Senior doctors need to do more to boost juniors’ moraleBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3892 (Published 12 July 2016) Cite this as: BMJ 2016;354:i3892
After the announcement that a new contract for junior doctors in England will be introduced despite their opposition, many believe that the support of senior doctors will be crucial to help improve morale. Abi Rimmer reports
England’s health secretary, Jeremy Hunt, announced on Wednesday 6 July that there would be a phased introduction of the new contract for junior doctors in England, starting in October.1 The news came after the BMA announced that 58% of junior doctors had voted to reject the proposed contract. After the announcement that the contract would be introduced, doctors called on senior clinicians to do more to support their colleagues in training.2
Seniors “not there” for juniors
Partha Kar, a diabetes and endocrinology consultant, said that beyond the issue of the new contract there had arisen a belief among many junior doctors of “seniors not necessarily being there for them—whether it be in an educational context, rotas, or simple day to day working.” He said, “We all lead busy lives. But as a senior, in my opinion, beyond being a specialist to our patients a big part of our role sits in the pastoral side and in the ability to inspire and to simply have an arm around the shoulder on tough days. As the saying goes, a smile sometimes can go a long way.”
Jane Dacre, president of the Royal College of Physicians, said that NHS trusts and senior doctors could do several things to make the working environment more supportive of junior doctors. “For individual consultants those simple things include saying, ‘Well done, you managed that patient really well in spite of it being in difficult circumstances,’” she said. “It’s about saying thank you and finding time for the team to get together either to have a cup of coffee or the good old fashioned thing of the consultant inviting the team round to their house one evening to get together outside the hospital environment.”
Dacre said that the contract dispute had highlighted the pressure that junior doctors were under. “I think that will go a large part of the way to making their consultants recognise that juniors need to be given a bit more time, a bit more support, and a bit more nurturing throughout their training careers.”
Beyond the contract
Alice Garth, a second year foundation trainee, also outlined things senior doctors could do to help improve junior doctors’ morale. “The thing that a lot of us [juniors] struggle with is that every four to six months we change jobs, we change city, we’re trying to work out a new computer system and a new ward,” she said. “It’s about senior doctors having an understanding of that—and in doing so having a bit more patience with us and maybe working a bit harder to create that team atmosphere that doesn’t really exist in the same way [as it used to].”
Garth said that it was important not to forget that issues of morale among junior doctors extended beyond the matters dealt with in the new contract. “We need to be careful not to just say that the morale issues are down to the new contract,” she said. “They are down to bigger things in the NHS, whether it be because we are constantly understaffed and feeling overstretched, which means that more of our colleagues are off on sick leave. Which means that we are even more overstretched and medicine has become more legalistic and defensive.”
National work on junior doctors’ morale
In February Jeremy Hunt announced that Sue Bailey, chair of the Academy of Medical Royal Colleges, would undertake a review of morale among junior doctors in England.3 But after renewed negotiations and an agreement being reached between the government and the BMA on a new contract in May,4 it was decided that the review of would not go ahead.
When Hunt announced this month that the new contract would be introduced in England, despite BMA members voting to reject it, he set out the work that the government was undertaking to improve junior doctors’ morale. He said that the Department of Health was continuing with a process “to look at how we can improve the working lives of junior doctors more broadly.”
The decision to impose the contract was not a rejection of the concerns of foundation year doctors, Hunt said. These doctors “often felt most disconnected in that period of their training before they have chosen a specialty,” he said. “We will continue to make progress in addressing these concerns under the leadership of Sheona Macleod at Health Education England (HEE), and we will continue to invite the BMA to attend those meetings.” This work explores concerns raised by juniors outside the contract negotiations, HEE said. It will look at how to improve information about rotations, how to widen access to flexible training, and how to make study leave provision fairer.
HEE said that it had also committed itself to improve training to help doctors who need time out for caring duties, for example. This would include targeted accelerated learning. It will also lead a review of the process that allows transfers between regions and training placements, HEE said.
Macleod, who is chair of HEE’s postgraduate deans, said, “We need a new approach to both training and delivery of service. This must allow the provision of high quality training that enables trainees to prioritise both their work and home life, and HEE is now working on this area.”
Bailey said that the academy’s trainee doctors’ group was also working on a project looking at how junior doctors can be supported through training. “An update on the group’s progress is due to be published very soon, and I know the group is considering the best way to carry this forward in future,” she said.