Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: My trust has shown how doctors’ assistants can help support clinicians

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q19 (Published 10 January 2024) Cite this as: BMJ 2024;384:q19
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}cantab.net
    Follow Scarlett on X/Twitter @scarlettmcnally

There are multiple problems in healthcare right now. Many people found that their health deteriorated during the pandemic through being less active and social.1 The NHS is struggling with large backlogs and delays to care, with rota gaps and overworked staff, unprofessional behaviour towards colleagues, disjointed care, increasing polypharmacy, and patients often not being given basic lifestyle advice to improve their condition. A lack of time is a major contributor to all these problems. Introducing doctors’ assistants and other administrative roles could help doctors use their time more productively.

We train, assess, and examine professionals on how they manage individual patients in an idealised setting. Yet we discipline them for systemic failures when they fail to deliver perfection while dealing with unmanageable numbers of patients, often with constant interruptions. We watch their moral injury2 as they’re forced to compromise care, and we see them resign, underperform, or get burnt out and stressed.

Healthcare needs more doctors and other senior clinicians who can individualise care, manage complexity, and share decision making with patients. I’ve written before about the need for more postgraduate training posts to develop senior clinicians.3 But, as I travel around the UK, I hear that doctors spend most of their working time on activities that don’t require a medical degree. For example, new IT systems have saved time for other staff—with fewer clerks filing and pushing trolleys of notes—but doctors must still wait for IT systems to load and reload for each patient, type discharge summaries, and fill in electronic forms.

This time spent on administration adds to doctors’ lengthy ward rounds and means that they see fewer patients in each clinic. Items that were just a few words and ticks on a paper form when I started as a consultant surgeon now take several minutes to complete digitally for each patient. The demise of the “firm” (a consultant led team of doctors) and fewer secretarial hours mean that we have no one to delegate admin and other tasks to.

Training others to do tasks that can be delegated

We need help to fix the underlying systemic problem of administrative tasks taking up doctors’ time. Proposals in the NHS workforce plan4 to increase physician associates and other medical associate practitioners by 10 000 won’t fix the real problem and may bring unintended consequences. What we need is administrative support, secretaries, clerks, scribes, and doctors’ assistants.5

At my NHS trust we won awards for introducing a “doctors’ assistant” role,67 showing that it increased doctors’ productivity and improved patient flow.5 The role involves admin, basic clinical skills, and communication with patients and across teams.48 It can be widely implemented and is already highlighted in paragraph 92 of the NHS workforce plan4 and the General Medical Council’s Caring for Doctors, Caring for Patients report.8

Seven level 3 apprenticeship options are listed for training senior healthcare support workers in areas including adult nursing, maternity, and diagnostic imaging.9 But there’s no such option for doctor support. At my trust we adapted the adult nursing support option to create an apprenticeship for our new role of doctors’ assistant. Let’s roll that out—and its apprenticeship—nationally.101112 Applicants can be recruited and trained rapidly from existing healthcare assistants and work at band 3 pay. If they wish to progress later they can enter the nursing associate pathway.

Ten years ago I did an MBA and learnt about applying traditional change theory to the NHS. In reality, effective change involves valuing “Trojan mice”13—staff within the system who are permitted to make small changes. Where such initiatives work they should be funded and rolled out more widely. My trust’s new role is an example of such an initiative, releasing more time for doctors to make decisions with complex patients and offer interventions.

So, let’s increase support staff for doctors: I’ve already committed to increase my productivity by 30% with administrative support. Surely, that’s worth rolling out.

Footnotes

  • Scarlett McNally is an orthopaedic surgeon, deputy director of the Centre for Perioperative Care, and president of the Medical Women’s Federation.

  • Provenance and peer review: Commissioned, not externally peer reviewed.

References