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Solving doctors

Thursday, 2 November 2017

Solving doctors

It’s been a week of helpful interventions. NHS England has told sustainability and transformation partnerships (STPs) to sort out the GP recruitment crisis. NHS Improvement has taken high-impact steps to enrich the lives of junior doctors. Two different initiatives, two different sets of doctors, two national bodies determined to make the world more doctor-based and success-centric.

Magic Kingdom

We have the HSJ to thank for the story that NHS England has set STPs targets for GP recruitment. Only lack of statutory powers, resources and candidates stand in their way.

Otherwise it’s a great idea. Devolution has been focused for too long on the vulgar business of funding and not enough on finding really practical solutions to problems that Big Government is too sausage-fingered to solve.

STP unorganisations already have secondary care deficits, hospital performance and decaying social care on their plates. Added to which they have the job of plotting the route to the Magic Kingdom, the fairytale world of accountable care organisations and new care models featured in Walt Disney’s Forward View. Sorting out the primary care workforce is a breeze by comparison. 

Local GP training initiatives could obviate the need for Health Education England, local education and training boards, royal colleges and other expensive bureaucratic paraphernalia. We could even finish the job started by Lord Lansley, and get rid of the Department of Health altogether. Think of the money we’d save.


It’s no coincidence that this news comes in the same week that the department announced a consultation on relaxing medical regulation. The current rules requiring years of training and learning on the job were designed for an age where doctors were compelled to practise medicine before they were allowed to practise medicine.

But there is little to be gained by harking back to the 1950s. We need to redefine “GP” for the new world. You wouldn’t dream of training someone for ten years to flip burgers, paint your home or drive an Uber taxi, so what makes doctors so special?

GP training could open up in a variety of innovative ways. They could include opportunities for stay-at-home mums planning a return to work, retraining for eastern European plumbers and builders seeking post-Brexit job security, and courses at local colleges enabling medicine to be combined with media studies, sociology and modern dance. E-learning would allow doctors to upskill at their own pace and still leave time for evening bar work.

We don’t need stuffy old colleges and mentoring schemes. There are thousands of qualified docs on social media who trainee community doctors and wellbeing assistants could turn to for advice and support.


In other news, junior doctors responded with gratitude to a guide from NHS Improvement to making their working lives better. It turns out that traditional forms of stress-relief - alcohol, drugs, sex and contract disputes - do not work. Eight High Impact Actions to Improve the Working Environment for Junior Doctors advises, among other top tips, that they should be given access to fresh water – leading one medic to wonder if the authors were confusing junior doctors with ducks.

Animal husbandry is a recurring theme. We also learn that hospitals could employ a “dedicated pastoral lead”, who would presumably ensure that busy doctors get a break for fresh air, exercise and grazing.

Other suggestions include “promoting rest”, “rewarding excellence”, and “better engagement with the board”. The authors may be on to something here. A couple of hours in a board meeting could be just the thing to make a long shift in an understaffed emergency department suddenly seem appealing.   


Concerned that NHS Improvement may have missed some even higher impact actions, we canvased doctors. Here are some of their ideas for enhancing the working environment.

  1. Take turns to have a go on the ride-on floor cleaners
  2. Do ward rounds/surgery outside if it’s nice
  3. Customise your pager’s ring-tone or choose your own call-sign, eg Iceman, Maverick
  4. A non-smoking room with retro nicotine décor and faux ashtrays
  5. Biscuits/stickers to reward excellence and celebrate success
  6. Allotments for growing vegetables
  7. Workshops on proactive chatting, compassionate breathing and mindful positivity led by NHS Horizons
  8. Complementary sanitising hand gel.

Hospitals that adopt these innovations can expect to see an up to 1000% improvement in the morale of junior doctors, albeit from a lowish base. Don’t forget to choose a suitably high-impact way to mark each achievement along the way. The Dam Busters theme played at high volume goes down particularly well on geriatric wards. Staff in other departments will have their own ideas.

Improvement editor: Julian Patterson 


Dee Gray
Dee Gray says:
Nov 03, 2017 07:59 AM

Motivational talks from Chief Execs have been overlooked. They are really good at getting doctors to deliver on targets, especially those that make money for NHS.

Anonymous says:
Nov 03, 2017 03:23 PM

Thanks JP. Glad to see Top Gun directly referenced in this week’s dispatches.

With reference to doctors training - I think the NHS should be looking to harmonise its approach around shared life experiences. This would help reduce the natural anxiety most feel when first encountering clinical environments. I am of course referring to the happy days spent by most flipping burgers, pulling pints and de-constructing lattes.

Suggest a bell at the nurse base would help promote an overall feeling of familiarity. For example, this could dinged every time a patient is discharged with an added incentive of two dings if the patient makes it onto transport before 1000am (Refer 2017 Top 10 high impact changes affecting discharge ).

Possibly for balance we should also look at a similar approach to re-admissions? The jury would need to decide whether introducing a Two Ronnie’s sound effect from the Phantom Raspberry Blower of Old
London Town would be an effective deterrent?

b/rgs ‘Goosed’