Authors: Dr Sarah Logan, deputy director, Medical Workforce Unit; Dr Rifca Le Dieu, deputy director, Medical Workforce Unit; Dr Harriet Gordon, chair, Flexibility and Wellbeing Group.
The COVID -19 pandemic has had a major impact on the working lives of physicians, which the RCP has tracked through a series of surveys. The aim has been to highlight the problems they have faced and help the NHS and government solve them.
For the June 2021 survey, the RCP flexibility and wellbeing group and the trainees committee wanted to know more about the long term impact of the pandemic. They worked together to develop questions that would help us understand how it had affected the way we work and what elements of “the new normal” we would like to keep.
We emailed the survey to the majority of our UK members, including medical students, foundation doctors, trainees, SAS doctors and consultants. 1,523 fellows and members responded, mainly consultants working in acute hospital trusts(81%). The responses by specialty, region, sex and ethnicity broadly reflected the profile of our membership.
The way doctors work has changed
During the pandemic, two thirds increased the number of hours they worked and worked more with inpatients. At the time of the survey, the majority of those (67%) had reverted to their pre pandemic work pattern.
Worryingly, among those still working differently, just over half had not had that reflected formally in a job plan. If these numbers reflect the general experience of doctors during the pandemic, that would mean around 10% working outside their job plan 15 months after the first lockdown began.
Working from home is now common: 57% were doing this at least some of the time. While some said there were drawbacks to home working, such as a lack of a clear boundary between work and home life, 67% felt it had improved their work/life balance.
In terms of what they do from home, doctors are increasingly delivering direct clinical care, most often as part of a multidisciplinary team. But 10% reported delivering outpatient clinics from home beyond their contracted hours, which is of concern.
Most physicians want to work more flexibly
We found that doctors want to work more flexibly at all stages of their careers. For most, this means working more from home (76%) and compressed hours (71%). But 36% said it would be difficult, very difficult or impossible to work more flexibly. The main barrier was not enough medical staff (79%), followed by an excessive workload (58%) and the need to do fixed face-to-face sessions (52%).
Over half of trainees wanted to train less than full time, which is now available to all HSTs. While workforce planning at a national and local level is critical to facilitate this, at a local level we need to think about how best to offer trainees opportunities to work differently. Can they work compressed hours, do they need to on site to deliver their role? Wanting more control over their work and training patterns was a strong theme in the responses, such as the use of self rostering and having plenty of time to arrange swaps with rotas sent out well in advance will all help.
What can organisations and medical leaders do about this?
At the same time as doctors are wanting to work more flexibly, more than a quarter (27%) of consultants said they plan to retire in the next 3 years. There is a clear need to make sure current doctors are retained as long as possible.
The impact of the pandemic and new patterns of working has taken its toll on autonomy, a key factor in job satisfaction. 64% of physicians in the survey felt that they had less control of their professional life compared to pre-pandemic. The impact of reducing the amount of time doctors have for supporting professional activities (46% reported this) without consultation for the majority (75%) cannot be underestimated.
“Huge increase in workload. Now no time in working week for CPD/appraisal activities. In job planning meeting when I raised this I was told I wasn’t alone but wouldn’t be paid or any opportunity to reduce other activity. Direct access for patients via emails has hugely increased clinical workload as we are generally approached before self care or primary care.”
Recognition of this by clinical leads is critical to having open honest conversations about what the “new normal” working pattern needs to look like. This could happen in job planning sessions or appraisal, and we need to make sure leads have the support they need to deliver appraisal and job planning under these new circumstances. These are key opportunities to reflect on what the last 18 months has felt like, what doors it has opened, what support is needed and critically what will lead to improved wellbeing at work.
“I have retired and returned so am I totally in control of my own life - previously I worked two days a week physically in the Highlands travelling up from Oxfordshire. Remote working is very effective so now I work from home 3 out of 4 weeks. I can still prescribe the chemo order, report scans and prescribe and plan radiotherapy remotely. It means I am prepared to remain working for longer which in a time of oncologist shortage seems good.”
Facilitating remote working
“Proper remote access is a brilliant improvement that has allowed all the doctors in our department to take a more flexible approach to when and how they work.”
We need to get the basics right if we’re going to support more flexible working. The majority of trusts had implemented changes to facilitate less face-to-face contact. Online meetings and remote IT access are now common place and 60% of respondents wanted these changes to remain in place. But there is still patchy provision of the right equipment in Trusts, which needs to be consistent.
“The simple answer is: we need vastly improved admin support for outpatient services and better IT in order to run services more flexibly, both for patient’s needs and preferences for example choice of TC/video/F2F, and also to support staff WFH. The more complex answer is: change of attitude.”
Effective group job planning
At the same time, we need more group job planning. This involves clearly mapping out service needs and fair and transparent discussion about who does what and from where. The sorts of questions we should be asking are:
What works virtually and what must be done face-to-face?
What do we like doing virtually and what do we prefer to do face to face?
Can that clinic be delivered virtually and from home?
Which departmental meetings can be done remotely?
Does the mixed model work for your team?
“I have a job plan agreed that is two sessions in the hospital face-to-face clinics, then telephone and televised clinics, SPA and admin at home. Apart from fixed clinics I can manage my own time within reason. This is a new way of working within the trust and works for me as I have two young children who I can take to school most days. I was prepared to leave my job to provide adequate support for my family but feel I can provide the patients/trust with a good service whilst being around for my family with this pattern.”
Changing the culture of presenteeism
Enabling remote working for doctors at all stages of their careers is a big cultural shift for NHS organisations. With the evolution of electronic patient records, easily accessed remotely, there should be no need for doctors to feel that they need to sit in crowded offices until their shift ends. An acute medical take and inpatient wards need to have safe staffing levels, but we should be encouraging doctors at all stages of training to do some work remotely.
“If more remote working is not allowed then I shall be leaving earlier than intended. Should be about productivity and not being seen at work.”
Virtual working is a training opportunity
The skills required to be an effective communicator in the new virtual world is important and should be assessed. Watching a trainee talk to a patient via video or speakerphone is a great learning opportunity that can be reflected as an assessment in an eportfolio. Chairing and organising online meetings, including MDT meetings, is now a core part of many trainees’ roles and is another great evaluation opportunity.
Many thanks to so many of you who took the time to respond to the survey. We value your replies and they inform our discussions about the working patterns of physicians with the NHS and government.
If you have any comments for suggestions, would like to know more or be involved with the work of the flexibility and wellbeing group, please contact us via firstname.lastname@example.org.