If staff are ill, who will care for patients?
Doctors want to do the best they can for their patients – it comes with the job. But the high level of demand and rising workload – exacerbated by gaps in the medical workforce – are unsurprisingly resulting in significant levels of sickness absence. Yes, working in the health service can be rewarding. But thousands of staff are having to take extended sick leave, many as a result of anxiety and stress – surely a symptom of a system under extreme pressure.
There is a vicious cycle going on, where a worker feels anxious or depressed but still goes into work because they don’t want to burden others. This then leads to them being unable to cope. Health staff, especially doctors, tend to do this – and particularly with illnesses such as anxiety and depression, where they simply try to soldier on.
It is partly to do with the stigma attached to anxiety and depression, as if someone is failing if they admit they feel this way. It is partly to do with guilt because the health service is stretched so tight and, if we take time off sick, we will be forcing our work upon our colleagues.
The nature of the job itself is also difficult. It is very stressful, even for fully-staffed units, although there are very few of these nowadays. Workers are constantly thinking about what they do each day and how things will turn out. For doctors there is an enormous amount of pressure, where one small mistake can have devastating consequences.
I have had many nights where I go home and think about all the things I couldn’t do because there were not enough hours in the day, or things I wish I could have done better.
People go into this line of work because they are compassionate and want to help people, so a lot of these thoughts are self-generated. But a lot of it comes from the work pressures upon them too, from society, and from the hard-pressed health service, which prevent us from being able to do everything we want for our patients.
This seems to be getting worse. We are starting to hear more and more often from our members that they feel stressed and anxious about the pressures facing the health service and how it impacts on their ability to do their jobs and provide the appropriate level of care for patients.
Recent information from health boards across Scotland, showing more than one in ten staff in the health service has taken long-term sick leave, will come as no surprise to our hard-pressed medical workforce. It is fractured, with significant gaps in staffing, both in general practice and in consultant, trainee and specialist posts in hospitals.
Audit Scotland reported consultant vacancy rates of 6.5 per cent overall, although there is significant variation among NHS boards. These vacancy rates are also likely to be an underestimate owing to the way the data is collected. A recent BMA Scotland survey showed a quarter of GP practices reporting that they are struggling to fill vacancies.
Audit Scotland also reported that 5 per cent of GP practices are being run directly by their local NHS board, mainly due to GPs retiring, the rural location of practices and problems recruiting GPs. The number of practices taken over by boards has been steadily increasing since 2013-14.
And there are challenges filling junior doctor training posts, with particular difficulties in some specialties, including general practice and psychiatry.
That means existing medical staff have the extra burden of dealing with vacant posts and the increased workload associated with that.
Doctors need to be empathetic and able to relate to their patients and it is not easy right now. In a survey of 900 GPs in Scotland last year, more than two-thirds stated that, while manageable, they experienced a significant amount of work-related stress. Sadly, 15 per cent felt their stress was significant and unmanageable.
One GP and BMA member recently told us in-depth how the demands affected her and admitted that she had reached a point where she dreaded going into work. She explained that the more stressed she was, the more detached she became from her patients.
She even started to cut patients off while they were talking, conscious of the other patients who w ere waiting to be seen.
Then she stopped sleeping well, often waking up in the night remembering things she had forgotten to do, and feeling incredibly guilty.
She told us: ‘I wasn’t the doctor I wanted or aspired to be. I wasn’t the compassionate, empathetic person I used to be.’
Sadly, this experience is not unique; doctors in all branches of practice are warning that the increased pressure and intensity of work in the NHS is not sustainable in the long term.
For a tired and overworked doctor, with only minutes to spend listening to a patient with complex care needs while juggling a list of patients to see, prescriptions to write, test results to interpret and calls to return, it is easy to see where the exhaustion and anxiety comes in.
With such stark warnings about what it feels like to work as a family doctor in Scotland, and a similar picture painted by those working in our hospitals, we are concerned about the toll that working in today’s health service is taking on doctors.
We have warned the Government that we will not be able to recruit and retain new doctors for the future if action is not taken now to make the role more attractive and the workload and expectations more manageable. At BMA Scotland our aim is for doctors to be valued and supported to deliver the highest-quality healthcare to the people of Scotland.
Medicine will always be a demanding career. There is no magic pill: it will require extra funding for the service, better workforce planning to deliver the type of services patients require in the right settings and with the most appropriate staff to respond to their issues. And it will need gaps in the workforce addressed urgently so staff do not feel like they are constantly papering over the cracks that appear when vacancies go unfilled for months at a time.
We already have fewer doctors per 1,000 of the population in Britain than in almost every other EU nation. With a diagnosis of a sick and tired workforce, every effort must be made to value the doctors and all other NHS staff to improve the long-term outlook.