Changing the conversation about health

The NHS has a duty of care to prevent doctor burn-out – for the well-being of staff AND patients

Professor David Peters, Clinical Director in the Faculty of Science and Technology, University of Westminster, warns the NHS urgently needs a Charter of Compassionate Practice to prevent staff demoralised by excessive workloads from leaving the healthcare system…  
The NHS now employs more than 1.7 million people and deals with a million people every 24 hours. Industrialised delivery was unavoidable as medical knowledge and technology boomed, boosting expectations and setting demands for healthcare soaring.
When the NHS launched in 1948, its budget was £437 million (roughly £9 billion at today’s value). Now it’s a gigantic industry, the world’s largest publicly funded health service, spending over £110 billion a year. Only the Chinese Army, Wal-Mart supermarkets and the Indian Railways employ more people!

Professor David Peters says conscientious doctors willing to overwork are being exploited by the NHS

Efficient competition and mass throughput require assembly lines for quality control in an NHS of profit and loss accounts, internal markets, performance management and ever changing targets. But staff risk becoming cogs in a larger machine, and we now see doctors and nurses leaving the service at an unprecedented rate.

A group of French GPs writing in 2012 suggested that empathy can prevent burnout, but that burnout is itself an empathy killer. They observed that to ‘preserve effective empathy in care, the health provider must be in a positive frame of mind and not affected by stress or burnout’(1).
Over 2000 GPs responded to the 2013 Pulse on-line burnout survey. 40 per cent felt depersonalised, 72 per cent were emotionally exhausted and 97 per cent were experiencing low levels of personal accomplishment.
Five years on, it’s clear that these burned out GPs were the canaries in the coalmine, harbingers of widespread distress and sickness among NHS staff.
On the conveyor belt that modern healthcare has become, excessive workloads are inevitable  at times, but on NHS production lines too many practitioners are under too much pressure.
It is well established that patients view empathic doctors as better doctors and that empathic doctors are happier in their work. But under pressure they are more prone to soak up their patients’ suffering, as tolerance for distress plummets when clinicians lack the time or skills to restore themselves emotionally and spiritually.
As austerity bites deeper, cutbacks eat up services, and staff quit toxic workplaces, NHS organisations must step up to their evident duty of care and prevent practitioner burnout. The dream-ticket would be to retain efficiency while supporting empathic effective practice.

Under such pressure, doctors are more prone to soak up their patients’ suffering, says Professor Peters

There would be multiple benefits, not the least of them reduced staff attrition, sickness absence and premature retirement.

The NHS will achieve this only if genuinely compassionate organisations make staff resilience their priority, and reward managers for developing workplaces that satisfy patients while  increasing job satisfaction.

Professor David Peters

Compassionate organisations would strive to re-humanise healthcare. Too much of the NHS has been hijacked by left-brain production-line thinking.
This bean-counting culture must now put a price on the human cost of endangering the well-being of staff and patients.
It is not acceptable for GPs to be working fifteen hour days, nor for understaffed hospitals to allocate too few nurses to too many patients(2), nor to turn a blind eye to violations of the European Working Time Directive by exploiting conscientious doctors’ willingness to overwork. (3)
To push back against these alarming trends a Charter of Compassionate Practice is being proposed… the NHS must find a way to prevent doctor burn-out for the well-being of all.
1 Franck Zenasni, Emilie Boujut,Aude Woerner. Burnout and empathy in primary care: three
hypotheses. Br J Gen Pract. 2012 July; 62(600): 346–347.
2 Ball JE, Murrells T, Rafferty AM, et al. BMJ Qual Saf Published Online First: [please include
Day Month Year] doi:10.1136/bmjqs- 2012-001767
3 Daniel K Sokol. Waking up to the effects of fatigue in doctors. BMJ 2013;347:f4906