Dr Christine Tomkins
If we expect doctors to be there for us in a crisis, we must properly support them.
After a short summer respite in which many dared to hope the worst of the pandemic was over, we are all facing the prospect of a long and difficult winter.
We expect that NHS staff will rise to the occasion - and invariably they do. Throughout this crisis, doctors have not been overwhelmed by a novel and deadly disease. They have been open-minded in exploring new interventions and sharing their learning; remained committed to the safe care of patients in the most challenging conditions; and quietly got on with the job in hand. In conversations with doctors in my own family, friends, professional colleagues and MDU members, I have been repeatedly struck by their adaptability and resilience.
But everyone has their breaking point. In my leader in the summer issue of the journal, I wrote about the enormous sacrifices that were quietly being made by those on the frontline. And I warned the immense psychological strain would have consequences for clinicians' mental health.
We are already seeing the evidence. The BMA's most recent tracker survey of the impact of the coronavirus of more than 7,800 doctors in England, Wales and Northern Ireland found that more than 43% believed their levels of stress, anxiety and emotional distress had worsened since the pandemic began and 66% were quite or extremely anxious about work in the coming months. Personal health and wellbeing were second only to staffing shortages in the list of issues that most concerned respondents.
This matters to all of us because we know that there is a link between work-related stress and adverse incidents. The Health and Social Care Select Committee has begun an inquiry into workforce burnout and resilience in the health service and social care. Giving evidence on 20 October, Professor Michael West, a senior visiting fellow at the Kings Fund highlighted the impact of chronic excessive workloads on clinical staff. He said: "It is like the pattern on the wallpaper that we no longer see, but it is the number 1 predictor of staff stress and staff intention to quit. It is also the number 1 predictor of patient dissatisfaction. It is highly associated with the level of errors." And he later noted: "We know that doctors subject to very high levels of work demands chronically are between 45% and 63% more likely to make a major medical error in the subsequent three months."
The mental health and wellbeing of healthcare professionals has become a growing cause for concern. Dr Clare Gerada, the former Chair of the RCGP has just written a timely book called Beneath the White Coat: Doctors, Their Minds and Mental Health to shed more light on the stress factors facing doctors and what can be done to help.
The pandemic has made this all the more pressing. I believe it is incumbent on all organisations who employ, regulate or represent doctors to consider how their actions can alleviate the pressure in the current situation and do all they can to achieve this.
The NHS has initiated welcome measures to support staff, including a helpline in partnership with the Samaritans. I also welcome the GMC's decision to produce guidance for its own staff on how to consider complaints against doctors in the context of the pandemic, taking into account issues such as unfamiliar practice settings, the availability of adequate PPE and the disproportionate impact of COVID-19 on doctors from black and minority ethnic (BME) backgrounds.
It is incumbent on all organisations who employ, regulate or represent doctors to consider how their actions can alleviate the pressure in the current situation and do all they can to achieve this.
The MDU has had a number of meetings with the GMC where we helped make the case for this new guidance and for a proportionate approach to fitness to practise more generally. We have seen an influx of over 130 new GMC cases since it restarted its investigations in July - almost 25% of GMC cases we received in the year to date arrived in August - and our concern is that the actions of doctors will be scrutinised many months down the line when memories have faded.
We know how distressing a GMC investigation can be for members on the receiving end. In this issue, you can read the testimony of one doctor who describes the impact on his mental and physical health and how he decided that he wanted to use the experience to help others after the GMC concluded its investigation. He is among the first to sign up to a new MDU peer support network, which puts members who are facing a complaint or claim in contact with fellow doctors who have been in the same situation, and who can provide guidance and reassurance about the process and a shoulder to lean on.
The Peer Support Network has already proved its value during the pilot stage and is an important addition to our efforts to support members' welfare, alongside our e-learning module on health and wellbeing. While the latter was developed with foundation doctors in mind, it includes stress and anxiety management tools which can help us all. The MDU is also working with some scholars from the Healthcare Leadership Academy on a project to investigate the impact of patient complaints on doctors and what additional support they might need. This promises to be a fruitful collaboration and I look forward to reporting the results in due course.
Of course, our immediate priority is offering members support, advice and assistance through the next difficult phase of the pandemic. I hope the spirit of togetherness that inspired a weekly clap for carers last time holds, so healthcare professionals are not subjected to complaints and criticism from a frustrated and anxious population. But if they are, members can be reassured that the MDU will be resolute in supporting and representing you.
And when we are eventually able to look back at the pandemic from a place of safety, it will be because of the dedication, knowledge and expertise of doctors, other healthcare workers and scientists to whom we all owe our unstinting support.