Intended for healthcare professionals

Opinion The Bottom Line

Partha Kar: We need to level up all staff, not level down doctors

BMJ 2024; 385 doi: (Published 18 April 2024) Cite this as: BMJ 2024;385:q892
  1. Partha Kar, consultant in diabetes and endocrinology
  1. Portsmouth Hospitals NHS Trust
  1. drparthakar{at}
    Follow Partha on X @parthaskar

After years of underfunding, being undervalued, and issues around pay and working conditions, something finally seems to have changed for doctors. Whisper it softly, but there seem to be signs that they’re acting more collectively against changes they disagree with in the healthcare system. I suspect that much of the credit must go to the younger generation, for speaking up and pushing back against learnt helplessness and reigniting the dedication to change.

We’ve seen years of gradual decline. It’s easy to blame the system or pin it on politicians, but this decline in working conditions has been facilitated by many clinicians and, in some cases, doctors in management roles themselves. Over the last 25 years I’ve been in the NHS it’s been fascinating to watch how, in the drive to create a “level playing field,” we’ve managed to level down the whole system, rather than level up. The many examples include failures to provide a doctors’ mess, resting facilities, food, or decent working conditions. Driven by a lack of funding along with an inability to make the case for improvement, health leaders decided that rather than pushing for all staff to have such provision, it was better to take it away from those who did. This mentality has been detrimental to everyone, rather than elevating all to better working conditions.

Yet over the past few years something seems to have changed, as our workforce leaders seem to have pushed doctors to the limit. Let’s face it: from working conditions to issues of discrimination, pay, or career development, medicine is a shambles. Rather than taking action to improve doctors’ working lives, our leaders have chosen to expand the number of physician associates who are in direct competition with them—and the NHS is in complete flux as a result. But the current generation of doctors seem to have developed an appetite to push back against changes they disagree with. They’re motivated by continued support for their profession and a desire for better work-life balance and working conditions. The resistance has been firm, something that those in power have struggled to handle.

Show of unity

Looking at some NHS issues today—whether it be consultants’ pay, changing the direction of royal colleges, or forcing NHS England into scrambling mode over defining the role of physician associates—something has certainly changed. Doctors are increasingly speaking out.

A case in point is the recent fiasco with NHS England declaring that secondary care colleagues would no longer be referred to NHS Practitioner Health, which provides mental health support and is a lifeline for many doctors. The announcement that funding was being removed brought a huge show of unity and strength from the medical community protesting strongly against the decision. After 48 hours NHS England made a U turn: it has extended the funding for 12 months. The decision to cut the service in the first place was no surprise, coming from the same team that rolled back work on tackling racism in the medical workforce.1 Instead of having something good, rolled out for all doctors, they chose to have nothing for everyone.

To those in power, for what it’s worth: listen to the voices of doctors and the concerns they raise. In an era of social media, blogs, and podcasts, the healthcare system has lost its ability to silence them or to bully them into submission. It would be naive to dismiss doctors’ views. People are speaking up—and it’s about time.

I have nothing but admiration for the new leaders of the system who refuse to back down and continue to fight for what’s right. The rebel in me loves to see protest against an unfair system and, with a relative degree of privilege, I’m happy to help with a bit of levelling the power dynamics where possible. I’d quietly encourage other senior medics to consider doing so too.

It’s not difficult to appreciate and support the need for better pay and working conditions, or to understand the angst. Examples exist of senior medical staff trying to silence juniors by using power dynamics or gaslighting them with the appearance of being kind. Support for people raising issues of patient safety should come naturally, too. We should aim to improve the working lives of all, not just our own.


  • Competing interests: see Partha Kar is national specialty adviser, diabetes, and former lead of the Medical Workforce Race Equality Standard.

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