The demands of the NHS, plus better conditions in the EU, means pressure will mount on already overstretched staff, says Bristol GP Zara Aziz. Writing in The Guardian, she expresses the fear she feels a catastrophic no-deal Brexit could have on primary care
This is an edited version of an article that first appeared in The Guardian.
Staff sickness and uncertainty caused by Brexit have worsened NHS staffing shortages. A recent NHS staff survey showed that just under 40% are unwell with stress, the highest we have seen in five years. And with health and social care relying heavily on staff from the EU, Brexit has the potential to compound our existing recruitment and retention problems. According to a recent report, the shortfall in GPs in England will almost triple, from 2,500 to 7,000, by 2023-24. There are already 1,300 fewer family doctors than in 2015.
I work in a 22,000-patient urban GP practice with a multidisciplinary staff of about 40 receptionists, administrators, doctors, nurses, pharmacists and healthcare assistants. Each plays a key role in keeping the wheels turning smoothly and, for short-term sickness, we usually cover one another. This is not sustainable for any longer-term absences as the pressure on the rest of the team becomes unbearable but, in hospitals, chronic staff shortages exist when managers (despite their best efforts) cannot recruit.
There is also a steady stream of staff leaving to work in the community, the private sector, or abroad. It is commonplace to see recruitment directed at NHS staff from recruiters in Australasia and even Europe. There was a recent campaign to recruit, post-Brexit, Polish doctors and nurses in the UK for a hospital in Germany – including an advert in The Guardian. A friend of mine, who is a nurse, is moving back to Spain after nearly 20 years here, citing the demands of NHS workload and better conditions in EU; she called working for the NHS ‘brutal’.
Workload has mushroomed to an unprecedented scale. It is the norm to work 12-14 hours a day in order to complete clinical work. Break is often a sandwich hurriedly eaten between home visits or consumed while going through blood results or signing prescriptions. A typical day at the practice does not end when we see our last patient at 7.15pm; if there are 40 hospital letters to read and action, or urgent referrals to complete in readiness for the secretaries the following morning, this work must be done.
These time pressures are big stress triggers, as staff work in excess of their contractual hours. We offer five, 10 or 15-minute appointments (for telephone, urgent or routine problems). I don’t want to rush patients but, at the same time, there are other people waiting, some of whom may need acute interventions or an emergency hospital admission. An on-call colleague may also need help with urgent calls or last-minute prescriptions.
To avoid burnout and ill health, many – like myself – choose to work part-time. I work two, 10-hour days. Others are looking for alternative work, such as in teaching, locum or out-of-hours work, where there is more control over hours and better work-life balance. This, inevitably, has an impact on continuity of care, but I know that if we were to take away this flexibility – which often does not exist in hospital settings – then primary care recruitment and retention would be an even bigger headache than they are now.
Sense of purpose and commitment
Most of us choose to work in the NHS due to a deep sense of purpose and commitment to its values. As we become more experienced this is coupled with a need to be autonomous and to learn and develop in our roles. However, the NHS is seriously hindered by high levels of bureaucracy and multiple reorganisations have only added to this. Staff shortages mean that service provision for patients always takes precedence over learning new skills and this erodes staff morale. Staff feel they are neither valued nor listened to by managers; this makes for a toxic and unhappy working environment with disengagement and high levels of emotional and physical illness.
The government, and various regulatory bodies, continue to stoke demand for healthcare and promote over-diagnosis, while simultaneously cutting public health budgets. In the interests of cost-cutting and efficiency we are steered towards becoming giant, impersonal organisations where individual staff matter little.
Unless our organisations invest, emotionally and practically, in the wellbeing of staff, the NHS will always struggle to retain them – a much bigger threat to its future than recruitment alone. My practice now has a wellbeing adviser – who doubles up as a deputy practice manager. She offers emotional and practical support to us, and is introducing themed lunches once a month and protected time for yoga, mindfulness and other social events. Although doctors may not always have time to attend, we hope other staff will benefit, especially from being able to talk about mental health issues, which is not easy when you work in healthcare.
Zara Aziz is a GP partner in inner-city Bristol.