People places and culture –meeting the healthcare challenges ahead

Charlie Massey at GMC Conference, 4 May 2022

Thank you to everyone for coming today. It’s been so nice to see so many people face to face. A theme throughout the day has been the pressure our healthcare systems are under, so I am particularly grateful to you for finding the time to join us today.

And I have been particularly struck by the energy in all of the discussions I have been part of. Your contributions have been hugely valuable, and there has been a lot of new insight for us to take away from those conversations. I always learn a tremendous amount at these conferences, and I hope it has been useful for you too.

As Carrie said in her opening remarks, the backdrop for today is of health services and a medical profession under immense strain. Through most of the last two years, doctors have been working in exceptionally difficult circumstances.

For many the daily reality was to cope with the loss of patients and colleagues, amid the physical and emotional challenges of working with covid restrictions. And of that being compounded for so long, leading to burnout and fatigue. It is important that we recognise that and give our gratitude to doctors and wider healthcare teams for everything they have done.

Although many of the day to day restrictions may now have disappeared, the effects of the pandemic will be with us for years to come.

Indeed, it is my belief that the next few years will be amongst the toughest our health services have ever experienced.

And our data supports that view. Our The state of medical education and practice in the UK report last year revealed significant deteriorations in wellbeing, burnout and intensity of workload among doctors. As a result, more doctors plan to leave the profession – last year 23% of doctors told us that they have been considering leaving, and the number of doctors taking hard steps to leave has more than doubled since 2019, from 3% to 7%. And that’s not including those who are stepping down due to retirement.

Those figures are sobering. But we shouldn’t be overwhelmed by the challenges in front of us, and we must focus our minds on the role we must all play in providing solutions.

We know, for example, that the pandemic also led to many doctors telling us about improvements in teamwork and leadership, so we must concentrate on how we can build on that. And I have heard more and more doctors speak with pride about how we have got through the last two years, and how that has given many people real and renewed confidence in our ability to address the challenges that lie ahead.

Of course, one of the most significant of those challenges is in relation to workforce. Understandably the political focus tends to be on things like numbers of new medical school places and numbers of new doctors entering training for different specialties.

I don’t deny that those things are important, but none of them will create overnight solutions. So what we really need to focus on to get through the next few years is to retain and value the people we already have.

Put simply:

• We need to get better at looking after doctors and their wellbeing.
• We need to get better at demonstrating how we value doctors and other healthcare professionals.
• We need to make sure that working environments are the best they can be.
• And we need to ensure that the culture within those workplaces is supportive, inclusive and kind.

Our data is pretty clear that too often it is the absence of these factors that drives so many doctors out of the profession. So addressing these issues will be absolutely critical if we are serious about improving retention in the period ahead.

And this isn’t just an issue for those of us sitting in national roles. We should all consider how we can role model this wherever we work.

For example, I recently visited a large city hospital and met a number of doctors. When I was speaking to the team working in the Paediatric Intensive Care Unit, I asked how they look after each other’s wellbeing given the emotional highs and lows they experience every day. The consultant leading the team replied and spoke in front of his colleagues about how hard he had found it to cope following a recent very difficult resus case. He went on to describe how he had used the team’s access to a psychologist to help him through that.

What struck me was his openness in front of the wider team about his vulnerability and the support that he needed. My reflection back to him was what an excellent role model he was, and how he demonstrated the qualities of compassion, humanity and great leadership.

I was also struck on that visit by the incredible diversity of the medical staff, and how that was celebrated and enriching, both for the teams and for the patients they serve.

But too often we fail to embrace that diversity, and instead see unfairness and exclusion. This has been a longstanding concern for us at the GMC and we see this inequality very clearly in our data – doctors from ethnic minorities have historically been more than twice as likely as their white counterparts to be referred to us by their employer. We also see stubborn gaps in the educational attainment of doctors from ethnic minorities: a 12% gap in pass rates for UK-trained doctors, rising to 30% for doctors trained overseas.

And the importance of this issue is shown particularly starkly when you consider the changing composition of the medical workforce – nearly 40% of the current medical workforce identify as being from an ethnic minority, rising to over 60% for new doctors joining our register.

If we don’t enable all our doctors to thrive, these inequalities will also have an adverse effect on patient care. Tackling this issue is therefore not just a moral imperative, but must also be at the heart of our plans for post-pandemic recovery.

That is why we have set very ambitious targets to eliminate that disproportionality in fitness to practise referrals and in educational attainment.

We are already working very hard to get there.

• We have made changes to our fitness to practise referral process and we have changed the nature of our conversations with responsible officers.
• We have worked with royal colleges, medical schools and others on action plans to address differential attainment.
• And we have developed and implemented our own action plan to improve diversity within the GMC, as we must recognise where we need to do better as an employer.

But ambitions to eliminate inequalities among doctors cannot be achieved by the GMC alone. In our equality, diversity and inclusion annual progress report published in February, we are very clear about our determination to work across the system to achieve our goals. And to highlight those areas where improvement is needed.

That commitment to work effectively across the system will continue to be a theme across all of our work.

I am absolutely clear in my mind that regulation should be an engine for improvement. That means that we cannot limit our role to making judgements after something has gone wrong – we must also share responsibility for preventing problems from occurring in the first place. So we must challenge ourselves and others to use our data, insight and regulatory levers to improve what we do and how we do it, and become better at anticipating and intervening before problems occur.

And I would like to share some examples with you to bring that to life.

• Firstly I spoke earlier about positives arising from the challenges during the pandemic including around teamwork. We all know that medicine is a team sport. So it should come as no surprise that a focus on teamwork is a key element of our consultation on changes to Good medical practice, and part of our continuing focus on generic skills for undergraduates and in postgraduate training.
• Second, the pandemic also forced us all to rethink appraisal, positioning it as less of a summative box-ticking exercise and more of a formative approach to help doctors reflect on and improve their practice.
• Similarly, it forced us to think with royal colleges about what we really needed to know and be assured about in enabling doctors to progress through training. I would expect that many of the changes to derogations in PG curricula will be changes that we will want to retain.

We also have a big opportunity ahead of us through forthcoming regulatory reform. Once the legislation is enacted, we will be able to make changes to our rules to make our processes faster, more focused, and less adversarial. That will benefit patients, but should also make our regulatory processes less stressful for doctors and other people involved. It will allow us to simplify the way in which doctors can have their skills recognised.

That legislative change will also bring physician associates and anaesthesia associates under our regulatory umbrella. That won’t just be a huge milestone for the GMC, but also gives us a fantastic opportunity to think about how this group of healthcare professionals can be grown and deployed to play a part in addressing the workforce challenges I described earlier.

I spoke at the start of this closing session about the challenges that lie ahead of us all in recovering from the pandemic. I know that the scale of those challenges can feel daunting, and our data underlines that. But I hope I have also been able to describe those areas where we can take action and look ahead with optimism and renewed determination.

Retention must be one of our top proprieties. And if we are to retain a committed and effective workforce, collaboration will be critical. In short, we must work together to create a healthcare system:

• that values and trusts its people
• that fosters a sense of place, belonging and pride
• and which builds supportive, open and compassionate cultures.

As your regulator, the GMC is wholly committed to playing its part.

I would like to finish by thanking all of our speakers, both in the plenary sessions and workshops. And the wider GMC team that has organised such a successful event.

And of course all of you for attending and participating throughout the day.

Safe journey home. Goodbye.