I remember when I first started my training as a junior doctor in Northampton. On my first day I remember walking into the hospital and how much it felt like being an imposter with a stethoscope. I knew it would be intense, and I knew it would be stressful, but ultimately I wanted more than anything to do my best for the patients in my care.
What I found more often during my medical career however, was the most notable challenge our staff faced, was overcoming the shortage of staff and resources required to provide the care we wanted to deliver. In particular, working in undersubscribed specialties like acute medicine or paediatrics, myself and peers find ourselves staying longer than anticipated, unable to book leave or provide the care we would want due to how few of us were on a rota.
New figures released by the British Medical Association show that this is now the rule, not the exception. The new research shows that nearly three quarters of all medical specialties had unfilled training posts in 2016, with dozens facing recruitment shortfalls year on year.
Recruitment is one part of the picture, but even more worrying is that at every stage of a doctors training, we are seeing more and people dropping off. The number of applications to UK medical schools has decreased, people are choosing not to go into the foundation programme, and more doctors are choosing to take career breaks. We have to ask why some, who have spent many years training to become a doctor, are deciding not to continue in the profession.
There are a number of reasons for this continuing decline. Although medicine remains competitive, rising tuition fees and higher student debt could be a major factor in the decline in applications. Doctors' student debts can exceed £80,000 and most are unlikely to repay their student loans back in full.
Rising workloads, worsening morale, the NHS pay cap which has seen doctors' pay fall by up to 17 per cent in recent years, and concerns around work life balance are also likely factors contributing to doctors taking time out from training or leaving the NHS altogether. Concerns raised last year by junior doctors around patient safety, workload and morale were repeatedly ignored by the government. The result is an NHS that is now at breaking point with staff working harder than ever under increasingly difficult circumstances.
There are a number of things that can be done to help this situation. Greater career flexibility, including greater access to part time working, parental leave, more flexibility around shift patterns and better rostering practices will help boost morale and stop those who have spent a great deal of time training from leaving.
Better workforce planning and tackling rota gaps is also so important. A recent BMA survey found that two thirds of doctors reported rota gaps in the department in which they work, with trainees put under pressure to accept extra shifts and cover additional wards as a result of rota gaps. The NHS needs to be able to deliver care in different locations as required, without leaving parts of the health service inappropriately or under staffed.
We also need protect the NHS' ability to recruit valuable staff we recruit from EEA countries. The UK needs a flexible immigration system post-Brexit so that it can recruit and retain enough doctors. EU nationals make up nearly seven per cent of the UK medical workforce, any drop in numbers will only make things worse.
Ignoring this staffing crisis creates to a vicious circle, compound existing problems, adding to pressure on existing staff making them more likely to leave. On almost every front, the NHS is being asked to deliver more, with less. Less money, fewer staff, more patients. You don't need to be a genius to work out this isn't sustainable and that something has got to give.
Short-term solutions to increasing demand, like using more agency staff or outsourcing work to the private sector, will plug holes in the service, but will ultimately lead to bigger financial problems in the future. We need urgent investment in health and social care, and a long-term plan to protect patients enduring some of the worst conditions in decades. Having fewer doctors progressing through training, at a time when demand on NHS services is growing, will be bad for not only doctors, but our patients too.Suggest a correction