Pandemic offers one-off chance to reform NHS culture and retain doctors, says GMC chair

The COVID-19 pandemic is a one-off opportunity to create a more compassionate work culture in the NHS that can help retain doctors by tackling discrimination and burnout, the chair of the GMC has said.

GMC chair Dame Clare Marx (Photo: GMC)
GMC chair Dame Clare Marx (Photo: GMC)

Dame Clare Marx said discrimination was ‘still visible’ within the medical profession, warning that many clinicians, particularly those from black and minority ethnic (BAME) groups, continued to face ‘intrinsic barriers’ while at work.

But she told the Leaders in Healthcare conference that the COVID-19 pandemic had freed the profession to ‘think the unthinkable and change the unchangeable’ - urging doctors to use it as a vehicle for changing ‘baked in’ behaviours.

The GMC chair encouraged doctors to develop working environments where ‘collaboration, communication and accessible leadership’ could help to improve patient care and increase job satisfaction.

BAME doctors

Research conducted by the GMC last year found that feelings of disempowerment were ‘significantly amplified’ for doctors in BAME groups, who reported higher rates of bullying, harassment and abuse from colleagues than their white counterparts in 77% of trusts.

BAME doctors are twice as likely to be referred to the GMC by their employer than white doctors, with 1,164 referred last year compared to 953 white colleagues. Dame Clare argued that the pandemic had thrown ‘long-standing inequalities into sharp relief’, and called on leaders to offer better support for staff.

‘There are intrinsic barriers in the system. Looking back, I remember multiple conversations with talented doctors who felt they couldn’t get on. I shudder as I recall one Sikh colleague who was told by a boss: "We just don't think you'd fit into this department.",' she said.

‘Tackling the underlying issues requires leadership. It requires us to be humble about what we don’t know and decisive in implementing solutions. There is no quick fix. But we know some of the elements that need to be in place. Chief among them is the right culture – open and compassionate, in which all staff have a voice.'

Doctor disatisfaction

Dame Clare continued: ‘As leaders, it is our duty to make this a lived reality. That is not a passive action – it  requires active effort and focus… These patterns of behaviour are not pre-ordained. Culture can be changed. But it  requires an active effort from all of us'.

A report into disproportionately high deaths among people in BAME groups from COVID-19 in June found that NHS staff from this group were less likely to speak up when they have concerns about PPE, testing or risk, putting them at increased risk.

The GMC chair also highlighted that poor working environments were a major factor in doctors leaving UK practice - telling health leaders there would be no progress without change. Dame Clare revealed that factors relating to doctors’ experiences at work, such as dissatisfaction, were more influential than financial drivers when deciding to quit the profession.

Over 35% of doctors said that job dissatisfaction was one of the reasons they left, and over 25% said it was a reason they wouldn’t return. Burnout has also been highlighted as a major issue, especially in general practice, where 43% said it was the main cause for their departure.

Poor working environment

Dame Clare said: ‘The environments in which doctors work – the support they receive, the way they  communicate with those around them, the ability they have to influence outcomes – have a material impact. Compassionate culture matters.

‘Environments that promote collaboration, communication and accessible leadership produce better outcomes. Environments where those factors are absent are, at best, unpleasant to work in and, at worst, downright dangerous. In this time of uncertainty, getting that supportive environment right is more important  than ever... So the right values must be instilled from the start, because they will define everything that comes after,’ she added.

Despite the GP workforce growing by more than 1% in the three months to September 2020, recent BMA polling found that one in six GPs plan to quit the NHS or retire early once the COVID-19 pandemic dies down. BMA chair Dr Chaand Nagpaul recently told MPs that GP workload was 'out of control' and urged contacts per day should be capped to prevent burnout.

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