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Bet we can't all wait for Clap for Carers to return. Photo by TOLGA AKMEN/AFP via Getty Images
The rainbows drawn by children at the beginning of lockdown and blue-tacked to the living room window are starting to look rather yellow at the edges, as the brief flurry of love for “our NHS” starts to fade. The pandemic rumbles on, and all the while the healthcare recruitment crisis grows ever more acute. A recent survey undertaken by the Doctor’s Association UK asked respondents “where do you see yourself working in the next one to three years?” Shockingly, almost two-thirds of doctors said they would be leaving the NHS.
The Covid-19 crisis is one reason for this exodus, but only one. Although a majority of doctors surveyed reported that the Government’s handling of the pandemic had made them more likely to leave the NHS, a much more significant factor was the lack of a real-terms pay rise. And indeed, at the beginning of this year, just before the pandemic took hold, an article in the BMJ warned of the threat of “Drexit (Doctor-Exit)”, described as:
“… the exponentially growing trend for doctors to walk away from their jobs in the NHS, either to new healthcare systems overseas such as Canada, Australia, New Zealand or perhaps worse, into new professions altogether, leaving behind their well-trained medical brains. This exodus has been gaining momentum for several years with the workforce now at breaking point.”
I’m a medical school drop-out. I applied for reasons that were, in retrospect, a bit silly; I liked both arts and science subjects, and thought (wrongly, as it turned out) that a medical degree could neatly combine the two. Also, I really did want to “help people” — pat, I know, but true.
I got in, I disliked it, I failed my first-year exams and, rather than resitting them, I decided to leave. The experience has left me with a very patchy knowledge of the human body (for instance I know a surprising amount about the anatomy of the thorax, and next to nothing about the anatomy of the head). But it hasn’t left me with any feelings of wistfulness — because I don’t know a single junior doctor who is happy in the job.
At the end of last year, I met up with four old friends from medical school, some of whom I hadn’t seen since I left. All of these women are highly capable graduates of UCL, one of the best and oldest medical schools in the world. But only one of them intends to remain in NHS clinical practice. One is leaving to do private cosmetic work, one is going into hospital management, and another is leaving the profession altogether. I also know several doctors who have emigrated to South Africa or Australia, enticed by a higher salary and a lower cost of living.
And why on earth wouldn’t they? As I know all too well, the desire to “help people” may be genuine, but it doesn’t always last. Medical students are selected for the three magic traits that together produce a highly desirable worker: high intelligence, industriousness, and good communication skills. With these talents, almost all could go and work in the city and earn lots of money if they wanted to. Or they could choose a lower paid role that offers a comfortable work-life balance.
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SubscribeI’m an ex-GP, I left at fifty six. It’s not about the money, in fact being well paid meant I could go early.
The problem is the endless micromanagement, endless regulation and bureaucracy, and the regulator’s assumption that all doctors need to constantly prove that they are not negligent, incompetent or criminal.
Particular highlights include
– the CQC inspections, which do nothing to improve standards, but waste several weeks of our time, and inevitably are counterproductive tickbox exercise where we get admonished for not laminating the toilet paper or not having a protocol for nuclear war or some such nonsense.
– appraisal and revalidation; an attempt to impose lifelong learning, as if we didn’t already do this, but has created another tickbox nightmare that undermines learning, wastes huge amount of time and money, and has helpfully provided another stick to beat us with.
– complaints; patients are encouraged to complain, there are multiple avenues, malicious and ludicrous complaints can last years before finally expiring. The GMC in particular takes no account of real-world circumstances and has driven numerous doctors to take their own life. The Bawa-Garba case was a classic example of scapegoating an individual doctor for the failings of the NHS.
– The NHS; where to start? It’s not working for patients or staff; take off the rose tinted glasses and learn from abroad.
– The RCGP; intolerant of any model of care but theirs, obsessed with trying to turn doctors into social workers, and busy replacing training with groupthink and “reflection” rather than seeing patients and learning.
– The half-wit managers in the ccg/pct trying to tell you how to run your Practice, huge sums of money squandered on the latest “good idea” but unable to afford to replace essential kit years out of date and repeatedly malfunctioning.
– The dumping of everyone else’s problems onto GP.
I didn’t want to give up caring for patients, or running my own Practice, but I was driven out. Again, it’s not about the money, which was more than I ever dreamt of as a student, any full-time Partner earning less than £140k is doing something wrong, thank f@ck, as it meant I could go before it was too late.
Exactly the above, except I stuck it out to age 60.
thanks for your lengthy reply. I recognise all too well the bureaucracy and box ticking. Unfortunately, it’s all over the UK public sector.
re Practice Managers: I’m reminded of my own surgery, where during a particularly harsh overnight snow storm, the PM decided to close the car park as it was very icy, resulting in cars parked all over the grass verges on a busy road. In an email sent to complaining patients, she stated that ‘we need a new Cold Weather Protocol’
No, you don’t love, you just need a couple of handy men with shovels and plenty of salt and grit.
I am a 92 year old retired GP
I resigned from the NHS 30 years ago with much publicity in protest against all the government impositions on general practice that started then. Previous to this I had enjoyed the last 32 years of blissful practice looking after my patients with total non interference from Whitehall. I forecast that the morale of practitioners I left behind would suffer which has indeed happened.
All this can be read in my memoir – Recollections of a Southwold GP (and much else!) on sale tomorrow
through Waterstones and Amazon
Have a good read!
Christopher Hopkins
“a man who stokes racist fires, who traduces democratic norms, who treats the office of president as a form of ego-massage, who bullies and who lies. His re-election as president might endanger the US’s democracy itself ” and perhaps still more so if he is not re-elected and refuses to accept the result.”
I keep hearing / reading these accusations about Trump – but I never seem to get specifics. It’s just Orange Man Bad over and over. FFS, tell me why in clear terms.
You’re right of course. In fact the “Bad”, his opposition/frustration of the Deep State agenda, is not permitted to be mentioned in right-thinking circles. But, equally, his Good, which I fear our author would not subscribe to, his body-count the lowest since Jimmy Carter, is unmentionable.
The problem with the NHS is the same as with the US system. There is zero price discovery. In what other area of our lives do you live without this vital sign? (We, in the US, have reserve currency status — for the moment — and can ‘print’ the sh*t like no tomorrow. That is quickly changing…..)
Amazing, isn’t it? NHS doctors defect to work in health services that are not national in a veritable tidal wave. Why? Because the NHS is a pile of ordure. But do you ever hear any them saying so, let alone staying in the organization that trained them and making an effort to reform it? Do you h3ll.
They do say it is ordure but you have to recognise the increasingly brutal and Stalinist practices of management. During early Covid clinical staff were threatened with disciplinary action or damage to their careers if they went on social media to complain about the lack of PPE. The latest story I heard was of an email sent to staff saying if they did not adhere to PPE practice and become ill and go on leave, they would not be paid. This despite staff informing management that they had not been provided with enough PPE during the early part of the pandemic! Look at the way whistle blowers are treated e.g. Dr Day. You need to understand this dynamic. Clinical staff are between a rock and a hard place. Complain about the lack of PPE and risk your career. Don’t complain about PPE in order to protect the government and risk dying of Covid.
As usual, this article confuses radiographers (not medically qualified) with radiologists (medically qualified). It then goes on to trot out the canard that “computers” aka “AI” will “outperform” those interpreting radiological images.
I’m old enough to remember the arrival of Computed Tomography (CT) scanning in the 1970s, and the prediction that the digital images which it produced would render radiologists obsolete. Then we had Nuclear Magnetic Resonance (NMR) in the 1980s, which some said stood for “No More Radiologists”. It changed its name to Magnetic Resonance Imaging (MRI), which of course also stands for “More Radiologists Indefinitely”. Now in 2020, despite and in fact because of these technological advances, we have even more need of trained radiologists and a chronic shortage thereof in the UK.
Yes, AI may help reduce Radiologists’ workloads by screening out “normals” in some specific applications, such as mammography. The trouble is that very few radiological investigations present a “normal” pattern. So many show slight variations, normal variants and incidental findings, and explaining these and making sure that they are not clinically significant takes up a large part of clinicians’ and radiologists’ time. So don’t count on them being replaced by computers any time soon.
“the role [doctor] requires a combination of brains, dexterity, and bedside manner.” With so many c**k ups and subsequent litigation over a few decades counter balancing the ‘we are ever so brilliant aren’t we’, perhaps Sincerity and Humbleness needs to be listed as well.
2 things:
– This is just the beginning: expect a huge brain-drain of qualified young people from next year onwards. Every young person I speak to wants out. Lockdown restrictions are only hastening the decline.
– Doctors will never get paid what they’re worth under socialised healthcare. If we want doctors and nurses to get a pay rise then we have to introduce some amount of private health insurance into the NHS.
When my old dad trained as a junior doctor in the 1950s he was on call 24 hrs a day,7 days a week with one Sunday afternoon off every two week. They were taught to observe., Today doctors just rely on tests. With no “face to face” appointments robots can do the same thing much better and cheaper.. Its a redundant skill in about 5 years. Nursing however is a different thing. Lets get back to the ideas of care that doesnt need a university education but simply requires good people caring for the sick. The old idea of “angels” long gone.
mmm…”… rely on tests…” Well, I think a CT brain scan is the best way to rule out an extradural haematoma, and I hope you agree.
I like Trump, but I don’t think he should get the Nobel Peace Prize. Let’s face it, the Nobel Peace Prize is such a devalued award now it might be better to scrap it altogether However, it is generally a bad idea to give heads of state or prime ministers the Nobel Peace prize. They are well compensated for their efforts and have security to protect them. The Nobel Peace prize used to go to women like Betty Williams and Betty Corrigan, who worked for peace with little compensation for their efforts and at great risk to themselves. There are still people like them in the world, and they are the people who should be considered for the Nobel Peace Prize, not Donald Trump.
If this is an attempt at black humor, or a theme issue doing porn apologetics, I apologize for my obtuseness.
The mirror image of the argument is the can good people do bad things for good reasons..and there as well I think really I would rather have have someone doing something they don’t believe in (such as now, Johnson limiting personal freedoms with some quite draconian powers) than someone doing the exact same things, but which happen to co-incide with their beliefs.
In a way our modern political system was about ensuring exactly those things happened, and despite all the noise and clamour around Brexit, and because Covid-19 is a convenient proxy for Brexit–that as well, right now we still have that.
Bumbling hesitancy in policy is vastly under-rated ,and square jawed, far horizon-gazing certainty, vastly over-rated, as almost any study of History shows really?