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Current Staff Shortages a Significant Threat to Patient Safety, Say Doctors

Editor's note: This story was updated with a quote from NHS Providers.

A survey has found that staff shortages are putting the health of patients, and of doctors, at risk, with doctors considering leaving the profession as a consequence.

The NHS Workforce Plan "must include mental health support to retain doctors currently in the workforce but on the verge of quitting," said President of the Medical Protection Society (MPS), Professor Dame Jane Dacre, following the results of the organisation's most recent survey of doctors.

For the survey, 861 doctors (457 working in hospital, 271 working in general practice, with the remainder not disclosing where they worked) were asked questions from 20 March to 17 April 2023 on a range of issues. These included their views on patient safety, how staff shortages were affecting their mental health, and what their future career plans were.

Of great concern was that 95% of doctors in the UK believed the current staff shortages presented "a significant threat" to patient safety, highlighted the authors of the report.

One anonymous surveyed doctor said: "Sometimes the standard of care is woefully inadequate due to long waits and pressures on the staff." Whilst another expressed how it was "demoralising to be continuously unable to provide the standard of care you know patients deserve due to inadequate staffing".

The BMA pointed out that the greatest proportion of vacancies remained in nursing, with 43,619 unfilled posts, which equated to over 1 in 10 (10.8%) nursing posts needing to be filled. 

However, the future looked bleak, as 9 out of 10 (91%) doctors surveyed could not see staffing levels improving in the foreseeable future.

Professor Dame Dacre, said that the fact that most doctors felt the under-resourced environments in which they worked presented a significant threat to patient safety, was a "sad reflection" of the times and was "distressing for patients and doctors alike".

Doctors' Mental Health Threatened

Over half (54%) of the doctors surveyed said that the impact of staff shortages on patients was affecting their mental health, with just under 4 out of 10 (79%) of those having expressed that the impact on their mental wellbeing was "moderate or significant".

Another surveyed doctor described how "watching patients get suboptimal care is exhausting and watching colleagues stretched beyond belief is upsetting". The doctor warned that patients were getting "sick waiting for care as an inpatient and outpatient".

Asked to comment by Medscape News UK , Saffron Cordery, deputy chief executive at NHS Providers said: "The 124,000 staff shortages in the NHS are piling pressure on overstretched workers and taking a huge toll on their mental health.

"Survey after survey reveals high levels of reported burnout and low morale, while anxiety, stress and depression are consistently the top reasons for staff sickness," she pointed out.

Dame Dacre alerted that "many doctors are also worried about becoming embroiled in medicolegal disputes following adverse incidents arising due to staff shortages".

The fear of being sued, or investigated, due to incidents arising from staff shortages had a detrimental impact on the mental health of 2 out of 5 (38%) doctors, the survey found.

To help doctors faced with this predicament, the MPS called on the General Medical Council (GMC) to reassure doctors that severe resource constraints would be considered if they were referred to the regulator following an adverse incident, particularly when referral to the regulator was due to staffing issues, which was "out of their control".

"During the pandemic, the GMC issued a statement to acknowledge the challenges doctors were facing and offer reassurance that the extreme context would be considered. They took the same step again last winter," Professor Dame Dacre pointed out. "We feel the current staffing crisis warrants similar reassurance."

Careers in Medicine Jeopardised

The most recently updated NHS medical staffing data analysis by the British Medical Association (BMA) highlighted that, as of December 2022, there were around 124,000 vacancies in secondary care in England, with 8728 of these vacancies being medical, which meant that over 1 in 20 (5.9%) of all hospital medical posts were vacant. 

The picture was no better in general practice, where the BMA said that "over the last year alone, the NHS has lost 408 individual (headcount) GP partners and 166 salaried, locum, and retainer GPs". This had created a net loss of 574 individual GPs since February 2022, it explained, and pointed out that in full-time equivalent (FTE) terms of 37.5 hours per week, this amounted to an equivalent loss of 463 full-time fully qualified GPs.

Nearly half (49%) of the doctors surveyed said they were "considering their career in medicine" due to the impact of staff shortages on patient safety. Another surveyed doctor said: "I am always exhausted. My career was everything to me, now I cannot wait to leave it."

"The workforce is exhausted, fearful and many need support with mental health issues," said Professor Dame Dacre. "When doctors' mental wellbeing is poor it is not only damaging for them but also jeopardises patient care.

"One of the many problems with staff shortages is the knock-on effect on the exhaustion and mental health of remaining staff. If we don’t tackle this, they will leave, and this will negate any planned injection of new doctors," she emphasised.

The MPS called for the yet-to-be-published 2023 NHS Workforce Plan, aimed at increasing the number of healthcare professionals in the NHS to ensure it can cope with future challenges, must include mental health support to help retain the "passionate, committed" doctors currently in the workforce but who are "demoralised" and on the verge of quitting medicine.

Professor Dame Dacre said that the plan "cannot come too soon", and hoped that once published in its entirety, it would give healthcare professionals "a light at the end of the tunnel".