The BMA released a statement on 03/05/21 regarding NHS doctors post-pandemic. As has been widely reported in the UK media, many NHS doctors are considering their career options now that the UK seems to be emerging from the worst of Covid-19. In a survey of over 5000 doctors, the BMA found potentially ‘thousands’ are planning to leave the NHS.
The reason for this, according to the press release, is the ‘stress and burnout without adequate respite from the exhaustion caused by the demands of the pandemic‘. It’s undeniable that the coronavirus Covid-19 pandemic took a huge toll on the mental health of all NHS professionals, including doctors. The mental health crisis on the NHS Covid-19 frontline is very real and the conversations on how to tackle it still have much momentum to gain.
At Remedium we’ve been taking active steps to bring the mental wellbeing of doctors and other healthcare professionals to the forefront of the national conversations. With initiatives like the Healing Our Healers event and our Doctor Wellbeing Resource Centre, we’ve started making our own contributions to ensuring the phenomenal contributions doctors made to the nation’s health during the pandemic don’t take an emotional toll they feel they must shoulder alone.
Low or mismanaged staffing levels have been a key contributor to stress, exhaustion, burnout, and poor mental health of NHS doctors since long before the Covid-19 pandemic. If NHS trusts want to implement real changes to promote both staff retention and mental wellbeing, workforce planning is one of the first areas they should assess.
What did the BMA survey find?
The April survey asked doctors a range of questions regarding their experiences during the Covid-19 pandemic. These focused on everything from how working through the pandemic impacted their mental health, to whether doctors felt adequately protected from Coronavirus in the workplace.
The responses which are of great concern to the BMA are to the question ‘How, if at all, have you changed your career plans for the next year in the following areas?‘.
5,521 doctors were surveyed as part of the research. Of these, 31.89% stated they were more likely to take early retirement (1,352), 25.15% reported an increased likelihood of taking a career break (1,065), and 17.7% would be more likely to seek work abroad (728). 20.83% are now more likely to consider leaving the NHS for another career entirely (882).
Will there be an ‘exodus’ of doctors from the NHS?
It is from these figures that some British media outlets are coining terms like ‘exodus’. Whether or not this term is accurate remains to be seen. It is important to remember that ‘more likely to consider…‘ is not the same as ‘definitely going to…‘.
That being said, if this data is accurate when extrapolated across all 122,000+ registered NHS doctors, a 20% reduction would mean the NHS losing over 24,000 uniquely trained and experienced medical professionals. A loss of even half of this magnitude would be incredibly damaging to the NHS’s ability to provide adequate patient care. Even if a sudden pandemic-created doctor shortage of the kind the press predict isn’t likely, it’s undeniable that steps need to be taken to ensure that the retention rates of NHS doctors don’t significantly drop.
Why are ‘thousands of doctors’ considering leaving the profession?
The BMA survey also asked participants what had influenced their answer. Unfortunately, this wasn’t broken down on a ‘per question’ basis, so it’s unclear which specific changes responses to the question ‘Which of the following best explain your reasons why you have changed your career plans?‘ refer to. Whilst the situation inferred by the data correlates with anecdotal reports from doctors on the current state of the profession in the NHS, it’s important to keep in mind that the following figures will be in reference to multiple answers to the ‘have you changed your career plans‘ question.
For those doctors more likely to consider a career change (it’s important to note that 28.05% of respondents reported no planned changes), there were two reasons in particular which stood out.
The first was personal well-being. This is unsurprising given the nature of the pandemic, with doctors and other frontline medical staff being at a significantly increased risk of contracting Covid-19. However, it’s more likely that the primary wellbeing concerns weren’t related to Coronavirus infection. The same study found that almost 40% of those surveyed (18,70) felt fully protected from Coronavirus infection in their place of work. Only 193 of the 5000+ respondents (around 4%) felt they were unprotected.
Why then did 43.25% of respondents cite personal wellbeing as a key influence in their decision to retire early, work internationally outside of the NHS, or leave the medical profession for a new career path? The second reason gives us some insight, as it directly impacts doctors mental and emotional health.
44.95% of doctors surveyed by the BMA stated workload was the key reason for their shift in career trajectory. Many doctors worked an unprecedented amount of hours during the pandemic. Often these would be as many as 12-14 hour shifts, 5-7 days weekly, sometimes without a break.
Whilst doctors expect long hours when they enter the profession, they are human. They have limits, and many saw those limits tested and broken on more than one occasion. One doctor interviewed by the BMA is quoted as saying “I love the NHS but I know I can’t keep this pace up indefinitely. My own mental and physical health will have to become a priority at some point.”
Is Covid-19 causing burnout amongst doctors?
As early as April 2020, approximately two months into the UK’s struggle against Covid-19, the BMA reported that almost half of UK doctors suffered from burnout, depression, or anxiety. However, as much as the increased pressure on the NHS from the pandemic significantly exacerbated the problem it did not create it. Stress and poor mental health caused by workload were already endemic amongst NHS doctors.
Burnout and exhaustion were two of the key reasons for mental ill-health amongst doctors long before Covid-19. A systematic literature review in 2018 found that over the prior two decades between 31-54.3% of doctors suffered from burnout and emotional exhaustion due to workload and extensive hours worked. Research carried out as recently as 2019 found as many as 1 in 2 surveyed doctors had considered leaving the profession for reasons of personal wellbeing.
Workforce planning and mental wellbeing
Outside of a pandemic, what is the reason many doctors have workloads they feel unable to manage?
One of the major contributing factors has always been staff shortages. Poor workforce planning and inadequate staffing levels have been cited by many professional bodies, including the BMA itself, as the root cause of many challenges facing the NHS. This includes the mental health and wellbeing of doctors. Without adequate available cover, proper allocation of personnel, and robust workforce planning, doctors have no choice but to take on an unsustainable workload to ensure patient care targets are met.
It is inevitable that under these conditions some NHS doctors will burn out and suffer from work-related stress, depression, anxiety, and general poor mental wellbeing. A 2018 report into the impact of NHS policy on UK doctors mental health found that ‘poor working conditions seem to have the strongest effects on wellbeing‘, and that ‘particular risk factors include high perceived workload and work intensity, (and) poor staffing levels‘.
Workforce mismanagement and a shortage of doctors across the NHS are the two leading causes of exhaustion and burnout. Unless they are addressed properly by NHS Trusts any attempts to combat the wellbeing and workload stress faced by doctors will fail to yield meaningful results. Mental wellbeing initiatives, training, and awareness programs are only one piece of the puzzle.
Why the mental wellbeing of doctors is important
Poor mental wellbeing is a recurring theme in NHS Trusts and hospitals with high staff turnover rates. Creating a culture and environment which isn’t detrimental to the emotional and mental health of staff directly increases staff retention levels and reduces turnover. This is true for all healthcare professionals, not just doctors.
If a Trust can effectively put the mental wellbeing of its staff as a core priority when making policy decisions then turnover rates will decrease exponentially. This will be especially true in the months and years following the pandemic, as the increased demand for NHS staff mental health and wellbeing services continues to be high.
Maintaining the mental and emotional wellbeing of staff is already a core principle of the NHS. However, if it isn’t translated into tangible policy at a Trust level this commitment becomes little more than lipservice in practice.
Workforce consulting: a key service for post-Covid doctor retention
Effective workforce planning is a challenge for an organisation as large and multifaceted as an NHS Trust. Whilst every Trust wants to allocate staff in the most effective way possible, maximising the standard of patient care whilst keeping workload at a sustainable level for doctors and other professionals, many find that this is a challenge. No NHS Trust operates with a limitless budget. Oftentimes there simply aren’t the financial resources available to ‘hire more doctors’, as many in the public and press often suggest.
However, oftentimes these budgets feel restrictive not because of the amount available but because of how it is allocated. At Remedium we have been helping NHS Trusts across the country with workforce consulting and staff procurement strategy. So far Remedium has saved the NHS over £180 million by providing a cost-effective permanent staffing solution for the procurement of doctors. We have also been working with Trusts to create a workforce planning strategy that utilises existing resources effectively, making budgeting constraints much less restrictive and allowing for a greater number of available doctors on rotas.
We know from experience just how much mental health matters to NHS doctors and their career plans. For the doctors we represent we provide a Doctor Wellbeing Resource Centre, and are actively involved in several events for doctors struggling with managing stress & anxiety during the pandemic. We understand the mental health concerns and challenges doctors are facing, and as such know just how much adequate workforce planning and a sustainable workload contribute to their alleviation.
If you represent an NHS Trust and need to reassess your current workforce strategy as we move closer to a pandemic-free future, why not make an enquiry. One of our healthcare workforce planning experts will reach out to arrange a meeting and assess where current policy leaves your Trust vulnerable to low doctor retention post-Covid. Whether it’s a locum-free solution to filling vacancies or a dedicated workforce consulting service, Remedium is here and available for every NHS Trust.