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How can NHS executives support trainee doctors?

Professor Jane Dacre, president of the Royal College of Physicians (RCP), discusses the vital role that NHS managers can play in supporting trainee doctors and providing a positive workplace environment.

The events of the past year have left our medical trainees feeling undervalued, disempowered and downtrodden. Morale is low, and it will take a very long time for this generation of doctors to recover. There are many things that need to be fixed in order for us to empower trainees again, and to guarantee that medicine will be the brilliant profession for them that I know it has been for me and my generation of doctors. 

I think there is often a perception that because doctors themselves supervise their training, it is only doctors who can improve the working lives of trainees. However, there are many areas of work outside the contract where NHS managers can support trainees by providing a positive working environment. Earlier this year I wrote to chief executives and medical directors of NHS trusts outlining the areas for national and local action. 

These include establishing robust induction programmes for trainees, monitoring workloads, supporting flexible working, and ensuring that trainees have access to healthy food and drink outside normal hospital catering hours.  

Work patterns and rotas should promote team working and a sense of joint staff responsibility for patients, but are too often driven by acute pressures, leading to a breakdown in team working. The recent RCP report, ‘Underdoctored, Underfunded, Overstretched’, painted a picture of a service struggling to cope with the daily workload, not enough doctors-in-training, rota gaps, fewer medical students and not enough medical school places. 

Small changes that make a real difference 

There are a number of small things that NHS executives can do to demonstrate that they value trainee doctors. Simple things like using their name when addressing them, demonstrating respect for their views by encouraging them to get involved in hospital-wide initiatives, and quality improvement projects; thanking them for a job well done; taking an interest in their career progression, or their life outside medicine. It is perhaps just common courtesy, but it makes a real difference. 

Only two weeks after the launch of our report, the health secretary, Jeremy Hunt, announced an extra 1,500 medical school places, which was very welcome. However, the wider political context of the announcement has been interpreted by some as meaning doctors from other countries are not as welcome as they should be, an interpretation that I am sure was not intended. Two in five hospital doctors qualified from outside the UK and our hospitals couldn’t cope without them. 

At the time of Brexit our message to them must be that we need and value them and want them to stay. Those new doctors will take time to be able to contribute to the service, so in the meantime, we need to involve our current trainees and other clinicians in designing the transformation plans that we need. It will empower them, and show them we value their contribution. 

There are opportunities for hospitals to employ international graduates through the Medical Training Initiative scheme, which offers working and training placements with a UK employer for up to two years. If your trust is not already accessing the scheme, it is definitely worth exploring. There is also our Chief Registrar programme, where trusts are employing medical registrars in NHS delivery for part of the week, and involving them in leadership activities for the rest of the time. 

While we wait for the welcome increase in medical school places to translate into more doctors in seven years’ time, NHS managers can have a large role in alleviating the current pressures in our day-to-day work. Establishing regular on-call teams, prioritising time for handover, planning rotas that allow time for training and are published in good time for trainees to have a better work/life balance – these are areas where a managerial focus, working with the medical team, can make all the difference. 

While helping out at my own trust during the strike, I also became aware of the burgeoning bureaucracy, form-filling and higher levels of IT literacy needed to be a junior doctor these days. It also underlined the importance of the work of the RCP’s Health Informatics Unit in promoting interoperability and generic record standards. Many of the day-to-day frustrations doctors have in providing patient care relate to the supporting systems and processes. By involving clinical staff in their development and function, care pathways can be better supported. 

Trainee doctors are able, articulate and committed clinicians, who came into medicine with a core set of values and a vocation to help patients. NHS executive staff can help to unleash their enormous intellect and enthusiasm for patient care.

FOR MORE INFORMATION

The ‘Underdoctored, Underfunded, Overstretched’ report can be accessed at:

W: http://tinyurl.com/NHE-RCP-Report