Health

Pressure on NHS is breaking doctors’ morale, says psychiatrist


Julia Patterson recalls clearly the moment she decided she had to quit two things she treasured – practising medicine and working in the NHS – in order to safeguard her own mental health. “I loved my job,” she said. “I love psychiatry, but I could no longer go to work every day without tackling what was happening.”

She broke down to her husband: “I told him I just couldn’t send another homeless mentally ill patient out on to the streets after they’d arrived in A&E at 3am, suicidal and alone.”

It was a huge decision – to take a break from the career she had wanted to pursue for so long. She was halfway through her psychiatrist’s training and had passed all the exams young doctors have to sit when starting out on their careers.

“Doctors love their jobs, and most wouldn’t do anything else,” she said. “It’s our vocation to care for our patients. However, the level of stress endured by frontline NHS staff is unbelievable. Understaffing leaves doctors feeling isolated and stretched. There is often pressure to take on more patients, to work extra shifts, to stretch themselves thinner and thinner.”

Patterson left behind a service that she says has been left “cut back to its very bones” after nine years of austerity funding.

“This is felt every day on the NHS frontline and in every patient encounter. Trying to give care when you don’t have ‘enough’ is heartbreaking. There is no longer enough time, enough staff, enough resources. It chips away at you daily: and your morale becomes broken. Doctors are stretched because so many of our colleagues have left – left the country for places that support them better or left the profession altogether.

“As each doctor leaves, it becomes harder to sustain a safe service for our patients. The gaps become wider and deeper. The stress levels increase.”

In her new role as a co-ordinator of both campaign group EveryDoctor, which works to improve doctors’ working lives, and The Political Mess, an online forum run by the Doctors’ Association UK, Patterson, who is 33, hears daily about the pressures medics are under. “Stress is endemic and burnout is common. Our more experienced doctors report that things have never been worse.”

The NHS in England alone is short of almost 10,000 medics. The result of all this is that worryingly large numbers of doctors are giving up either during their training or after experiencing the realities of working in an NHS that is visibly struggling to cope, or are retiring early. GPs and hospital doctors alike feel forced out or are glad to have left their jobs at a time when the health service needs them more than ever. Some, as Patterson adds, kill themselves.

New findings shared exclusively with the Observer by legal support service the Medical Protection Society (MPS) confirm the deep discontent in Britain’s medical profession. It has found that 52% of doctors working in the UK are dissatisfied with their work-life balance, 46% feel guilty about taking time off, and almost 40% believe their employer does not give them the support they need to do their job well.

“These are sobering findings,” said the society’s president, Professor Dame Jane Dacre, who until 2018 was president of the Royal College of Physicians (RCP), which represents many hospital doctors in England.

“They tell us that the human impact of all these things – rota gaps, austerity, low morale, working in hospitals with paint peeling off the walls and equipment that doesn’t work, and not feeling that you can do your best for patients – is becoming disproportionate and is undermining doctors’ sense of vocation.”

Perhaps the most telling statistic to emerge from an MPS survey of 275 UK doctors is that more than a third have considered moving abroad to safeguard their personal wellbeing. In addition, 68% said time for rest and recovery during often long shifts was not the norm, while 57% felt unable to take even a short break in between two clinically demanding procedures.

While the sample was small, its conclusions tally with the growing evidence that more and more doctors feel unable to cope with the demands placed on them.

Dacre visited 80% of England’s hospitals during her time at the RCP. “At each hospital,” she recalled, “we held open forums for doctors to come and talk about things that were on their minds. But very often open forums became like open season. The picture that emerged was of an unhappy and frustrated medical workforce.

“It was heartbreaking to see these articulate, intelligent, empathic and skilled people feeling undervalued, under-resourced, demotivated, crushed and wanting to leave – despite medicine being the thing they loved doing. Burnout was endemic.”

Doctors are trained to get diagnoses and treatment right – because lives depend on it. They face many frustrations: long hours of unpaid overtime, often antisocial working hours, and an inability to rest, eat or drink easily on a night shift, as well as bullying and pressure from managers to see more patients. But what is worse for them, says Dacre, is a feeling that they can’t be proud of the standard of care they are providing because there are too few staff, too many demands and too little time.

Details of the government’s NHS People Plan for England are due in the next few weeks. But with staff shortages now so routine, easing doctors’ burden may not be simple.

“These are people that deal with death, emergency situations, other people’s misfortunes on a daily basis,” said Dacre. “They save lives. Somebody needs to start thinking about saving them.”



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