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GMC Response to HEE Call for Evidence – Strategic Workforce Review

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GMC Response to HEE Call for Evidence – Strategic Workforce Review GMC response to HEE call for evidence – Strategic workforce review Please contact Naomi Day ([email protected]) with any queries. Note on evidence sources 1 The evidence presented here comes from four key sources: National Training Surveys (NTS) - a census of 63,000 doctors in training and their trainers completed annually. The data presented here is taken from the 2021 trainee survey, with some reference to findings from previous years. The data covers those training in England only. Further detail can be found on the NTS webpages where there is a data reporting tool available. Barometer survey - an annual survey of a representative sample of practising doctors which has been running since 2019. The survey has around 3,000 – 3,500 completions annually. The data presented here is UK wide (national differences are insubstantial) and mostly taken from the 2019 and 2020 surveys. Analysis and quality assurance of 2021 data is ongoing and will be available to share in detail from November 2021. A detailed write up of analysis from the 2019 and 2020 surveys and full data tables can be found on the ‘State of medical education and practice’ webpages. Caring for doctors caring for patients – In 2018 we commissioned Professor Michael West and Dame Denise Coia to carry out a UK-wide review to help tackle the causes of poor wellbeing faced by medical students and doctors. Fair to refer? – The research was commissioned to understand why some groups of doctors are referred to the GMC for fitness to practise concerns more, or less, than others by their employers or contractors and what can be done about it. Employers and healthcare providers are more likely to refer doctors who obtained their primary medical qualification outside the UK and those who are from a black and minority ethnic (BME) background to the GMC than they are to refer their UK qualified or white peers. This is particularly important as complaints from employers are more likely to result in an investigation being opened and, ultimately, more likely to result in a sanction being applied, than complaints from other sources. Category: staff and student/trainee expectations Factor 1 – expectations of working life 1A – Flexible working The overall trend among doctors is a move towards more flexible working than in the past. While this may have a positive impact on individual doctor’s personal and professional wellbeing and a knock-on positive impact on retention, there will need to be higher overall headcount to achieve the same workforce capacity (full time equivalent – FTE). More flexible role definitions will also be needed to facilitate flexible working which works for patients and professionals. Evidence: 1 In the Barometer survey 2020, 21% of respondents reported that they were working part-time. However, we are conscious of the challenges and lack of consistency in defining full and part time across different areas of medicine and portfolio careers, so this finding is indicative at best. 2 In the NTS survey trainees are asked about Less Than Full Time (LTFT) training. In 2021, 16% of respondents reported formally working LTFT as approved by their deanery/HEE local team. A further 3% had considered applying for LTFT training but decided not to. None reported an application for LTFT training being rejected. 3 By far the most common reasons for working LTFT selected by respondents was childcare (55%). 16% reported a disability, illness or health related reason. 4 Of those working LTFT, the vast majority worked 0.6 (42%) or 0.8 (43%) of a fulltime contract. Factor 1 – expectations of working life 1B – Burnout and work-related stress Burnout and stress are a significant consideration in workforce planning due to the risk to the retention of professionals and, potentially, to recruitment if medicine becomes unattractive as a result. Medicine is well known to be a high-pressure, high-responsibility career, but we must ensure that doctors are supported so this doesn’t become unsustainable pressure, risking personal and professional wellbeing. Not only might burnout and stress cause long-term workforce issues that need addressing with future 2 planning, but also result in short-term absences which are difficult to fill with the current workforce and stretch the capacity in the system. Evidence: 1 The ‘Caring for doctors, caring for patients’ report found that burnt out doctors were significantly more likely to make a serious medical error than those who were not burnt out. Protecting and supporting doctors’ wellbeing is not just good for individual professionals and workforce supply, but fundamental to safe patient care. 2 The NTS and Barometer surveys both use the Copenhagen Burnout Index (CBI) to give an indication of burnout risk. The index is made up of 7 questions. In NTS 2021: 59% of trainees reported being often or always exhausted at the end of the working day. 44% reported that their work is emotionally exhausting to a high or very high degree. 37% reported that they often or always felt exhausted in the morning at the thought of another day at work 32% felt burnout by their work to a high or very high degree. 27% were frustrated by their work to a high or very high degree. 19% reported that they seldom or never had enough time for friends and family. 17% often or always felt that every working hour was tiring for them 3 Overall, in 2021, 15% of trainees were at a high risk of burnout based on their responses to the indicator questions. This is an increase on 2019 and 2020 when the proportions were 11% and 10% respectively. The proportion of doctors now at a moderate risk of burnout has also increased, from 33% in 2020 to 40% in 2021 (this is a return to 2019 levels). 4 The Barometer survey also uses the CBI to give an indication of burnout risk across a representative sample of practising doctors. In 2020 there was a reduction in those experiencing a high risk of burnout – 10% compared to 15% in 2019. It is likely that this improvement was the result of several factors including: The time at which the survey was completed (after the Spring peak of the pandemic had subsided and before things started to build again through the autumn) 3 Changes to working patterns, workloads, and supporting administrative tasks being undertaken A sense of ‘mucking in’ and camaraderie across the health service. 5 Early indications from 2021 data suggest a return to 2019 levels of burnout risk. 6 In the 2019 and 2020 Barometer surveys, GPs were consistently the group the most likely to be at a high or very high risk of burnout. A detailed analysis of burnout risk by registration type can be found in the ‘State of medical education and practice’ reports from 2019 and 2020. 7 In the Barometer survey, respondents are asked how often they have had to take a leave of absence due to stress in the past 12 months. In 2020, 14% of doctors reported that they had taken a leave of absence at some point in the preceding year. This was consistent with 2019 when 12% had taken a leave of absence. Factor 1 – expectations of working life 1C – Tackling bullying and harassment Bullying, undermining, and harassment have no place in supportive working and caring environments. The scale of bullying and harassment in the medical profession is difficult to determine due to concerns about underreporting. What is clear is that where bullying is present it has a huge impact on individual’s wellbeing, wider cultures, and ultimately on patient care and staff retention. Tackling bullying and harassment are key to workforce considerations as failing to address these issues could have serious implications for the retention of staff and make medicine a less attractive career option. Considering how different healthcare professionals work and train together in multidisciplinary teams will also be crucial in developing a cohesive healthcare workforce. Evidence: 1 In 2021, 37% of trainees reported that they had never experienced any rudeness or incivility in their current training post. However, 14% agreed or strongly agreed that rudeness and incivility were negatively affecting their experience in their post. 2 Trainees are also asked about their ability to raise concerns, a crucial element of creating just cultures free of bullying and harassment. 77% of trainees agreed or strongly agreed that their current post has a culture of proactively raising concerns, whereas 5% disagreed or strongly disagreed. 62% agreed or strongly agreed that they were confident that concerns were dealt with effectively. 4 3 The vast majority (80%) of respondents felt that there was a culture of learning lessons when concerns were raised. 57% felt that the actions as a result of raising concerns were fed back appropriately. Factor 1 – expectations of working life 1D – Time to care Doctors’ time is under increasing pressure from the number of patients they must see, the preparatory, administrative and follow-up tasks required of them, and additional roles they take on alongside their clinical work. The Covid-19 pandemic has also brought with it a raft of new challenging processes doctors must follow and care backlogs. All of these mean that the time they have available to care for individual patients is squeezed. This issue is significant to workforce planning in two ways: Firstly, it speaks to an issue with overall supply and availability of appropriate professionals (within and outside medicine) to meet patient needs. This needs considering both in terms of the total number of doctors available, where and in what specialities those doctors are practising, and also the multidisciplinary skills mix which best supports system-wide patient care.
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