I’m not even sure I know what to say with this. And I’m rarely one to struggle for words. But our most recent survey results are massively concerning and paint an incredibly bleak picture. Working in A&E and talking to junior doctors and other colleagues across NHS Scotland regularly I’m acutely aware of how bad things are, across the board and have been for a while. But still the results of our most recent snap survey show just how awful the situation is for junior doctors, and that it’s getting worse, and as we approach what we all know will likely be the worst winter the NHS has ever seen – it’s more than a little terrifying.
Nearly 9 out of 10 of you told us that you don’t reliably get your breaks when you should, or nearly 99% of foundation doctors. With 1 in 5 telling us you rarely get your breaks it’s no surprise that burnout rates are rising so rapidly across the workforce.
Responses about monitoring and rotas in advance were sadly much the same, although the proportion of you telling us you had 1 week or less notice had risen to 15% which is simply unacceptable. Made even worse by the huge issues you told us you had with receiving communications from rota teams before changeover. We’ve been working with employers, NES and government on this, with some progress being made and I am hopeful that we should get significant improvement on this by next August.
One of the most alarming results from this survey was seeing just how badly work/life balance is affected by non-clinical work, with nearly 98% of you reporting that your work life balance was compromised in some way by it. Which is unsurprising when nearly 10% of junior doctors told us that they’re spending more than 40 hours a month outside of their rostered hours doing non-clinical work – potentially working 58 hours a week or more (despite European Working Time Directive limiting us to an average of 48 hours), and that’s without even including staying late or not getting breaks. Nearly half of the respondents told us they spend more than 16 hours a month on non-clinical work out with their rota – at least an extra half day a week!
A glimmer of hope in amongst all of this is seeing the new rota safety rules limiting the maximum number of consecutive long shifts to 4 in any 7 days being applied – with only 10% telling us it wasn’t happening for them yet. We’ll of course be making sure we work with employers and government to ensure full compliance with this by February 2023 and to ensure it’s having the intended effect and positive impact on working patterns.
There were more troubling statistics about inductions, with many complaining they were poor and nearly ¾ of you having to do statutory/mandatory e-learning in your own time. Concerns about teaching, study leave and taster weeks, and some comments about bullying and other unacceptable behaviours – it really doesn’t make for great reading!
It’s no surprise that in the context of all this that 90% said your morale had decreased over the last year, with more than half saying it was significantly so. If this wasn’t enough, more than 50% said they had considered leaving the NHS in the next 2 years, with a third saying they had considered leaving medicine, two thirds thought about reducing hours and nearly 60% thinking about leaving training for at least a period.
We’ll be compiling these results into a formal report, sharing with stakeholders such as NES, employers and Scottish Government. This will add to the constructive discussions we have begun with Scottish government and NES about the need to secure urgent and tangible action to improve the experience of being a junior doctor in Scotland. However, it’s undeniable that there hasn’t yet been enough concrete action and there is still much, much more to be done. Our new SJDC meets tomorrow and we’ll be discussing these results then, with the pay survey results and the context of ever increasing pressures on junior doctors across Scotland. As I hand over the baton to Chris Smith as the new chair of SJDC and move into slightly different roles within BMA Scotland it is clear that there is so much work needing to be done – on working conditions such as these, on pay, on recruitment and retention, and to manage the current extortionate workload so many of us are facing.
So, as I stand down as your SJDC chair, I make 2 pleas.
The first is to our government, that almost a year ago to the day made a full commitment to improving our working conditions as the Expert Working Group report was finally published (nearly two years late). We still only have one recommendation in place – for most junior doctors, but not quite all. There’s so much more that needs to be done. We need more than positive conversations and sentiment – we need action, urgently. We deserve better. As do the patients we work so hard to look after. Please act now, before it’s too late.
The second is to you – our members, the hardworking junior doctors of Scotland. I know how tough things are, I’ve suffered from burnout myself before and have felt that gut-wrenching guilt we all know, from the burden of leaving our teams even more short staffed than normal. But if you don’t look after yourself, you are no use to patients, to our wider teams or beyond. You are so much more than a line on an understaffed rota. There is no resilience left in our NHS but that doesn’t mean the burden is yours alone to carry. We aren’t heroes, we are very much human. So do your best to get your breaks, to leave on time and leave your work at work. Fill in your monitoring forms! By these survey results, it would suggest that nearly 9 in 10 rotas should be band 3 – yet the biggest issue with monitoring is insufficient returns. As issues arise – let us know, big or small. We can’t do anything if we don’t know where the problems are. Work with your regional junior doctor subcommittees so they can work on your behalf – or better still join them! We genuinely are better together – that’s the true power of our union.
Dr Lailah Peel, outgoing chair SJDC