Intended for healthcare professionals


“Going the extra mile” endangers doctors, patients, and NHS

BMJ 2017; 358 doi: (Published 26 July 2017) Cite this as: BMJ 2017;358:j3547

Re: Right question, wrong answer

The NHS may be in relative crisis but if a BMA work-to-rule policy by doctors pushes it over the edge the public will be slow to forgive them, particularly when this will inevitably lead to giving more incentive to private practice by the same doctors as well as more time to practise it.

There is a world of difference between avoiding abuses and adopting a 9 to 5 mentality. Never doing anything “for free” is an unhealthy culture to have in one’s private or public life. The introduction of contracted sessions did much to recognise the unseen commitments of doctors in the hospital service and to the allocation of time for functions other than direct patient contact and to emergency work. There remained – as with many organisations -- a large amount of “unpaid” work: that aimed at developing the service, teaching, communication, etc . . . and seeing the sick patient or families outside contracted working hours or simply for clinical interest and education. Far from being the downfall of the NHS, much of what is good in the service and the way it is esteemed by the public has been achieved by staff going “the extra mile”.

The suggestion that doctors should only do work for which they are paid will also leave many working excessive hours. Medico-legal shroud waving does little to help, and the balance sheet in the accelerating trend to defensive medicine has not been costed in terms of money or time spent covering one’s back. Most of the high profile legal cases have not centred on lack of resources or overstressed working practices. When it clearly does, then that will be an incentive for change.

It would be useful to have a hard – not just anecdotal – evidence basis on this score. Nor for that matter does belittling the role of a doctor in patient care – it does make a difference if a doctor takes time out of a clinic or operating list to visit the GP for a minor illness or check-up , albeit in line with what might be seen as normal amongst the public. Most practising doctors know this. If there has to be a “cultural” change as suggested, perhaps this should be in the general public, not the profession. Meanwhile the BMA should draw up realistic proposals about just what services can be provided within present resources and make these public and we should work towards this.

Competing interests: No competing interests

03 August 2017
Simon Kenwright
Rtd physician