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Signals of distress point to ‘state of unease’ among doctors, GMC finds

The unprecedented state of unease among NHS doctors in the UK needs to be addressed, the General Medical Council (GMC) has said in its annual report.

The report said that standards for healthcare in the UK remain high. There were 8,629 complaints about doctors’ fitness to practice in 2015, a 7% decrease since 2014, and the introduction of revalidation has strengthened clinical guidance.

However, Professor Terence Stephenson, the GMC’s chair, and Niall Dickson, its chief executive, said in their foreword that they had encountered unprecedented discontent among the profession.

“There is a state of unease within the medical profession across the UK that risks affecting patients as well as doctors,” they said.

“The reasons are complex and multifactorial, and some are long standing. The signals of distress are not always easy to interpret but they are unmistakable. This should not be seen as a counsel of despair but as a message to governments, employers, regulators, and the profession itself.

“The GMC is concerned because of the impact this might have on the professional standards for which we are responsible.”

The report comes at a time of acute stress for the NHS. A recent Royal College of Physicians report called the health service “underfunded, underdoctored and overstretched” as it struggles to shrink its deficit and cope with staff shortages coupled with increasing demand.

The NHS has also been hit by waves of junior doctors’ strikes over the imposition of a controversial new contract.

The GMC found that the percentage of doctors who were proceeding to specialty training after their foundation year had fallen from 78% to 66%. Stephenson and Dickson the reasons for this were not clear and the gap would need careful monitoring to ensure that it didn’t lead to “a prolonged reduction in the supply of new doctors”.

The body welcomed the government’s recent promise of more places for medical students, but said that they will not graduate until 2023, so the medical system would need to “think creatively” about how to retain new graduates and oversees doctors and keep older doctors from retiring.

Its chair and CEO also said the GMC would continue to try to support doctors by reducing the need for full-scale fitness to practice investigations.

However, the report said it was being held back by an “out-of-date” legal process that would need legislative reform.

An NHS Employers spokesperson welcomed the insight the report gave “into the huge financial and service pressures the NHS is under”, adding: “We know insufficient social care funding is an immediate threat to the NHS and the wider health and care system putting increasing pressure on frontline staff and patients.

“We need the government to incentivise greater coordination between local authorities and the NHS and to invest more in out-of-hospital health and care.”

The spokesperson also argued that the report underlined the health service’s reliance on foreign-born workers, who are “hugely valued and appreciated”.

“With colleagues in the Cavendish Coalition we are working hard to influence and support the government in a way which allows it to grant indefinite leave to remain for the vital 144,000 EU workers in health and social care, including over 20,000 doctors practising in the UK as well as working with employers to do more to attract UK nationals into health and social care careers,” they added.

Responding to the GMC’s findings, a Department of Health spokesperson said that the “dedication and sheer hard work of our NHS doctors is absolutely crucial to delivering world-class care for patients”.

“As the report makes clear, the standard of care provided by doctors working in the UK remains among the best in the world,” the department added. “1.6 million more NHS operations now take place each year compared to 2010 and hundreds of thousands more people are seen in A&E within four hours.

“The government is investing £10bn to fund the NHS's own plan to transform services for the future - central to which is listening to the concerns of staff.”

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