How can the NHS offer fulfilling, lifelong careers?
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1100 (Published 08 March 2019) Cite this as: BMJ 2019;364:l1100All rapid responses
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All suggestions in this article are extremely pertinent to the current situation where staff retention in the NHS is an issue and will become more of an issue with Brexit.
In surgical practice, an apprenticeship model isn't a bad one and the loss of 'the firm' has been a key cause of disconnect between more junior and senior staff, where this feeling of being unsupported seems to be quite rampant. It is a little difficult to comprehend the loss of the apprenticeship model in some shape of form considering the UK government is encouraging this in other civil service reforms seen in some of the allied health professionals pathways.
Apart from this, the greater centralisation of hospital services into ever larger units has perpetrated this, I believe.
Service managers designing these even larger hospitals, ever wanting to replicate Toyota's success, have ignored the fact that hospitals are communities in their own right: not just a car-manufacturing plant where individuals are there just to perform a specific task. The loss of the doctors' mess, the sitting room for nursing staff, a specific canteen (away from the public eye) and even to an extent the Res committee have eroded this sense of community. It takes a community to run a hospital, not just individuals disconnected from frontline services.
I believe by bringing some of these back and even where a team can sit down to a cup of tea to discuss the daily chores might foster a better working relationship where the team members will probably feel a little less isolated.
Competing interests: No competing interests
Re: How can the NHS offer fulfilling, lifelong careers?
The NHS could offer more fulfilling lifelong careers by taking more of an interest in the daily lives of those who work for it. Understanding a job plan is insufficient to understand the stresses and strains of work on the front line. Gone are the days of endless hours on-call, but the daily challenges of increasingly early starts to catch up with the accumulation of work, trying to avoid living off the hospital vending machines, fighting for a parking space or even receiving a ticket for parking at your place of work - as well as constantly rotating to new trusts with ever varying computer systems, protocols and passwords - distract and discourage and can slowly grind a workforce down.
To keep the plates of patient care spinning throughout the day is a never-ending and often amazing stage show played to an audience of none: everyone is just too busy to notice. The performance relies on ad-libs, leeway and workarounds. Understanding that ad-libs are necessary, understanding the need for leeway and understanding the nature of the workarounds is vital to an understanding of how the system and the people in that system really work. All of these things however are usually unseen, ignored or misinterpreted as being due to lack of professionalism, lack of commitment, lack of cooperation, lack of motivation, lack of intelligence or just plain laziness.
Currently the gulf is a very wide one - and unlikely to be addressable over a cup of tea - or by one.
Competing interests: No competing interests