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Opinion: The NHS must become a flexible employer if it wants to retain its workforce

By Dr Anas Nader, NHS doctor and former Darzi fellow.

We are seeing UK start-ups make huge strides when it comes to how patients are able to see their doctors. Technology-led solutions are increasing in popularity – from video-based consultations to remote tracking of conditions. But whilst the hype is currently focused on access, more attention should be paid to the desperate challenges facing NHS staffing.

The question going forward shouldn’t be, how can I see my doctor? But, will there be a doctor to see me at all?

The NHS’ staffing dilemmas are well documented. 2018 saw, for the first time, the number of junior doctors continuing on to specialist training following their foundation years drop below 50%. Whether taking a break, heading abroad or moving into locum work, this annual exodus is now staggeringly high.

And the recently released ten-year plan, which struck a hugely welcoming tone for a digitally-led future, attracted criticism over how it plans (or lack thereof) to approach some of the chronic issues at the heart of NHS staff shortages. The plan noted that a “significant uplift” in international recruitment would be needed to deliver on the plan’s laudable ambitions, but there was little in the way of detail about tackling the structural issues that have led us to this point.

There is a surfeit of people looking to train as NHS doctors and nurses – demand is not necessarily the issue. And additional efforts are being made to further boost the number of undergraduate and nursing places to keep numbers up. Instead, we are failing to retain those who qualify into NHS clinical roles.

Whilst the world of work has changed dramatically over recent years, the NHS approach and systems have remained largely static. Workplaces across the UK have become more flexible with hours, freelancing and remote working is on the rise, and portfolio careers are increasingly the norm. But the NHS, despite being Britain’s biggest employer, has failed to keep up with the times.

Indeed, the ten-year plan highlights the institution’s lack of flexibility and responsiveness “in the light of changing staff expectations for their working lives and careers” and states that many of those leaving their roles would remain if opportunities for development and more flexible working improved.

Our health service, but dint of scale and decades of gradual evolution, has created a rod for its own back when it comes to staffing. Hitherto unable to be the flexible, modern employer desired by its own staff, unsustainable solutions such as increasingly expensive reliance on agency locums and international staff have filled the void. This has created financial burdens for the system, whilst failing to tackle the root causes of staff churn. And the impact of this is something we can no longer ignore.

The health of our existing medical professionals is on the line. According to ONS figures, 430 health professionals took their own lives between 2011 and 2015. Two-thirds of doctors responding to the BMA’s 2018 survey said their stress levels in the workplace had increased over the previous twelve months. And figures released by the Royal College of General Practioners in December showed that a third of GPs said they wouldn’t be working in general practice in five years. Stress was cited as one of the most common reasons.

We are operating an unhealthy environment for clinical staff. We are all familiar with the macro and micro issues which have led us to this point – the strains and pressures of a system struggling to cope with demand. But NHS staffing and the happiness of our clinicians cannot continue to be the elephant in the room whilst we navigate our way towards a health service fit for 21st century challenges. The cracks in the system are too big to ignore.

NHS England and individual Trusts must be willing to challenge the status quo when it comes to what a career in the NHS looks like. We must focus energies on creating a modern workplace where modern clinicians want to stay and progress. Our junior doctor training should be less prescriptive. The route of General Practice shouldn’t be the only option for those seeking a semblance of work-life balance. Trusts shouldn’t have to rely on agency staff to fill rota gaps. And nor should doctors revert to locum work by default when they feel stretched to the limit by full-time practice.

As we put increasing amounts of energy into improving the way in which patients can access clinicians and track or share their health data, we mustn’t neglect the health and wellbeing of those whose job it is to protect ours. We have to focus on creating a sustainable, scalable working environment where clinicians are able to work and care for patients without burn-out, stress or low morale driving them away from the institution which has never needed them more.