Future fit: how to ensure a viable workforce now and in the future

Charlie Massey, Chief Executive of the GMC, spoke on a panel today at the Health Service Journal's Patient Safety Congress in Manchester, which focused on putting safety at the heart of reform.

Thank you for the opportunity to be here today.

I’m going to talk briefly about:

• the big shifts we’re seeing in the make-up of the medical profession
• our continuing worries around wellbeing
• and, lastly, why, more than ever, we need to focus on productivity and retention.

The medical workforce today

Starting with the shape of the medical workforce, where we have seen significant change in recent years.

For the first time, there are more doctors from an ethnic minority background on the medical register than white doctors, and more female doctors than male. Non-UK graduates make up a significant proportion of the profession, accounting for over two thirds of joiners in 2023.

Doctors’ career paths are also rapidly evolving.

A linear trajectory leading to consultant status is no longer the norm, with locally employed (LE) doctors now the fastest-growing doctor group.

Meanwhile, our data show that doctors’ wellbeing continues to be a concern. In 2024:

• nearly 30% of doctors were classed as ‘struggling’, with around a fifth categorised as being at high risk of burnout
• almost a quarter of doctors took a leave of absence due to stress, nearly double the 2019 figure
• and a fifth of doctors signalled their intention to leave UK practice, with 15% taking hard steps to do so.

While there are poor experiences across the board, certain groups are more at risk than others.

Ethnic minority doctors experience worse outcomes across education, training and practice. Despite the system-wide focus on these issues in recent years, too many doctors are still stuck in a cycle of discrimination and disadvantage.

The impact on patients

All of this has real world consequences for patients.

Doctors’ perceptions of the quality of care provided are notably poorer today than pre-pandemic. Indeed, 40% of doctors witnessed patient safety being compromised in 2024, compared to 32% in 2019.

Our data suggest that one of the standout factors behind this decline are issues relating to culture and leadership, and their material roles in driving outcomes

Put simply, too many doctors are burnt out and struggling, too many find themselves victims of discrimination, and too many are considering leaving UK practice. And the combination of these issues creates real risks to patient care.

Something must have gone badly wrong when, as our national training survey found, more than a fifth of trainees report feeling apprehensive about escalating a patient to the supervising clinician.

That doctors are making life or death decisions in environments where they feel fearful to speak up is profoundly concerning. Those are the very factors that lead to cover-up over candour, and obfuscation over honesty. And it is in those cultures that the greatest patient harm occurs.

Everyone in this room will be aware of the scandals of recent years concerning maternity care.

This is one of the most high risk and high pressure areas of medicine. One where the consequences of things going wrong can be especially tragic and far-reaching, affecting both a mother and her baby, not to mention their wider family.

So the fact that our data point to worse wellbeing indicators in this specialty should sound alarm bells for us all.

Doctors in obstetrics and gynaecology are amongst those at the highest risk of burnout. Obs and gynae trainees are also more likely than average to feel apprehensive about escalating a patient to a senior colleague, while the specialty overall reports higher levels of workload stress, incivility, and bullying. It is also telling that obs and gynae doctors are much less likely to report feeling supported by their immediate colleagues.

These data suggest a situation where, too often, patient safety is falling victim to unhealthy culture. The unthinkable – harm to mothers and their babies – is at risk of being normalised. And toxic culture is in no small part to blame.

Behind these statistics lie real people, real tragedies. I have met some of them and their testimony is searing.

So for them, and for all the patients we’re here to serve, we must demand better, and never accept as normal cultures which don’t have safe care at their heart.

The change we need to see

Mutual respect within and across the different health professional groups is crucial to this. Medicine is notoriously tribal. But everyone involved in delivering care has a responsibility to act in the interests of their patients above all else, treating them as they would their own loved ones.

Employers also have a role to play.

In a fragmented system, a sense of belonging and inclusion is vital, especially for newcomers to UK practice.

Fostering this requires employers to recognise their role in setting the culture. Failure to do so leaves doctors with the sense that they’re not valued – a sentiment we’ve seen expressed in recent strike action.

On a practical level, taking a more consistent and considerate approach to things like rotas, rotations and requests to book leave would go a long way.

Crucially, we need to see employers adopt a more emphatic approach to addressing poor behaviours, wherever they originate. Doctors on the receiving end of discrimination and other unacceptable conduct will not deliver patient care to the best of their ability. So there’s a clear business imperative here, as well as a moral one.

Of course there is a role here for regulators too. We need to do more to work together, spotting common patterns across our responsibilities and aligning on action to tackle them. We're already doing this around maternity and ED&I, with ambitions for further collaboration in the future.

Lastly, as the government’s ambitions are made more concrete in the forthcoming workforce plan, we need to see education and training given the attention they deserve. That means modernising the rigid and outdated medical training system and developing a more flexible framework – one that better meets the needs of the profession and the public they care for.

Conclusion

To conclude, poor care doesn’t happen in a vacuum – it is the result of what is seen, heard and tolerated every day. Our data plainly identify where change is most urgently needed. And we urge everyone to use it to make the improvements the public and profession so desperately need.

Doctor wellbeing is fundamentally an issue of patient safety. As we’ve seen all too often, the consequences of not giving culture the attention it warrants are profoundly serious.

So we all have a duty to get this right – in the interests of the future sustainability of the health system, and, crucially, the patients we’re all here to serve.

Thank you.