Intended for healthcare professionals

Views And Reviews The Bottom Line

Partha Kar: The NHS really isn’t a bad place to work

BMJ 2019; 366 doi: (Published 10 September 2019) Cite this as: BMJ 2019;366:l5451

Working for the NHS in a hell or heaven?

I have read the article by Dr. Kar (1) with great interest. I agree with his statement that individual opinions would be very diverse amongst the healthcare staff. The article heading implies that there have been short comings in the NHS (The NHS really isn’t a bad place to work). If you look at the whole issue in an “holistic approach” I would agree with the author; not a bad place to work but I am afraid to say that there are lots of shortcomings in the current clumsy NHS:

1. Clinical teams and managers are near deaf for “innovations” and “ innovative projects”. For example: Artificial Intelligence (AI) has been very very hot in the world and we have been very sluggish to adopt it. Mr Boris Johnson, PM, mentioned it’s on the way for the NHS, but I doubt the adoption pace will be as fast as it should be in the climate of the pre-Brexit era. Solution: I don’t know, maybe change the mindset to more innovative thinking, but this would take some generations.

2. Personal Development of an individual doctor is far from the reality and discussions in your appraisal are far from reality. The real support is weak or none. For example, I really focused on developing AI skills, and attended onsite conferences and webinars remotely, all out of my own pocket (this is at my discretion though, as our Trust annual support for conferences are £400-£500 per annum). Solution: Appraisals and job plans should be merged, tailored with personal professional needs and should be authoritative.

3. “Underestimation of some individuals skills”. This is so hideous and a part of a ghettoism issue and hard to detect and eradicate. Proud of diversity —to me— seems to be a covert lie. A symbiotic approach is much more valid in the current NHS: “ If you do something for me, I'll do something for you” “ See me, see you” approach.

4. Sabbatical leave for improving yourself have been a thing of the past for a while.

5. The saga “team work” is a good initiative and again its effectiveness can be argued. For example, I did an informal verbal survey amongst all people working in our Breast Care Unit. I approached about 30 individuals from receptionist to senior consultants in the unit asking them “Who is our new Chief Executive?” There was one receptionist remembered her first name. Neither of us remember her full name despite receiving several e-mails from her in about a 4 month time frame. Who is to blame? Yourself or the Chief Executive?

The author’s and my view are coming from our experiences but are still not enough to come to a conclusion. We need to look at nationwide “NHS staff satisfaction surveys”
Latest 2018 survey ( more than 300 Trusts and near half million participants with a 46% low participation rate) showed there are still issues about equality, diversity, health and wellbeing problems, etc. (2).

If you think that tehr are 150 million homeless people (3) in the world, to have a well paid job in the pre-Brexit UK is a good thing and feel grateful to NHS and ultimately God.
The NHS is a great organisation that needs to be revised and modernised and I feel this is not a governmental initiative alone.

There is no point in mourning and remaining demotivated. Be proactive and build up / strengthen the team work spirit in your organisation. Please have your say in forthcoming NHS staff survey in 2019 and do not forget to put forward your remedy recipe within it as well. Are you working in a hell or heaven? Have your say!

1. Kar P. The NHS isn’t a really bad place to work. BMJ 2019;366:I5451.
2. NHS staff survey results 2018. ( accessed on 11.09.2019).
3. Yale online. As Cities Grow Worldwide, So Do the Numbers of Homeless htpps:// (accessed on 11.09.2019).

Competing interests: No competing interests

11 September 2019
Emre Pakdemirli
Consultant Radiologist
West Hertfordshire hospitals NHS trust
Waverley Road, St. Albans City hospital, AL3 5PN