Dear Editor
It is good to see Dr Al-Najjar clearly express the challenges of supporting medical practitioners with mental health issues via the NHSE funded PHP that in my humble view does wish to strive to be a positive organisation for good, where many employees within its remit wish to provide effective systems of support, treatment and psychological safe places.
I became a consultant in 2000 in the East Midlands and over my now approaching 25 years have over 80% medical practitioner patient/client only clinics across the spectrum of undergraduate and postgraduate cases. They are becoming more complicated and expectations from all parties for quick solutions is not necessarily helpful, when the specific world of work involves other human beings, blended teams, patient safety considerations and longer waiting list pressures because of the pandemic. Let's not even mention financial well-being issues and the psycho-social challenges outside of work for healthcare staff.
It is imperative that any clinician supporting doctors and other healthcare practitioners understands the nuances and evolving case complexities with the need to deliver a balanced practitioner health perspective across the employer-employee-trainee interface. This is all with the background of the NHS long-term plan and emerging varied occupational groups undertaking interdisciplinary case mix delivery models both in primary and secondary care.
Post code lottery occupational health support for the NHS employees has been around for sometime and i suspect some of that maybe an issue for PHP as well, in its attempts to deliver best consistent practice across the UK but at least money is coming from NHSE but for how long?
The quality of occupational health skills/support within the NHS is dependent on the specific funding from the base NHS employer as there is no national budget or consistency of service delivery. This is particular so with medical undergraduate, PGDiT cases and regional pastoral support systems.
The majority of NHS trained Occupational medicine PGDiTs within the UK move to private practice or commercial organisations with only a few like Leicester attracting and retaining them within the wider NHS East Midlands region.
I have worked in a collaborative approach with PHP on a number of sensitive complex cases with several senior PHP practitioners including a number of medical directors - this approach is successful.
If you build it, they will come - they have been coming to NHS occupational health for many years even before PHP's inauguration in 2008 but where is the consistent sustainable national investment for in house quality assured NHS occupational health services? These in house services have been at the precipice of closure for many years.
Competing interests: Employed NHS as an occupational health physician since 1995; National training programme director @ National School Occupational health
Many trainees do not feel valued in the NHS
Dear Editor
Dr Kar has correctly mentioned in his article several of the issues affecting us trainees, as well as issues affecting the NHS itself. For many trainees, amidst all these issues, the same core feeling is shared: we do not feel valued by our NHS trusts.
One can find several anecdotes from vocal trainees which give weight to this feeling, by having a short perusal of the medical ‘corridor’ of social media. These examples range from unnecessary difficulties with trusts’ parking permit departments resulting in the receipt of parking fines on hospital grounds, to doctors’ messes which are inadequate or non-existent.(1) In addition, bullying of trainees is still present in the NHS, with a recent example of this seen within the general surgery department of a London hospital.(2)
In response to feeling undervalued, many doctors are leaving the NHS. Thousands have already left for better hospital environments abroad, and this is likely costing the NHS billions.(3) Several who have not left are strongly considering doing so, with over 75% of doctors in a recent GMC survey reporting that they feel under-valued professionally.(4)
Fortunately, trainees are gradually finding the courage to voice these feelings. Nevertheless, we welcome the help of senior colleagues like Dr Kar to amplify our voice.
NHS leaders need a robust plan to urgently address this shared core feeling, or otherwise risk a potentially continuous exodus of doctors. In the words of Charlie Massey, GMC Chief Executive, “It’s much easier to dissuade someone from leaving by acting upon concerns, than to persuade them to return.”(4)
References
1. Kar P. Partha Kar: We need to level up all staff, not level down doctors. Bmj. 2024;385:q892. doi: https://doi.org/10.1136/bmj.q892
2. Rimmer A. Trainees are removed from London surgery department after findings of bullying and poor supervision. Bmj. 2024;385:q906. doi: https://doi.org/10.1136/bmj.q906
3. Iacobucci G. Losing NHS doctors early is costing £2.4bn a year, BMA estimates. Bmj. 2024;385:q932. doi: https://doi.org/10.1136/bmj.q932
4. General Medical Council. Thousands of doctors could be considering leaving UK practice – new GMC research reveals what might make them stay. 2024. https://www.gmc-uk.org/news/news-archive/thousands-of-doctors-could-be-c....
Competing interests: No competing interests