Finn O’Dwyer-Cunliffe: Providers are innovating to give doctors a break, but more is needed

As part of its Wellbeing campaign, The BMJ is telling the sector it is time to give doctors a break. We couldn’t agree more.

The NHS will shortly publish its long awaited interim People Plan, setting out the stall for strategic workforce development in the service over the next decade. Canvassing our members for views to contribute to this plan, we were reminded of the urgency around restoring the sense of value NHS staff get from their working lives, and providing insight into the initiatives trust directors are taking forward to improve culture and wellbeing within their organisations.  

Workforce concerns are the most pressing for NHS trusts and foundation trust boards, more so than tackling the daily challenge of meeting financial or performance targets. This has been clear for some time now and was evidenced in There for Us: our call for government action to address the national workforce challenge.   

This report—and NHS Providers’ work on Eight high impact actions to improve the working environment for junior doctors—re-emphasised the extent to which medical staff are stretched in a service with limited capacity to meet rising demand. There is ample evidence to suggest the situation has worsened over the past 18 months.

Trusts boards know they have an important role to play in addressing these issues and there are examples across the country of providers innovating to improve the wellbeing of valued staff. For example, Sheffield Teaching Hospitals Trust has introduced flexible working schemes to enhance work-life balance, including an option for some staff to take on term-time only working. The impact of this and other initiatives has been an increase in staff retention to 91%: one of the highest levels in the country.

Kingston Hospital NHS Foundation Trust has recently implemented a new health and wellbeing strategy which includes access to a staff support chaplain providing free pastoral care and counselling to those affected by stress, anxiety or depression. Telford Hospital has teamed up with the local council to offer free housing to 24 junior doctors as part of its recruitment drive, while an annual leave day for staff birthdays has been introduced by at least one trust in England.  

Innovative schemes like these make a big difference, but the benefits have not been felt by staff throughout the service. One of the more disappointing findings in the 2018 NHS staff survey is the fact that only 28.6% of respondents feel their organisation definitely takes positive action to improve staff health and wellbeing: a 3% decrease from 2017.

But while trusts have an important role to play as employers, too much of the equation around burnout is out of an individual organisation’s control. Research has shown that workload is the single greatest determinant of stress at work. Only 22% of respondents to the staff survey last year reported they ‘never’ or ‘rarely’ suffered from unrealistic time pressures in their jobs and over two thirds feel there is not enough staff at their organisation to enable them to do their jobs properly.  

Trusts will struggle to tackle such workload concerns in a meaningful way while demand for services continues to outstrip the NHS funding settlement (even taking into account the additional funding for the long term plan). These pressures are exacerbated by the fact they are unable to recruit to vacant posts. With 100,000 staff vacancies across NHS trusts in England—and unfilled nursing posts in particular continuing to rise—an enormous strain is being placed on doctors leading treating teams to somehow meet the ever expanding needs of patients. Not to mention the severe pressures faced in primary and social care where recruitment and retention issues are, frankly, even worse.

The interim People Plan will provide a welcome “reset moment” to tackle England’s severe NHS workforce shortages, with reports that ministers and senior NHS leaders are seeking to develop a sorely needed “new offer” for NHS staff. This would be supported by a stated commitment for trust regulators to no longer prioritise financial standards over the wellbeing of staff.

Trusts are continuing to innovate to improve staff wellbeing and reduce the impact of work-related stress on doctors’ lives. More can and will be done within individual organisations: a focus on cultural change and the impact of strong staff engagement will help this. However, efforts to tackle burnout and stress—making the job of doctors and all NHS staff much more “doable”—will continue to depend greatly on the success of ongoing initiatives to expand the size of the NHS workforce as a whole.

Finn O’Dwyer-Cunliffe is a policy advisor at NHS Providers.      

Competing interests: None declared

The BMJ is calling for doctors to be able to take the breaks that they need for their wellbeing and for patient safety. You can follow our work at and take part in the campaign by sharing your examples of where things are changing for the better or where more work needs to be done through social media using #giveusabreak.