice as likely to be referred to the GMC by their employer than their white counterparts. They’re more likely to be treated as outsiders, and to find themselves working in isolated roles without adequate support.
At the same time, the events of this year have illuminated the painful reality of structural inequality, not least in the disproportionate deaths of BME health workers.
We know what the issues are. Now is the time to act. There has never been a better opportunity to tackle the discrimination that still pervades medicine. And we all have a role to play.
At the most basic level, concerted efforts must be made to welcome every doctor.
We’re playing our part in this, ramping up our free induction training for overseas doctors to help them settle into UK practice.
But more needs to be done across the healthcare system. Employers have a particularly important role in establishing the right culture and clinical governance systems, and in ensuring that doctors and other healthcare workers get the support and high quality induction they need.
This has been an exceptional year and I’m sure all of us hope that 2021 will be less eventful.
But we also know that the workforce challenges that existed before the pandemic won’t disappear when it finally abates.
Ultimately, we need to take a long-term view, taking action now to build a workforce that can meet the needs of today, and tomorrow.
Part of the solution will be recruitment, but the bigger issues are around getting the most out of the doctors we have, and encouraging them to stay. That means removing barriers to progression, so they can fulfil their potential. It means regulation that is able to respond quickly to the changing environment. And it means creating supportive and inclusive workplace cultures, where all doctors are valued and can give of their best.
We all need to play our part in delivering this.
We should take a lot of confidence from what we’ve all been able to achieve this year. Let’s take action now to continue what’s been started – to meet the needs of the patients we serve.