The NHS was recruiting like mad when I applied for my first job as a doctor in 2001. They were responding to a shortage like the one that is happening now – in which a staffing crisis is said to have become so significant it is putting patient safety at risk. A Commons Health and Social Care Select Committee report released today (25 July) finds that the UK is short of 12,000 hospital doctors and more than 50,000 nurses and midwives.
Back when I started, there was an incentive to join the NHS. It wasn’t glamorous, with its Florence Nightingale-style wards and grand but inadequate hospital buildings. But doctors had a good salary, good career progression and they seemed to be obsessively dedicated to improving patient care. The optimism of the tail end years of Cool Britannia was in the air. I got married, I bought a flat.
But now, I question why anyone would want to work for the NHS. Fast forward 20 years and I am a consultant in geriatric and general medicine. I open my emails. One of them tells me the CT machine that has intermittently broken down over the past two years has broken again. And we are short of staff. Not just us, the doctors. The nurses too – there are only two trained nurses in my unit of 29 beds. I wonder how I will be able to finish the ward round when I have six extra patients in another ward, no junior doctor and a clunky IT system that keeps logging me off. I look at my patient list: is there anyone the junior doctor could see on their own? We plod on, fuelling ourselves with coffee and black humour. But we are tired, and we cannot work any faster.
In this environment, I look at my 21-year-old General Medical Council (GMC, the public body that sets professional standards in medicine) manual: “The duties of a doctor”. Am I being a doctor to my patients? Or am I being a pawn to the NHS? It is an important existential question that needs to be answered. Our trainees “know their stuff”, but can they perform when there are way too many patients, too few junior support staff and too few nurses around them? If the answer is “no” there are consequences. Their training can be prolonged further, overzealously scrutinised or stopped altogether; their ability to pay the student debt that saddles them for years and their dreams, gone.
The only way to play the game of survival is to play smarter, not harder. Branching out into medical education, appraisal or management departments pays the same as face-to-face patient care. If we work harder, our pension contributions are disproportionately taxed (I know it; for my dozens of extra shifts during Covid, I received a tin badge and a £3,400 tax bill). The NHS seems to be the arena of managers; staff write operating procedures about what to do when there is no staff. The care is mediocre, and the pay is too; consultant salaries have gone down by more than 35 per cent in real terms over the past 15 years. A diabolical tax system and a pension trap have done the rest; shifts go unfilled, patients suffer. The media, meanwhile, reminds us of how greedy we are. My junior doctors sometimes get married, but they are not buying that flat.
The day is ending and I open my emails. One asks me to reflect on my answer to a complaint in the typically corporate, passive aggressive tone that has become the norm for this type of communication, reminding me it is my contractual duty and necessary for my yearly appraisal. I must reflect on every complaint and every answer, even that one where the disgruntled relative asked where I had got my degree from, or the one where they complained about my accent. But without adequate appraisal my revalidation medical officer will not recommend me to the GMC, and I will not be able to continue working as a doctor. It hurts. I have put too much in. They have me like they have a slave; everybody knows, even myself, that I will not leave.
My niece told me she wanted to be a doctor – she is clever and hard-working: she would be a great doctor. But I know she will get stuck like me, so I tell her she shouldn’t get embroiled in the NHS. I do not want anyone to feel like this.
[See also: NHS workforce shortages may be even worse than official data suggests]