Junior doctors - 48-hour maximum working week (without averaging): expert working group report

4. GMC Report

‘Caring for Doctors Caring for Patients: How to transform UK healthcare environments to support doctors and medical students caring for patients’ (November 2019)

In recent years, the evolving crises in medical recruitment and retention, poor job satisfaction and increasing evidence of burnout in the medical profession have been widely recognised as a cause for concern. In response, the GMC commissioned Professor Michael West and Dame Denise Coia to undertake a UK wide review to identify the causes of poor wellbeing in doctors and medical students and help provide solutions that can be actioned in the NHS.

Their report ‘Caring for Doctors Caring for Patients: How to transform UK healthcare environments to support doctors and medical students to care for patients’ was published by the GMC in November 2019.

The report makes eight key recommendations focussed on delivering safe, supportive and inclusive environments and compassionate cultures. The authors challenge health service leaders to implement all recommendations in order to improve the wellbeing and sustainability of the medical workforce – an outcome known to correlate with higher quality patient care and higher levels of patient satisfaction.

The GMC report has a much wider scope than the specific focus of the EWG to make recommendations on achieving a 48 hour maximum working week (without averaging) for Junior Doctors. However, two of the key recommendations in ‘Caring for Doctors Caring for Patients’ are pertinent to Junior Doctor working hours:

Key recommendation two (Caring for Doctors Caring for Patients, November 2019)

Work conditions

To introduce UK-wide minimum standards for basic facilities in healthcare organisations.

• All healthcare employers should provide all doctors with places and time to rest and sleep, access to nutritious food and drink, the tools needed to do their job and should implement the BMA’s Fatigue and Facilities charter.
• The leadership and boards of every organisation employing doctors should review facilities to ensure compliance with the BMA’s Fatigue and Facilities charter.
• Systems regulators, improvement bodies and partners listed should check that employers have implemented the BMA’s Fatigue and Facilities charter in all working environments.
• The GMC should continue to work with partners via the insights and data obtained through their NTS to monitor, assess and support implementation. Where issues are identified, the GMC should work with postgraduate deans, medical royal colleges and employers to ensure they are promptly and fairly addressed.

Key recommendation three (Caring for Doctors Caring for Patients, November 2019)

Work schedule and rotas

To introduce UK-wide standards for the development and maintenance of work schedules and rotas based on realistic forecasting that supports safe shift swapping, enables breaks, takes account of fatigue and involves doctors with knowledge of the specialty to consider the demands that will be placed on them.

• NHS England, NHS Wales, NHS Boards in Scotland and the Department of Health (Northern Ireland) should fully implement the BMA’s and NHS Employers’ Good Rostering Guide (see new deal monitoring guidance in Scotland) in all healthcare environments
• Healthcare organisations across the UK should develop and maintain mechanisms to enable doctors to report rotas that are not compliant with the BMA’s and NHS Employers’ Good Rostering Guide (see new deal monitoring guidance in Scotland). Guardians of safe working hours in England should encourage doctors in training to raise exception reports about rostering issues and should monitor such exception reports and take steps to address the issues raised
• Systems regulators, improvement bodies and partners listed vi should check employers have implemented the BMA’s and NHS Employers’ Good Rostering Guide (see new deal monitoring guidance in Scotland)
• The GMC should work with partners listed above to monitor implementation of the BMA’s

The EWG programme of work had been completed when ‘Caring for Doctors Caring for Patients’ was published. We did, nonetheless, re-visit the EWG report section ‘Evidence of Fatigue and relationship to hours of work and rota design’ and compare our conclusions with the relevant recommendations in the GMC report. The outcome of this confirms great synergy between the findings and recommendations on quality of experience as work and rota design in relation to Junior Doctors fatigue and wellbeing.

‘Caring for Doctors Caring for Patients’ does not make specific reference to Junior Doctors’ hours of work so there are no conclusions or recommendations about a desired or optimum maximum working week.