Intended for healthcare professionals


Commentary: Working better, not harder

BMJ 2017; 356 doi: (Published 17 January 2017) Cite this as: BMJ 2017;356:j216
  1. Jennifer Dixon, chief executive
  1. Health Foundation, London, UK
  1. jennifer.dixon{at}

Asking your medical friends how life is at work always provokes gripes, but the pressure the NHS is now under has hiked these to fever pitch. There is ample reason.

The NHS is under unprecedented budget constraint,1 staff are working flat out, under enormous pressure to protect patients and at great cost to themselves. Social care is at “tipping point.”2 The strain is uniquely challenging, and should not be underestimated.

Many working in clinical care feel fury: bitter blame is heaped on politicians, managers, commissioners, regulators; and there is a loud chorus for more money and staff, less bureaucracy and interference, and more support. If I want to be very unpopular, I ask medical colleagues if any are involved in management, and then bolt for the bunker because this often induces apoplexy. But …

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