Dr Mark Porter, chair of the British Medical Association (BMA), said the increasingly common practice of hospital departments requiring junior doctors to work overtime, or filling gaps with expensive agency staff, should be a “real concern to patients” – while the UK’s top emergency doctor cautioned that the NHS had now become used to working with a “skeleton staff” at A&E departments.
The warnings come in the light of a survey of 430 young doctors which suggests that rota gaps are now more commonplace than ever.
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Many young doctors surveyed said their own willingness to work extra hours was affecting their work-life balance – with one medic admitting hospitals sometimes resorted to “emotional blackmail” when it comes to persuading staff to work overtime. Despite the burden on doctors, the survey found the vast majority were still happy to work in the NHS.
However, Dr Clifford Mann, chairman of the Royal College of Emergency Medicine, said the flow of British-trained doctors going abroad – as they are unprepared to work under conditions now common in the health service – needed to be stopped because it was wasting hundreds of millions of pounds.
The survey results follow the announcement of a “new deal” for GPs by the Health Secretary, Jeremy Hunt, amid a recruitment and retirement crisis in the profession. Eighty per cent of GP trainees consulted by the survey said there was a shortage of family doctors in their area.
Most junior hospital doctors work on a rota basis. Of those that do, six in 10 told the BMA survey there were or had been long-term gaps in their rota – compared with less than half in last year’s survey. Another 30 per cent said there were often short-term rota gaps.
These gaps were usually filled by expensive locum staff, the survey found, but half of the doctors surveyed said their wards often operated with a staff shortage. The BMA, which has tracked the careers of the 430 doctors since they graduated in 2006, called the findings “alarming”.
Despite the NHS’s dependence on agency staff – who cost the health service £3.3bn last year – the Government has ordered a crackdown that could lead to even greater pressure on full-time staff.
Dr Porter said the “normal experience of a junior doctor working in the NHS is to see gaps in cover around them”. He added: “The Government must tackle this as a matter of urgency.”
Pressures are greatest in certain specialties, with higher surgical training, obstetrics and gynaecology and emergency medicine specialists reporting the worst work-life balance.
Dr Mann said the NHS was using a “skeleton staff” in emergency departments “most of the time”.
“Any unpredictable event such as illness, injury, pregnancy, means that gaps open up in the rota and you’re reliant on either short or long-term locums,” he said. “There’s a consistent mismatch between demand and capacity.”
He said one solution would be for the NHS to stop “wasting doctors it had trained”, by improving working conditions and stemming the flow of young medics who leave the UK to work in Australia and New Zealand, where the work-life balance is better.
“We’ve got over 500 UK-trained emergency doctors working in Australia at the moment, and in a survey last year, 92 per cent said they did not plan to come back to the UK,” he said.
“The cost of those 500 doctors is £250m spent training them, and £500m spent on locums in the past three years to fill the gaps in the rotas. We need to change the terms and conditions.” He said annual leave allowance should be linked to the proportion of night, evening and weekend shifts doctors had to work.
Three in 10 doctors told the BMA’s survey that they planned to work abroad.
Three-quarters said they often work additional, often unpaid, hours to deliver care to their patients. Dr Aaron Borbora, 29, a senior house officer in surgery at a hospital in the North-west of England, which he asked not be named, said that hospitals were “not above emotional blackmail” to encourage young doctors to work extra hours.
“While they may not be able contractually to force you to cover the shifts, hospitals aren’t above using emotional blackmail on doctors,” he said. “People are under pressure to work more than their [full-time] 48 hours. Legally, they can say no, but it’s made difficult.”
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The Department for Health said it was for individual hospital trusts to respond to concerns about their rotas.
Mr Hunt outlined details of measures aimed at taking pressure off GPs.
As well as a long-standing commitment to recruit 5,000 more GPs by 2020, Mr Hunt also wants 5,000 other GP practice staff – including 1,000 physician’s associates, health professionals trained for two years to perform some of the roles of a doctor.
NHS Leicester City Clinical Commissioning Group is spending £600,000 bringing in 10 such US-trained professionals, the GP magazine Pulse reported, despite concerns among some that they might be used as a cheap way to fill vacancies that should be taken on by a fully trained doctor.
Case study: The perils of rota gaps
Aaron Borbora, 29, is a senior house officer in surgery at a hospital in the North-west.
“Any doctor in the country will be familiar with rota gaps in some parts of their hospital,” he says. “Over the last couple of years, half of the rotas I have worked on have had gaps. It’s bad for a doctor’s training and it’s bad for a doctor’s work-life balance. It’s bad for patients and for the health service too. Agency staff who provide cover are not as familiar as someone who is doing the work most days.
“It shouldn’t be tolerated. There should be a way doctors can highlight their rota is understaffed [in case there’s] a safety issue.
“While they can’t contractually force you to cover the shift, hospitals aren’t above using emotional blackmail on the doctors. They say: ‘Can you please help us out? We’re really short-staffed.’
“People are under pressure to work more than their 48 hours. They can legally say no but it is made difficult.”
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