UK Doctors Research Articles

Embracing diversity: when is it OK to speak languages other than English in the consulting room?

It is well recognised that language is central to good communication in all clinical consultations. The national focus on clinical staff being fluent in English is important and proportionate. Recently, a midwife was suspended from the UK Nursing and Midwifery Council Register because of deficient competency in English1 until she is able to demonstrate that she has reached the necessary standard of English for safe practice.2 The General Medical Council (GMC) similarly expects all licensed doctors to: ‘… have the necessary knowledge of the English language to provide a good standard of practice and care in the UK.’ 3 For those European doctors who are not required by the GMC to pass a national English language test, the current GMC guidance states that: ‘To practise safely in the UK doctors must have sufficient knowledge of English.’ 4 So why, in Central Midlands, has NHS England felt it necessary to develop guidance for clinicians who may be tempted to consult in languages other than English? The answer lies in the language competencies of our international recruits to general practice in Lincolnshire and the patients who consult them. Lincolnshire, a predominantly rural county in the East Midlands of England, where recruitment and retention of GPs has long been a significant challenge to delivery for the NHS, is the site of an innovative collaborative approach to international recruitment into general practice. Since 2016, the Lincolnshire Local Medical Committee, working with NHS England and Health Education England (HEE), has recruited a cohort of 26 doctors from several European Union countries, all of whom were trained in family practice in their home countries and eligible for entry to the …

Evaluating the impact of a national clinical leadership fellow scheme

BackgroundThe drive towards engaging UK doctors in clinical leadership and management has involved a number of initiatives at various levels, including specific fellowships for doctors in training which enable them...

Doctors' decisions when disclosing their mental ill-health.

Understanding of what prevents doctors from seeking help for mental ill-health has improved. However, less is known about what promotes timely disclosure and the nature of doctors' decision making. This study aimed to define how doctors make decisions about their own mental ill-health, and what facilitates disclosure. It explored the disclosure experiences of doctors and medical students; their attitudes to their decisions, and how they evaluate potential outcomes. Qualitative, semi-structured interviews with UK doctors and medical students with personal experience of mental ill-health. Participants were recruited through relevant organizations, utilizing regular communications such as newsletters, e-mails and social media. Data were subject to a thematic analysis. Forty-six interviews were conducted. All participants had disclosed their mental ill-health to someone; not all to their workplace. Decision making was complex, with many participants facing multiple decisions throughout their careers. Disclosures were made despite the many obstacles identified in the literature; participants described enablers to and benefits of disclosing. The importance of appropriate responses to first disclosures was highlighted. Motivations to disclose mental ill-health are complex and multifactorial. An obstacle for one was an enabler for another. Understanding this and the importance of the first disclosure has important implications for how best to support doctors and medical students in need.

Does occupational distress raise the risk of alcohol use, binge-eating, ill health and sleep problems among medical doctors? A UK cross-sectional study

ObjectivesThis study aims to assess the prevalence of health problems (eg, insomnia, binge-eating, substance use and ill health) among UK doctors and to investigate whether occupational distress increases the risk...

Relationship between sociodemographic factors and specialty destination of UK trainee doctors: a national cohort study

ObjectivesMany countries are driving forward policies to widen the socioeconomic profile of medical students and to train more medical students for certain specialties. However, little is known about how socioeconomic...

What is the financial incentive to immigrate? An analysis of salary disparities between health workers working in the Caribbean and popular destination countries

BackgroundThe continuous migration of Human Resources for Health (HRH) compromises the quality of health services in the developing supplying countries. The ability to increase earnings potentially serves as a strong motivator for HRH to migrate abroad. This study adds to limited available literature on HRH salaries within the Caribbean region and establishes the wage gap between selected Caribbean and popular destination countries.MethodsSalaries are reported for registered nurses, medical doctors and specialists. Within these cadres, experience is incorporated at three different levels. Earnings are compared using purchasing power parity (PPP) exchange rates allowing for cost of living adjusted salary differentials, awarded to different levels of work experience for the chosen health cadres in the selected Caribbean countries (Jamaica, Dominica, St Lucia and Grenada) and the three destination countries (United States, United Kingdom and Canada).ResultsRegistered nurses in the destination countries, across all experience levels, have greater spending power compared to their Caribbean counterparts. Recently qualified registered nurses earn substantially more in the UK (86.4%), US (214.2%) and Canada (182.5% more). The highest PPP salary ($) gap amongst more experienced nurses (5-10 years) is found within the US, with a gap of 163.9%. PPP salary gaps amongst medical doctors were pronounced, with experienced cadres (10–20 years of experience) in the US earning 316.3% more than their Caribbean counterparts, whilst UK doctors (183.5%) and Canadian doctors (251.3%) also earning significantly more. Large salary differentials remained for medical specialists and consultants. US specialist salaries were 540.4% higher than their Caribbean based counterparts, whilst UK and Canadian specialists earned 95.2 and 181.6% more respectively.ConclusionThe PPP adjusted HRH salaries in the three destination countries are superior to those of comparable HRH working in the Caribbean countries selected. The extent of the salary gaps vary according to country and the health cadre under examination, but remain considerable even for newly qualified HRH. The financial incentive to migrate for HRH trained and working in the Caribbean region remains strong, with governments having to consider earning potential abroad when formulating policies and strategies aimed at retaining health professionals.

Do doctors in dispensing practices with a financial conflict of interest prescribe more expensive drugs? A cross-sectional analysis of English primary care prescribing data

ObjectivesApproximately one in eight practices in primary care in England are ‘dispensing practices’ with an in-house dispensary providing medication directly to patients. These practices can generate additional income by negotiating...

A Culture of Learning for the NHS

A recent report suggests that current conditions in the NHS may be preventing the delivery of optimal patient care. For example, patients with various common cancers or cardiovascular diseases can expect sub-optimal treatment in the NHS [1]. In March 2018, the King’s Fund confirmed common knowledge on poor NHS performance, staff shortages, lengthening waiting lists, cancelled operations and financial pressures [2]. The UK is out-performed by comparable countries, coming 30th out of 192 countries in a worldwide study [3] and 16th out of 35 countries in a European study with Switzerland in the first place [4]. In addition to poor outcomes, health-care professionals (HCPs) are shown to have behaved badly in a long series of scandals [5]. Almost 8,000 UK doctors were consulted in the recent BMA’s Caring, Supportive, Collaborative project [6]. The findings point to the persistence of a culture of fear and blame in the NHS, despite this being highlighted as a problem in two major reports [7,8]. Today’s NHS may be represented as a demotivated workforce with low morale, lacking opportunities for meaningful professional development, and resentful of an autocratic and remote bureaucracy [9]. As an example, the proportion of hospital doctors taking voluntary early retirement in the last decade has increased from 14% to 27% [10]. Medical and surgical firms with their “chiefs” no longer exist. The complexity of junior doctor rotas has prevented seniors from mentoring and supporting juniors. Medical collegiality is vanishing. Poor outcomes and disaffected HCPs suggest a dysfunctional organisational culture.

Davos report highlights UK doctors' fears around medical cannabis prescribing

Davos report highlights UK doctors' fears around medical cannabis prescribing

What could make a difference to the mental health of UK doctors? A review of the research evidence

A new study commissioned and funded by the Louise Tebboth Foundation has revealed that UK doctors are at greater risk of work-related stress, burnout and depression and anxiety than the general population. The incidence of suicide, especially among women doctors and for GPs and trainees, is also comparatively high. The report, entitled ‘What could make a difference to the mental health of UK doctors?’ and published in conjunction with the Society for Occupational Medicine, finds that the incidence of mental health problems among doctors is increasing alongside the growing demands and diminishing resources experienced in the healthcare sector. GPs, trainee and junior doctors appear to be particularly vulnerable, experiencing distress and burnout early in their career. The stigma associated with disclosing mental health problems and ‘a failure to cope’ revealed in the report mean that many doctors are reluctant to seek help as they fear sanctions and even job loss. The report, carried out by Professor Gail Kinman of the University of Bedfordshire and Dr Kevin Teoh of Birkbeck University of London, reviewed research on the mental health of doctors, the factors that increased the risk of poor mental health, and the implications for their own wellbeing and that of their patients. Professor Kinman commented: “The findings of our report are alarming. The poor mental health evident among UK doctors and the implications for themselves and their patients should be of grave concern to all healthcare stakeholders. Action is urgently required to address a working environment that can be toxic to health.” Dr Teoh added: “It is crucial to provide doctors with more support from recruitment to retirement and develop a culture that challenges the mental health stigma and encourages help seeking.” Dr Alex Freeman, the LTF Chair, said: “This report should be of interest to policy makers, employers, and others who have a responsibility for doctors’ mental health. Whilst initiatives to treat and support doctors who are struggling are to be welcomed, what is needed is to develop a healthy working environment. Prevention should be taken seriously, at all stages of a doctor’s career. The level of suicide in the profession is of major concern, and support for the bereaved workplace affected by such suicides is lacking. The concerns identified in the report must be taken seriously. For this reason we welcome the announcement made yesterday by NHS chief Simon Stevens that there will be national funding for a new mental health support scheme which will cover all doctors working in the NHS. The scheme will cover approximately 110,000 more doctors in addition to those already supported.

Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study

BackgroundThe predictive validity of postgraduate examinations, such as MRCGP and MRCP(UK) in the UK, is hard to assess, particularly for clinically relevant outcomes. The sanctions imposed on doctors by the UK’s General Medical Council (GMC), including erasure from the Medical Register, are indicators of serious problems with fitness to practise (FtP) that threaten patient safety or wellbeing. This data linkage study combined data on GMC sanctions with data on postgraduate examination performance.MethodsExamination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test (AKT; n = 27,561) or Clinical Skills Assessment (CSA; n = 17,365) at first attempt between 2010 and 2016 or taking MRCP(UK) Part 1 (MCQ; n = 37,358), Part 2 (MCQ; n = 28,285) or Practical Assessment of Clinical Examination Skills (PACES; n = 27,040) at first attempt between 2001 and 2016. Exam data were linked with GMC actions on a doctor’s registration from September 2008 to January 2017, sanctions including Erasure, Suspension, Conditions on Practice, Undertakings or Warnings (ESCUW). Examination results were only considered at first attempts. Multiple logistic regression assessed the odds ratio for ESCUW in relation to examination results. Multiple imputation was used for structurally missing values.ResultsDoctors sanctioned by the GMC performed substantially less well on MRCGP and MRCP(UK), with a mean Cohen’s d across the five exams of − 0.68. Doctors on the 2.5th percentile of exam performance were about 12 times more likely to have FtP problems than those on the 97.5th percentile. Knowledge assessments and clinical assessments were independent predictors of future sanctions, with clinical assessments predicting ESCUW significantly better. The log odds of an FtP sanction were linearly related to examination marks over the entire range of performance, additional performance increments lowering the risk of FtP sanctions at all performance levels.ConclusionsMRCGP and MRCP(UK) performance are valid predictors of professionally important outcomes that transcend simple knowledge or skills and the GMC puts under the headings of conduct and trust. Postgraduate examinations may predict FtP sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.

Should we be issuing prescriptions for lifestyle advice?

Nurse PrescribingVol. 16, No. 11 News AnalysisShould we be issuing prescriptions for lifestyle advice?Aysha MendesAysha MendesSearch for more papers by this authorAysha MendesPublished Online:9 Nov 2018https://doi.org/10.12968/npre.2018.16.11.526AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bollinger T. The Top 5 Cancer-Fighting Healthy Fruits You Should be Eating. 2017. https://thetruthaboutcancer.com/5-cancer-fighting-healthy-fruits/ (accessed 17 October 2018) Google ScholarBritish Heart Foundation. Risk Factors. 2018. https://www.bhf.org.uk/informationsupport/risk-factors (accessed 17 October 2018) Google ScholarCancer Research UK. Stomach cancer statistics. 2018. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/stomach-cancer#heading-Zero (accessed 17 October 2018) Google ScholarCharlesworth A. Even on its 70th birthyday, social care remains a Cinderella service. 2018. https://tinyurl.com/y8kb3fec (accessed 22 October 2018) Google ScholarChaterjee R. Lifestyle Medicine to be taught to UK doctors. 2018. https://www.youtube.com/watch?v=rlTTJTY4NMU (accessed 17 October 2018) Google ScholarGorostegi-Anduaga I, Maldonado-Martin S, MartinezAguirre-Betolaza A et al.. Effects on cardiovascular risk scores and vascular age after aerobic exercise and nutritional intervention in sedentary and overweight/obese adults with primary hypertension: The EXERDIET-HTA Randomized Trial Study. High Blood Press Cardiovasc Prev. 2018; [Epub ahead of print]. https://doi.org/10.1007/s40292-018-0281-0 Crossref, Google ScholarHinderliter A, Smith P, Sherwood A et al.. Lifestyle interventions reduce the need for guideline-directed antihypertensive medication. Chicago IL: AHA/ASH Joint Hypertension 2018 Scientific Sessions; 2018 Google ScholarLevy J. Top 12 Cancer-Fighting Foods. 2018. https://draxe.com/cancer-fighting-foods/ (accessed 17 October 2018) Google ScholarMalhotra A. Lifestyle medicine to save the NHS billions and halt healthcare crisis. 2018. http://doctoraseem.com/lifestyle-medicine-save-nhs-billions-halt-healthcare-crisis/ (accessed 17 October 2018) Google ScholarMendes A. Treating patients with long-term conditions in the 21st century. Br J Community Nurs. 2018; 23(10): 468–469 Link, Google ScholarPharmaceutical Services Negotiating Committee. Essential facts, stats and quotes relating to long-term conditions. 2018. https://tinyurl.com/z3dbk2k (accessed 18 September 2018) Google Scholar FiguresReferencesRelatedDetails 2 November 2018Volume 16Issue 11ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 9 November 2018 Published in print 2 November 2018 Information© MA Healthcare LimitedPDF download

Views of UK doctors in training on the timing of choosing a clinical specialty: quantitative and qualitative analysis of surveys 3 years after graduation

BackgroundWorkforce studies show a declining proportion of UK junior doctors proceeding directly to specialist training, with many taking career breaks. Doctors may be choosing to delay this important career decision.AimTo...

Vaginal mesh implants: putting the relations between UK doctors and industry in plain sight

Despite government guidance, it remains difficult to unpick industry funding of clinicians in the UK—and specialists in vaginal mesh treatment are no exception. Jonathan Gornall reports on the NHS surgeons,...

How do specialist trainee doctors acquire skills to practice patient-centred care? A qualitative exploration

ObjectivesThe importance of patient-centred care (PCC) has been increasingly recognised. However, there is limited work exploring what doctors actually understand by PCC, and how they perceive they acquire PCC skills...

Now Gosport: what next?

Last month saw the long-awaited publication of the independent inquiry into deaths at Gosport War Memorial Hospital between 1989 and 2000. The inquiry panel, led by The Right Reverend James Jones KBE, concluded that ‘the lives of over 450 people were shortened as a direct result of the pattern of prescribing and administering opioids’ .1 Following Harold Shipman’s conviction for murder in 2000, and the publication of the Shipman inquiry, concerns were raised about the regulation of GPs in the UK, particularly in relation to opioid prescribing. Not surprisingly, there is evidence that the case had impacted upon the prescribing practices of doctors, particularly when treating non-cancer patients at the end of life. In 2005, shortly after Shipman committed suicide in prison, a small survey of UK doctors found that nearly half of the respondents (46%) had new uncertainty about prescribing opioids and sedation for terminally ill patients, and 17% of GPs stated that their practice had changed substantially due to concerns about facing a charge of unlawful killing.2 More recently, a qualitative study looking at dyspnoea management in advanced chronic obstructive pulmonary disease (COPD) suggested that the Shipman …

Retirement ages of senior UK doctors: national surveys of the medical graduates of 1974 and 1977

ObjectiveTo report on retirement ages of two cohorts of senior doctors in the latter stages of their careers.DesignQuestionnaires sent in 2014 to all medical graduates of 1974 and 1977.SettingUK.Participants3695 UK...

A novel simulator for training junior doctors in breast surgery –a model for the future?

Introduction: The availability of breast surgery training for junior doctors in UK and Ireland is becoming ever more limited, due to a reduction in the number of hours available for practice since the introduction of the European Working Time Directive (EWTD), and other service provision commitments.

What advice is given to newly qualified doctors on Twitter? An analysis of #TipsForNewDocs tweets.

Twitter is a social media platform on which users post very brief messages that can be rapidly communicated across wide geographical areas and audiences. Many doctors use Twitter for personal as well as professional communications and networking. The #TipsForNewDocs hashtag is used on Twitter to give advice to newly qualified doctors as they commence their careers. This study explores the nature and focus of such advice. An analysis of Twitter activity containing the #TipsForNewDocs hashtag was performed using Symplur health care analytics software. Tweets sent during a peak 48-hour period in 2016 (immediately preceding the first day of work for newly qualified UK doctors) were studied. The geographical locations and professional backgrounds of participants were categorised and the content of tweets was subjected to thematic analysis. During 1 and 2 August 2016, 661 unique #TipsForNewDocs tweets were posted. A total of 621 (94.0%) were posted by people in the UK; 522 (79.0%) were posted by doctors, and the remainder by allied health care professionals and patients. The majority of included tweets focused on aspects of professional development, improving personal or professional knowledge, particularly tacit knowledge, and developing 'know-how'. These aspects of professional knowledge have previously been described as fundamental to professional education and training. However, a significant subset of tweets focused on accelerating socialisation into the profession, an essential step in joining a professional community. The tweets relating to socialisation were often humorous and colloquial in nature. Despite their brief and often jocular nature, #TipsForNewDocs tweets provided meaningful advice for newcomers to the profession, often focusing on tacit learning and professional socialisation. Hashtag-driven enquiries can be a valuable and time-efficient way of accessing and sharing tacitly held knowledge. Social media content analysis can provide valuable insights into key educational issues.

What factors are critical to attracting NHS foundation doctors into specialty or core training? A discrete choice experiment

ObjectivesMultiple personal and work-related factors influence medical trainees’ career decision-making. The relative value of these diverse factors is under-researched, yet this intelligence is crucially important for informing medical workforce planning...