GMC’s annual report into workplace experiences has identified worrying trends around higher workloads, stress related absence and risk of burnout. What are the key findings, what solutions are proposed and how does this tally with what is happening in ophthalmology?
Based on a 2022 survey of doctors and qualitative interviews, the findings of the General Medical Council’s (GMC) annual report into workplace experiences make for stark reading.
Published today, The state of medical education and practice in the UK: workplace experiences 2023 found that:
- Doctors are feeling less satisfied amid rising workloads and increasing difficulties providing sufficient patient care
Half of doctors were satisfied in 2022, down from 70% in 2021. More doctors reported working beyond their rostered hours on a weekly basis (70%, up from 59% in 2021), having difficulty taking breaks each week (68%, up from 49% in 2021), and feeling unable to cope with their workload each week (42%, up from 30% in 2021). More than two-fifths of doctors (44%) said they found it difficult to provide sufficient patient care at least once a week. This is a significant increase from 2021, when a quarter of doctors (25%) reported this, and more than 2019, when a third of doctors said this (34%).
- Burnout, stress related absence and plans to leave profession are all on the rise
A quarter of doctors surveyed (25%) were categorised as being at high risk of burnout in 2022, compared with 17% in 2021. More than one out of five doctors (22%) took a leave of absence due to stress—a higher percentage than in 2021 (17%). Nearly three out of ten doctors in training (29%) and SAS and LE doctors (28%) took time off due to stress in 2022. More doctors than ever also said they were likely to leave the UK profession and had taken hard steps towards doing so (excluding doctors of retirement age who were planning to retire). 15% of doctors said they had taken steps to leave, up from 7% in 2021.
- SAS doctors, trainers and those with a disability face particular challenges
58% of SAS and locally employed doctors who gained their primary medical qualification in the UK had seen or experienced compromised patient safety or care, a higher proportion than other groups of SAS and LE doctors and doctors of other registration types. 18% of trainers disagreed that they were supported by senior medical staff, compared with 10% of non-trainers. Half of trainers reported experiencing compromised patient safety or care (51%) and having difficulty providing sufficient patient care each week (49%), compared with two-fifths of non-trainers (39% and 43% respectively). Fewer disabled doctors were satisfied in their work, 44% compared with 51% of non-disabled doctors. Almost half (47%) of disabled doctors were categorised as struggling with their workload, compared with 37% of non-disabled doctors.
What is GMC proposing as solutions?
In response to this gloomy picture, the GMC stresses that ‘long-term actions are needed to address structural challenges’. They highlight the ‘long overdue’ need to increase training numbers and understand workforce planning better, areas expected to be covered in government’s forthcoming Long Term Workforce Plan – which RCOphth and other royal colleges have long called for.
GMC also sumarises what should be done in the shorter-term to improve the working environment of doctors and aid retention. It emphasises the importance of sharing and scaling up good practice in relation to ‘being part of a supportive team and having a strong sense of belonging’. GMC also advocates ‘improvements in… fair and timely rota design, facilities for rest breaks, and provision of food and drink’. The report is also keen to address the specific needs of trainers, noting that ‘It will not be possible to deliver the much-needed expansion of training capacity without both an increase in trainer numbers and concrete steps to support their specific needs. Investment in this area must be a priority as governments across the UK define plans to address longer-term workforce challenges’.
How does the report reflect the experiences and priorities of ophthalmology?
RCOphth’s 2022 workforce census, published earlier this year, identified many of the same pressures faced both by individual doctors and ophthalmology units collectively. For those in the ophthalmology workforce who reported their role becoming less fulfilling over the last 12 months, the leading reasons were work-life balance, stress and too few staff. Lack of appropriate equipment and sufficient space within their unit were also cited by many as negatively affecting how fulfilled they felt in their role, both symptoms of under-investment in ophthalmology units.
However while the GMC survey found doctor’s morale sharply declining, our census found a less negative picture among the ophthalmology workforce – with a roughly equal split between those who reported their role became more fulfilling (28%) compared to those reporting it less fulfilling (32%) over the previous 12 months.
As part of our census, clinical leads in NHS ophthalmology units across the UK reported their growing concerns about the pressure their units faced. Over three quarters (76%) did not have enough consultants to meet current demand, with 74% more concerned about the impact of outpatient backlogs on patient care compared to 12 months previously.
One of the key solutions we recommended in our census report echoes what the GMC says when it emphasised the need for more training numbers and better workforce planning in the long term. We have called for, and will work with policymakers to deliver, a phased increase in ophthalmology training places, alongside the development of eye care workforce plans across the four nations of the UK which should encompass the whole multidisciplinary eye care team.
We also agree with the GMC that shorter term solutions are needed to improve the working experience in ophthalmology and aid retention. Ensuring ophthalmology units are properly resourced to meet patient need, particularly in terms of the provision of theatre space and the training and deployment of the multi-disciplinary eyecare team, would make a big positive difference.