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Part-Time Doctors are not A 'Risk' to the NHS

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The Telegraph recently sported the headline " Part Time Women Doctors are a 'risk'" to the NHS". The page showed a lady doctor reviewing x-rays. The lead into the article wrote

"Rising numbers of women doctors working part-tine present a 'huge risk' to the NHS, the General Medical Council (GMC) is warning, with hospitals potentially having to employ many more foreign-trained medics to plug gaps"

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This headline has been replicated in numerous smaller publications around the UK.

Now, it is this negative headline that will cause shockwaves in most human resources departments in the National Health Service (NHS). It creates the impression that women doctors are a risk to the NHS and a threat to patient safety. This may well cause further discrimination during interviews where it will be assumed that a male doctor is more reliable. If this situation did occur, it would be entirely unacceptable. The headline is neither evidence based nor is it true.

One could argue that presenting such a negative view of women doctors in a leading national newspaper without any evidence is counterproductive and not in the public interest. On a cursory glance at the complaints statistics, it is interesting to note that the GMC's second annual State of Medical Education and Practice in the UK report found that nearly three quarters of all complaints in 2011 were about male doctors, though only 57% of all registered doctors were men. It therefore appears bizarre that the General Medical Council would pluck an idea out of thin air and assume female doctors were a risk to the NHS.

Risk can be linked to the disintegration of clinical teams over the years. This has been caused by the European Working Time Directive (EWTD) and junior doctor's shift systems. This has effectively damaged continuity of care. In April 2012, this was debated in Parliament . It is worth reading this debate in detail. One extract reads:-

"Doctors have been making the case strongly, and trying to get the political class to hear. They have warned that the working time directive is devastating the NHS in three ways. First, on doctor training, it is eroding the professional ethos that upholds the NHS, and beginning to replace it with a clock on, clock off culture. New generations of junior doctors will know only that. They will never know the old ethos that sustained our NHS. Secondly, the safety of patients--our constituents--is being seriously jeopardised daily. Thirdly, I am sure the Minister appreciates that the financial cost is absolutely massive. I will deal with those three issues in turn, before concluding on the final, biggest blow, which is that the directive does not achieve its aim of a better work-life balance for doctors, and in some cases it makes matters worse.

The previous Government estimated that the introduction of the EWTD, given the existing new deal limitation of a 56-hour working week for doctors, would be the equivalent of taking 4,000 doctors out of circulation. The Royal College of Surgeons estimated the loss of surgical time per month to be 400,000 hours. To put that into perspective, that is equivalent to 45 years of surgical time per month being lost to the NHS"

Of course, it is not as if the GMC has not been aware of these critical problems in work force planning. The medical establishment (including the GMC) were solely responsible for bringing in the EWTD and changing the junior doctors career structure (Modernising Medical Careers ) without first assessing the impact of their actions on the future of the workforce.

The implication is that the very nature of part-time doctors leads to a service failure. Well, firstly, part-time doctors are a minority group. Secondly, good patient care in the NHS is linked to good team work. If the medical fraternity had preserved these clinical teams then the impact of the part-time doctor would not be cited as a 'risk'. The fact is that the current problems are a product of poor strategic management and forward planning of the NHS workforce. The net result is a weakened infrastructure with little tolerance for shortfalls which must then be made up by foreign doctors. Ironically, they too are often (unfairly) considered a risk to patient safety by the medical fraternity.

Instead of blaming the influx of women doctors into the profession, the medical establishment should be reviewing their previous mistakes. They should then find ways of correcting the current problems. For instance, adequate job sharing is a possibility. Currently supernumerary positions are not allowed although it is a valid option. The reintroduction of a sub-consultant grade is also another option. The solution does not lie in blaming women doctors, the solution lies in investigating the actual cause of the risk in the UK's hospitals.

The actual cause appears to be the European Working Time Directive and Modernising Medical Careers - both which appear to have been ill thought out with a negative impact on patient care.

It is of course even more interesting to note that the changes implemented by the medical fraternity did not lower the medical negligence bill. Indeed, it recently past the £1 billion mark . Perhaps the GMC will develop a broader mindset on the issues posing an actual threat to clinical safety instead of raising unreasonable doubts against a group of doctors who do their very best under difficult circumstances.

The catastrophic disintegration in continuity of care should to be corrected as a matter of urgency. Stronger clinical teams will improve patient safety and sustain any short falls. Perhaps the GMC could start by analysing the causes of the disintegration of continuity of care and then make constructive evidence based suggestions to improve patient safety. This would be a more pro-active positive approach in a environment where patient safety is paramount.