I met John (not his real name) during a busy ward round. As a junior doctor he was efficient and polite, but I could tell that something wasn’t right. He was tired and withdrawn. I asked him how he was finding work and was saddened to hear him say, ‘I think about leaving the NHS all the time—like most of my peers.’
John explained that he had qualified as a doctor £60,000 in debt, that he had no certainty as to where his training would take him in the country, and that he could not afford to buy a house. He was tired from working long, antisocial shifts, often at night and beyond his contracted hours, due to the rota gaps that opened up with staff taking sick leave. He admitted to doing the bare minimum in order to get through each shift.
John is not alone in experiencing burnout. In the international classification of diseases, burnout is categorised as an occupational phenomenon. It is a syndrome resulting from work-based stress that has not been successfully managed, and is characterised by three factors:
- Feelings of energy depletion or exhaustion,
- Increased mental distance from one’s job, or feelings of negativity towards one’s job, and
- Reduced professional efficacy.
An increasing number of junior doctors are now leaving the NHS before the completion of their training, and burnout is the main cause. This exodus started prior to Covid-19, although the pandemic exacerbated the trend. In 2010, the number of Foundation Year 2 (FY2) doctors who progressed onto specialist training programmes was 83 percent. By 2017, that had plummeted to 42.6 percent.
Recent research by the General Medical Council paints a startling picture of increasingly high demands on healthcare workers coupled with the inability to deliver all the health needs of the population. In combination, this causes ‘exhaustion and disillusionment’ among doctors. The result is that more doctors than ever before are taking steps to leave the profession entirely, especially within general practice.
It’s not difficult to understand why general practitioners (GPs) are leaving the NHS in droves. Bethan, a GP trainee who switched from a career in neurosurgery, explains that GPs are used as a scapegoat by much of the mainstream media and some politicians, who want to deflect attention from the Conservative government’s chronic underfunding of the NHS, which forms a central part of its austerity programme.
‘Every week, there is vile and offensive rhetoric from the tabloids and broadsheets about GPs who are painted as lazy and making money from the pandemic by sitting at home and refusing to see patients,’ she says. ‘It’s far from the truth.’ She bemoans the lack of ‘pushback’ from politicians and the Royal College of Physicians and GPs, with only a few small voices on social media trying to redress the inaccurate and defamatory depiction of her profession.
Those of us who work in the NHS know firsthand that the government, and as a consequence, NHS trusts, are notoriously bad at workforce planning. On 30 March 2022, the latest NHS workforce survey reported that three quarters of respondents worked in NHS organisations that had insufficient staffing levels to allow them to perform their jobs adequately. This prompted calls from a range of healthcare unions, NHS organisations, and think tanks for the government to develop an NHS workforce strategy. In a cruel twist, on the same day, MPs voted against a proposed amendment to the Health and Social Care Bill that would have required the health and social care secretary to publish an independently verified workforce assessment and plan at least every two years.
This was a missed opportunity to investigate why doctors and other healthcare workers are leaving the NHS, and more importantly, to develop a sustainable strategy to retain and recruit more staff in the long term. A damning research paper on why doctors leave the NHS to work in other healthcare systems found, in October last year, that the majority of NHS doctors are not given an ‘exit interview,’ to establish the reasons for their departure and to reassure them that a return to the NHS is still a viable option.
The paper showed that while burnout was a major reason for leaving the NHS, that burnout was resolved in over 89.3 percent of doctors who worked in healthcare systems abroad. The reasons cited included better pay, better work-life balance, and training opportunities. This exposes the truth: the majority of doctors who leave the NHS are not burnt out from medicine, but from the NHS itself.
I asked John if he was getting enough support at work. His wry reply: ‘Emails encouraging me to participate in yoga at lunchtime might help me to relax but they won’t tackle the underlying cause of my burnout.’ NHS staff are some of the brightest and most altruistic members of our society. While the current situation suggests a bleak outlook for the future of the NHS, a proactive approach from the government with a sustainable approach to workforce planning could turn things around.