Note
This is the drafted version of the speech and might be slightly different to the delivered.

What’s next for the NHS? Support, compassion and a sustainable workforce

Professor Dame Carrie MacEwen at the Royal College of Physicians on 31 March 2022.

Introduction

Over the past two years, as everyone in this room so well recognises, the NHS has been grappling with the many implications and challenges of Covid-19: treating it, preventing it and trying to deliver safe care across the board. And all this amid the restrictions that the pandemic entailed.

This pandemic brought into sharp focus not only that our staff are highly trained, dedicated and adaptable, but also has lifted the lid on the problems that faced the workforce pre-Covid – because they became magnified such that they could no longer be ignored. These are not going to go away quickly.

And as the pandemic has become a long-term situation, it is clear that this brings additional challenges, linked to sustained pressure much greater than the acute emergency.

So what impact does this have on the NHS’s future, and on the place of doctors in the wider system?

The state of medical education and practice in the UK (SoMEP)

At the end of last year, we published our annual State of medical education and practice report. I don’t think its findings will have come as a huge surprise to any of you.

SoMEP tells us general fatigue, burnout and care backlogs are taking an increasingly serious toll on doctors. Eighteen percent of doctors told us they intended to stop practising and many more were planning to reduce their hours.

Seven percent – and this excludes doctors who were just retiring – had already taken hard steps to leave the profession.

That potential depletion of the NHS’s medical workforce really is very concerning regarding retention of highly trained, highly skilled professionals – who are already in short supply - and it reflects a profession that is under severe pressure.

We gathered that data during the pandemic, of course – but, as I have mentioned already, Covid hasn’t caused those problems. It’s simply exacerbated them.

GMC support - practicalities

The GMC is committed to doing everything it can to support the post-pandemic recovery of the NHS.

Ultimately our role, as a regulator, is to protect patients and, we know that by supporting doctors in their working environments, to help safeguard their psychological safety there are recognised benefits to the care of patients and their outcomes.

During the pandemic, we needed to be clear in our support of doctors to provide the best possible care – and that meant taking into account the difficult environments and circumstances they might be working in.

Alongside constructive messages, we produced pandemic-specific fitness to practise guidance so that doctors could be confident that we’re considering the difficult context in which they are working, should any concerns be raised.

In addition, there are practical things we, as a regulator, have been doing to help address the workforce challenges – to assist recruitment and retention and thus reduce the staffing pressures.

Doctors from overseas are a vital part of the engine that keeps the NHS running, but after two years of disruption to world travel last year, we built a temporary second clinical assessment centre to double the number of PLAB tests we can administer to assess IMGs regarding their entry to the UK workforce.

Not doing so would have been disastrous for the NHS’s medical workforce, which is reliant on the expertise and dedication of colleagues from all over the world.

We’ve recently updated our initial pandemic-specific guidance to take Covid’s longer-term legacy into account, and we are also reviewing Good medical practice.

As you are aware, Good medical practice is the supportive framework that sets out what it means to be a good doctor, so it’s pretty fundamental – and it needs to be fit for purpose in a changing NHS. The updated version is about to go out to consultation and I hope that you’ll be able to find time to give us your views on that.

We all recognise that no NHS doctor is practising in isolation… and one of the positive findings of the SoMEP report was that multi-disciplinary working improved during the pandemic.

It is relevant to note in this context that there are legislative reforms under way that, among other things, will bring physician and anaesthesia associates under the GMC’s regulatory umbrella.

With increasing pressure and staff shortages it’s more important than ever to consider how doctors and other healthcare professionals work together to optimise the skills and roles of everyone.

Compassionate cultures and leadership

But there’s a broader issue that we need to consider for the NHS, now and in the future, and it’s one that starts with people rather than practicalities.

Compassionate leadership and safe, supportive working environments are absolutely vital - not only to the welfare of doctors, but also to the future of the NHS and to the safety of patients.

We often hold people’s lives in our hands. How can we keep them safe if we’re working in environments where we can’t ask for help, or express a concern, or admit to our mistakes? If we don’t look after each other, how can we look after patients?

Doctors who feel exhausted, harassed or excluded at work, or are practising in teams who don’t communicate and support each other are, not only more likely to make mistakes, but are also less likely to speak up about patient safety concerns.

They’re also more likely to think about leaving the NHS – or indeed, the medical profession. Post-Covid, the NHS needs to focus on retention…and doctors’ wellbeing is key to that.

We won’t have a sustainable medical workforce if we don’t make the NHS a safe and supportive place to work.

Equality, diversity and inclusion

A sustainable workforce must, of course, be a diverse one – and indeed, the NHS currently has a more ethnically diverse workforce now than ever before, with around 40 per cent of medical staff coming from an ethnic minority background.

But what’s worrying is that doctors from ethnic minorities are still under-represented at senior levels.

BME doctors are also more likely to report abuse and discrimination from their colleagues, less likely to progress directly through training and are more frequently referred with fitness to practice concerns by their employers.

Last year, we set ourselves some targets to tackle that differential attainment in educational progressions and the disproportionate pattern of employer referrals for doctors from those groups.

Let’s be clear: we’ve committed to these measures because they are absolutely the right thing to do. It’s unacceptable that any doctor’s ethnicity or any other protected characteristic affects how they are treated in the workplace and their ability to progress and work to their maximum capacity.

These targets are also vital for a better, more effective and sustainable NHS workforce. We need a health service that recognises the contribution made by everyone and supports and values all doctors and their wellbeing – if the NHS doesn’t do that, it simply won’t be able to retain the doctors it needs.

Conclusion

So, what is next for the NHS?

We currently have an opportunistic window to make positive change -

A regulator like the GMC wants and needs to be instrumental in bringing about that change but we can’t do it on our own. We’re only one part of a much wider system. That’s why we’re committed to working with doctors, with the NHS and with medical educational bodies – such as the RCP – to put openness, inclusion and compassionate leadership at the heart of the NHS’s culture.

Doctors told us that fatigue and burnout rose during the pandemic – but perhaps remarkably, many of them also told us that the Covid-19 response brought about some positive developments in terms of effective teamwork and support from colleagues.

Let’s learn from that and make it the first step towards an NHS for the future that takes the importance and wellbeing of its people seriously.