NHS trust leaders are worried about their staff. The NHS has just experienced the most challenging year in its history, with staff working tirelessly to overcome the difficulties of delivering care throughout the pandemic. It is clear that we haven’t yet seen the full effects of this.
Recent surveys like the BMA’s covid-19 tracker snapshot from April point towards this worry, with half of doctors who responded to the survey hoping to work fewer hours, and a quarter more likely to consider a career break than they were before. The General Medical Council’s (GMC) report on the state of medical education and practice in the UK, published in Autumn 2020 after the first wave, found that 1 in 10 doctors were considering leaving the profession. The BMA’s survey has now set this figure at just over 1 in 5 among its own respondents. In discussion with the GMC, we have heard that there was an almost 30% drop in the number of doctors who relinquished their license across the past year (compared to the year-on-year average). This has likely stemmed from a sense of duty to stay and support the NHS effort in the pandemic. This phenomenon points to a very real concern that a large proportion of this 30%, as well as doctors experiencing burnout or those who were planning to exit the service anyway, may leave as the immediate threat of the pandemic abates. Given that the health service was operating with over 100,000 vacancies before the pandemic, this would have a huge impact.
We know that there are similar levels of burnout across other staff groups too, with an NHS Providers survey showing that 99% of trust leaders were concerned about it even before the most recent peak of covid-19 hit. There are clearly, then, enormous staff wellbeing issues to manage, particularly as the NHS accelerates efforts to address a vast care backlog with an exhausted workforce in the coming months. Trust leaders have responded to this, and there has been a significant upswing in the provision of local wellbeing initiatives over the course of the pandemic, enabled by a surge in public donations to NHS charities and a temporary funding injection from the Treasury. We have seen increases in the provision of counselling services, to support staff at this stage and in preparation for the longer term effects of work related trauma; the development of wellbeing teams and organisation wide listening exercises, to ensure that leaders are addressing the most pressing issues for their workforce; and repurposing of empty spaces into places where staff can rest and access free hot drinks and food.
Trusts have been incredibly creative in doing what they can with what they have, but so much more is needed. There must be a collective endeavour between leaders and doctors, based on evidence, and underpinned by national funding and central support to make these necessary changes a reality. There is currently a lack of long term funding to ensure that local wellbeing initiatives can be sustained.
On top of this, the fact remains that the only way to truly protect the wellbeing of the NHS workforce is to ensure that there are enough staff not only to fill workforce gaps, but to build flexibility into the system. This is what will protect work/life balance, breaks, and annual leave—key reasons that the BMA’s respondents gave for considering leaving their roles. Staff were being asked to carry an unsustainable workload even before covid-19 hit, and the fundamental driver to change this is by increasing numbers to a point where we can confidently say we have the right size and shape of the NHS workforce in place. This will be a multi-year task, but it is vital to ensuring that the NHS continues to provide the best possible care for all patients and is better prepared for any future public health crises. This is why NHS Providers, along with a number of other organisations, is calling for the development of a fully costed and funded workforce plan.
The impact of consistently underfunding the NHS is painfully clear as we look to the care backlog. Trust leaders have emphasised the enormity of tackling this challenge with an exhausted workforce. In some cases, high hourly rates for additional work are having to be paid to already swamped staff who are struggling to take on the significant levels of additional work excess, and indeed need to rest. This can divert funding from other areas, including wellbeing initiatives that trusts are seeking to expand and offer beyond the short-term—the vicious cycle of workforce gaps both increasing staff costs and worsening staff wellbeing. The solution has to be to properly plan and fund the service, which is the first and most vital step towards making the NHS “the best place to work:” a critical commitment within the NHS People Plan.
The problems facing the NHS workforce are huge, but as we leave the immediate pressures of the pandemic behind us, we are faced with a key opportunity. If we implement funded, recuperative policies and properly invest in a long term workforce plan, the NHS can be made sustainable, and its people can be properly supported.
Sarah White is a senior policy officer at NHS Providers, focusing on workforce. Prior to joining the organisation she worked as a senior policy advisor for the BMA, undertaking national negotiations for doctors’ pay and terms and conditions of service.
Competing interests: none declared.