There are too few doctors on hospital shifts and those that are on duty are either taking on the work of more than one doctor or are inexperienced and without more senior support.
These are the findings of a report published today by the BMA. It reveals the extent to which gaps in doctors’ rotas are impacting the delivery of care, limiting access to training and contributing to low morale amongst staff.
The findings show that doctors are coming under considerable emotional and physical strain as limited training opportunities and unmanageable workloads are putting patient care at risk.
As part of the report, more than 1,000 doctors in England were surveyed. Many told how they had been asked to step up into more senior positions without adequate experience, increasing the risk of errors when diagnosing, treating and caring for patients.
Analysis of the survey by the BMA shows that:
- More than two-thirds of doctors (68 %) had been asked to act up into more senior roles or cover for more junior colleagues adding greater pressures to inexperienced doctors;
- More than three in four (80%) said that individuals are encouraged to take on the workload of multiple staff;
- Two in three (65%) said medical trainees are pressured to take on extra shifts;
- More than a third (34.6%) reported that their employers had re-designed rotas to include fewer doctors;
- There was evidence of cover being provided by doctors working without the appropriate senior clinical supervision, with 21.8% reporting having worked an on-call shift and 17.7% reporting having worked a weekend shift in this way.
As well as calling on the government to tackle the root causes of rota gaps, primarily by providing investment to recruit and retain more medical staff, the BMA has identified practical solutions and examples of good practice to mitigate the negative impact of gaps in rotas.
Among the key recommendations are:
- More effective long-term workforce planning to anticipate rota gaps with the use of focus groups to work towards addressing and managing the issues arising;
- Improving access to medical training for doctors with more flexible training pathways to ensure competence is not compromised;
- Calling for the government to recognise the value and contribution of the locum workforce and thereby end the cap on the locum spend;
- Improvements to IT so that there is full implementation of the NHS e-referral service and ensuring that all employers have properly adopted e-rostering systems.
Faced with a historically low input of A&E training for juniors, massive staff shortages and an inability to recruit to non-training clinical fellow posts, Dr Rob Galloway, an A&E Consultant at Brighton and Sussex University Hospital NHS Trust, came up with an innovative idea to overcome the recruitment and rota gap issues at his hospital.
Working alongside colleagues, he developed an annualised rota with new doctors having their time divided between two-thirds clinical and one-third special interest work with posts given on a yearly, rather than four-month basis.
The results have been ‘dramatic’ as the hospital has undergone an impressive shift with a significant increase in recruitment and retention and doctors reporting a much more satisfactory work/life balance.
Dr Galloway said: “Our programme is helping to create a new generation of doctors who realise the importance of general and acute skills and know how to manage undifferentiated patients in a holistic way. At the same time, we are improving the running of the A&E department. It is a win-win for all.”
Commenting on the findings in the report, BMA junior doctor committee deputy chair, Dr Pete Campbell, said:
“With many doctors beginning new placements this week, these findings highlight the scale of rota gap issues across the country and bring to light the severity of the problems we face.
“The BMA has consistently warned of the serious risk to patient safety because of rota gaps as the increasing pressure that doctors are being placed under means that they are often unable to deliver satisfactory levels of care.
“As well as being placed at increased risk of burnout and stress, doctors are being routinely failed by missing out on important training and career development opportunities which has an obvious impact on morale and work satisfaction, undermining our ability to deliver high-quality care in the future.
“With significant recruitment and retention issues throughout medical specialties across the country, the government must finally recognise how serious this problem is and address the huge recruitment and retention issues facing us.
“The solutions outlined in this report are in direct response to listening to the serious concerns of those working on the frontline and should be taken on board. Ignoring these concerns will undoubtedly have further negative consequences for patient care and exacerbate what is already an unmanageable workforce crisis.”
