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1、The state of medical education and practice in the UKWorkplace experiences2023Read the report at gmc-uk.org/stateofmedJoin the conversation using#StateOfMedThe Executive summary is available in Welsh on our website,at gmc-uk.orgPublished June 2023 2023 General Medical CouncilThe text of this documen
2、t may be reproduced free of charge in any format or medium providing it is reproduced accurately and not in a misleading context.The material must be acknowledged as GMC copyright and the document title specified.To ask for this publication in another format or language,please call us on 0161 923 66
3、02 or email us at publicationsgmc-uk.orgPublished by:General Medical Council Regents Place 350 Euston Road London NW1 3JNTelephone:0161 923 6602 Website:gmc-uk.orgGeneral Medical Council 01ContentsForeword 03Executive summary 05 Chapter 1:Doctors workplace experiences in 2022 07 Chapter 2:Breaking t
4、he cycle in the short term 09 Chapter 3:Looking ahead reflections for the health sector to consider when looking to the future 12 Conclusion 13Chapter 1:Doctors workplace experiences in 2022 14 Summary 15 Introduction 16 Doctors workloads are increasing 19 Implications of workload pressure for docto
5、rs and their patients 27 Variation of experiences across the workforce 40 SAS doctors and LE doctors 43 Chapter conclusion 50Chapter 2:Breaking the cycle in the short term 51 Summary 52 Introduction 53 Part 1:Breaking the vicious cycle by building virtuous cycles that improve workplace conditions 54
6、 Part 2:Practical steps organisations can take to improve satisfaction and wellbeing 61 Chapter conclusion 67General Medical Council 02ContentsChapter 3:Looking ahead reflections for the health sector to consider when looking to the future 68 Summary 69 Introduction 70 Long term strategic priorities
7、 71 Chapter conclusion 81Conclusion 83List of acronyms 85A note on research and data 86References 93Acknowledgements 97General Medical Council 03ForewordThis is a time of unparalleled pressure in the healthcare sector.The testimony weve heard from doctors is stark.Workloads are up,stress-related abs
8、ence and risk of burnout have increased,and large numbers of doctors feel unable to cope.This not only has a damaging impact on clinicians,but also on the patients in their care.In 2022,44%of doctors found it difficult to provide patient care at least once a week,compared to 25%in 2021.1Its not surp
9、rising,then,that more doctors told us they had taken steps to leave UK practice.As clinicians vote with their feet,the gap they leave behind compounds workload pressures,feeding into a vicious cycle.The coronavirus pandemic was hugely challenging and left those who worked through it with deep-seated
10、 and painful memories,which mark them to this day.But,in many places,it also disrupted the vicious cycle and showed that things could be done differently.In 2021,60%of doctors reported that the pandemic had had a positive impact on teamwork.40%felt there had been a positive impact on the visibility
11、of senior leadership.Since then,the long-term problems and pressures we observed in 20192 have returned in full force,alongside the additional demands of the treatment backlog.Long-term actions are needed to address structural challenges in the service.Steps to better understand future workforce nee
12、ds,and increase training numbers for doctors and other professionals,are long overdue and welcome.But,in the short term,our focus must be on retaining and better supporting the medical staff we already have.Without urgent changes now,the vicious cycle will intensify,patients will suffer and doctors
13、increasingly risk burnout,fatigue,and moral injury.We know that being part of a supportive team and having a strong sense of belonging lead to higher satisfaction and better patient safety.These protective factors must be treated as a priority now,with good practice being shared and scaled up.While
14、the root causes of inadequate staffing,waiting lists,and unprecedented demand are tackled on a larger scale,local changes can be made today to improve doctors working lives and make them feel that they belong and are valued.Improvements in areas such as fair and timely rota design,facilities for res
15、t breaks,and provision of food and drink could make a huge difference to staff on the ground.They could also be instrumental in creating more virtuous cycles and helping us retain the healthcare professionals that we need to provide safe patient care.General Medical Council 04ForewordWhile there are
16、 difficulties across the board,our research shows that certain groups report worse workplace experiences and require targeted support.Crucially,trainers face added pressures compared to non-trainers,being more likely to work beyond their rostered hours and more likely to describe their days as high
17、intensity.It will not be possible to deliver the much-needed expansion of training capacity without both an increase in trainer numbers and concrete steps to support their specific needs.Investment in this area must be a priority as governments across the UK define plans to address longer-term workf
18、orce challenges.Addressing these concerns requires concerted action across the UK healthcare systems.Improving doctors wellbeing must lie at the heart of shared efforts to bridge the gap until long-term solutions are implemented.This is crucial not only to their satisfaction and desire to remain in
19、the service,but also to the safety of those in their care.We are committed to playing our part in that endeavour.Whether its our induction programme for overseas doctors to help them thrive in UK practice,our targets to eliminate disproportionate referrals and differential attainment,or our work wit
20、h employers to improve local resolution of concerns,were committed to improving doctors working lives,so they can give the best possible patient care.Patient safety is protected when doctors feel supported.In an increasingly pressurised environment,a sustained focus on compassionate leadership and c
21、ulture must be centre stage,as we navigate the challenges ahead.Professor Dame Carrie MacEwen ChairCharlie Massey Chief Executive and RegistrarGeneral Medical Council 05Executive summary The state of medical education and practice in the UK:Workplace experiences 2023 is published at a time when the
22、UK health systems face extensive challenges.This report shares concerning data about the experiences of doctors and the challenges to providing adequate care to patients.In this context,careful and constructive exploration of the practical,evidence-based steps that can be taken to improve the situat
23、ion is critical,to protect both patients and the doctors who care for them.This report sets out our insights on doctors workplace experiences and the effects of these experiences.These insights are drawn from our Barometer survey 2022 and qualitative research that involved interviews with doctors,tr
24、ainers,and senior stakeholders from UK healthcare organisations.Views on patient care are the perceptions of doctors and stakeholders,this report does not include research with patients.Doctors working environment is increasingly challengingIn 2018,3 we first identified that doctors were affected by
25、 vicious cycles relating to workforce pressures and lack of time for patients,development,and personal wellbeing.The COVID-19 pandemic was an enormous shock to UK health systems and caused tremendous pressures and struggles.But,in many areas,it also disrupted the vicious cycles,often in temporary an
26、d localised ways.Figure 1:Vicious cycle affecting doctors Changing working patterns,careers or locationleading to fewer working hours and doctors leaving UK practiceUnmanageable workloads High levels of burnoutLow workplace satisfactionGeneral Medical Council 06Executive summaryAlongside the necessa
27、ry prioritisation of treatment were beneficial innovations relating to service design and ways of working,and in 2020 doctors reported a range of positive changes.But,as the UK health systems dealt with the considerable treatment backlog,20211 saw higher levels of burnout risk,growing workloads,and
28、declining levels of job satisfaction.Now,as well as dealing with the treatment backlog and the persistence of COVID-19,the long-term problems and pressures we explored in 20192 have returned in force.Our latest Barometer survey of doctors,conducted in 2022 to inform this report,revealed that more do
29、ctors are dissatisfied,at higher risk of burnout,considering leaving the profession,and have experienced compromised patient safety or care and risk of moral injury.Support is key to reducing burnout and increasing satisfactionOur Barometer survey findings highlight the importance of team working an
30、d inclusion to good,safe patient care.The development of supportive teams may have been affected by a rapid change towards online working,and shift work and rapid rotation of trainees may contribute to difficulties in establishing relationships.Effective induction of doctors is important,and particu
31、lar challenges are associated with integrating doctors arriving from overseas and incorporating locum and bank staff into teams.Our findings show doctors feel less supported by colleagues and managers,with some of the improvements in this area seen during the pandemic being eroded.The UK health syst
32、ems prioritise protection of patients,often over the wellbeing of staff,but,in the long term,patient care and safety depend on staff wellbeing.Many staff and senior stakeholders believe some beneficial workplace changes are possible even within the current challenges and constraints.Urgent action is
33、 needed by employersWhile long-term solutions to underlying issues are being implemented,the detrimental impact on doctor wellbeing needs to be mitigated as much as possible in the short term.This will involve taking immediate action to improve working conditions for all healthcare staff,and working
34、 to improve inclusion and belonging in order to enable effective team working.Making progress on these issues will contribute to improving retention,helping reduce workplace pressure,and so help to protect patients as well as staff.These issues also cross professional and organisational boundaries,a
35、nd our influence as the GMC is limited.The delivery of urgently needed solutions demands collaborative action across the UK health systems.General Medical Council 07Executive summaryChapter 1:Doctors workplace experiences in 2022We have tracked doctors workplace experiences via our Barometer survey
36、since 2019.The Barometer survey 2022 shows a deterioration in doctors experiences since 2020 and a continuation of the vicious cycle reported in previous years.Doctors experiences are now worse than at any time since we began the Barometer survey.Half of doctors(50%)were satisfied in 2022,down from
37、70%in 2021.1 In 2022,more doctors reported working beyond their rostered hours on a weekly basis(70%,up from 59%in 2021),having difficulty taking breaks each week(68%,up from 49%in 2021),and feeling unable to cope with their workload each week(42%,up from 30%in 2021).A quarter of doctors surveyed(25
38、%)were categorised as being at high risk of burnout in 2022,compared with 17%in 2021.In 2022,more than two-fifths of doctors(44%)said they found it difficult to provide sufficient patient care at least once a week.This is a significant increase from 2021,when a quarter ofdoctors(25%)reported this,an
39、d more than 2019,2 when a third of doctors said this(34%).Moral injury is distress caused by people acting,or seeing others act,in a way that goes against their values and moral beliefs.We do not measure moral injury at present,but there is a risk that many doctors and other staff have suffered mora
40、l injury due to their work experiences.Possible causes could include not being able to provide patients with the level of care they would have wished,having to prioritise some patients over others due to a lack of time or resources,or being unable to support colleagues as much as they would like.Mor
41、e doctors than ever said they were likely to leave the UK profession and had taken hard steps towards doing so(excluding doctors of retirement age who were planning to retire).15%of doctors said they had taken steps to leave,up from 7%in 2021.We added new response options that count as hard steps to
42、 the Barometer survey 2022,and this has had some effect,but even if these are excluded the increase is significant.Figure 2:Percentage of doctors at high risk of burnout,regularly finding it hard to provide sufficient care to patients,and taking hard steps to leave,20192022 n=3,876(all doctors),the
43、Barometer survey 2019 QD1/D2/D3-9/B3.n=3,693(all doctors),the Barometer survey 2020 QD1/D2/D3-9/B3.n=3,386(all doctors),the Barometer survey 2021 QD1/D2/D3-9/B3.n=4,269(all doctors),the Barometer survey 2022 QD1/D2/D3-9/B334%25%25%44%20022Regularly found it hard to provide sufficient care
44、 to patients16%10%17%25%2019 22020 42021 12022High risk of burnout4%7%15%2019*202020212022Hard steps to leaveComparable data for this metric not available in 2019*General Medical Council 08Executive summaryGPsGPs had poor workplace experiences,causing issues filling vacancies and reducing service ca
45、pacity.In 2022,38%of GPs said they were satisfied,fewer than other doctors and down from 51%1 in 2021.Over half of GPs(55%)were categorised as struggling with their workload,compared with 38%of all doctors.45%of GPs reported experiencing compromised patient safety or care,and 62%found it difficult t
46、o provide sufficient patient care each week.TrainersDoctors who were trainers had more negative experiences than those who were not.For example,18%of trainers disagreed that they were supported by senior medical staff,compared with 10%of non-trainers.Half of trainers reported experiencing compromise
47、d patient safety or care(51%)and having difficulty providing sufficient patient care each week(49%),compared with two-fifths of non-trainers (39%and 43%respectively).Doctors with a disabilityDoctors with a disability had a less positive experience across multiple measures.This is likely to prevent t
48、hese doctors making the full contribution to healthcare service delivery of which they are capable,despite their workplace challenges being potentially remediable.As in previous years,fewer disabled doctors were satisfied in their work,44%compared with 51%of non-disabled doctors.Almost half(47%)of d
49、isabled doctors were categorised as struggling with their workload,compared with 37%of non-disabled doctors.SAS doctors and LE doctorsSpecialty and associate specialist(SAS)doctors and locally employed(LE)doctors are an essential and diverse group,and the fastest-growing part of the UK medical workf
50、orce.Changes to the Barometer survey mean that,for the first time,we can report on SAS and LE doctors separately,based on the Barometer survey 2022,and look at their particular challenges.However,comparison with earlier years is not possible because previous Barometer surveys grouped SAS and LE doct
51、ors together.Our data show particular concerns are associated with LE doctors who gained their primary medical qualification(PMQ)in the UK.This group is relatively young,and 58%had seen or experienced compromised patient safety or care,a higher proportion than other groups of SAS and LE doctors and
52、doctors of other registration types.Another group of interest is SAS doctors with a PMQ from outside the UK.44%of this group were doing well in terms of workload,but they may be underutilised;29%often carried out tasks usually completed by a more junior doctor.Given the significance of our analysis
53、of distinct groups of SAS and LE doctors,we are sharing our initial findings in this report.We will publish a fuller analysis of the working experiences of SAS and LE doctors later in 2023.General Medical Council 09Executive summaryChapter 2:Breaking the cycle in the short termThe vicious cycle desc
54、ribed in chapter 1 must be broken to improve doctors working experiences,and ultimately improve patient care.The most commonly cited barriers to providing good patient care were inadequate staffing (33%of doctors)and pressure on workloads(24%).Resolving issues relating to these areas is a significan
55、t and long-term undertaking which will include additional healthcare staff,additional supporting roles and systems,and robust and transparent long-term workforce planning.Our research indicated that positive feedback loops that improve workplace experiences would have significant benefits.Such virtu
56、ous cycles could act as an antidote to vicious cycles,with the positive effects likely to exceed the sum of their parts.Feeling valued by their employers will help cultivate a sense of belonging amongst doctors.This sense of value can be developed by providing different levels and types of support f
57、or healthcare professionals,improving communication,and tackling bullying and discrimination,while providing facilities such as rest areas,making tea and coffee available,and developing a fairer approach to rota design.The effect of these changes could improve doctors workplace experiences,thereby i
58、mproving retention,decreasing workloads,and improving patient safety.Learning environments should be developed,providing trainers and trainees with more protected learning time.This would allow better support to be given to trainees,whose competence and confidence will therefore improve,allowing the
59、m to work more independently.Figure 3:Maintaining high satisfaction can help halt the vicious cycle Figure 1:Maintaining high satisfaction can halt the vicious cycleChangingworking patterns,careers or locationUnmanageable workloads High levels of burnoutHigher workplace satisfactionLowworkplace sati
60、sfactionApositiveinterventionmeansMore manageable workloadsBetter retentionLower levelsof burnoutGeneral Medical Council 10Executive summaryTo protect patient safety,there is an urgent need to focus on doctors wellbeing,which itself is anchored in having support from colleagues and leaders,satisfact
61、ion in their work,and a strong sense of belonging.81%of doctors who reported that they had not experienced compromised patient safety or care said that they were part of a supportive team,while only 68%of those who had experienced compromised patient safety or care agreed that their team was support
62、ive.Team working and support are protective factors associated with increased doctors satisfaction in their work.They also promote patient safety.Declining levels of support and effective team working may lead to further loss of satisfaction,with implications for the retention of doctors in the work
63、force,which could together jeopardise the delivery of effective and safe patient care.Immediate action to improve working conditions is neededIt is crucial to act immediately to improve working conditions in workplaces across the UK health systems,so the workforce feels valued and supported.We belie
64、ve changes that will deliver benefit quickly can be made in the following areas.Ensure doctors feel valued by their employers and have a strong sense of belongingA workforce that feels valued will have higher rates of retention,which will ultimately have a positive impact on patient safety.Employers
65、 can make clear to staff in many ways that they and their work are valued.As outlined in chapter 2,our commissioned report Caring for doctors,Caring for patients5 outlines the ABC that doctors need in order to feel valued and secure in their work:autonomy,belonging,and competence.Changes that relate
66、 to each of these important areas are discussed across chapters 2 and 3.Enable effective and supportive team working to improve belongingEffective teamwork and a sense of belonging can protect against the negative impacts of high and intense workloads,enhance doctor wellbeing,and contribute to impro
67、ved patient safety and care.Working in a supportive team is a key component of belonging,so more effective teamwork and improved support for doctors who are struggling could be a way to start to alleviate the strain on them.Doctors sense of belonging and inclusion in teams needs to be improved,focus
68、ing first on groups who have worse experiences.As set out in chapter 1,different groups of doctors have widely varying working experiences.For example,doctors who gained their PMQ outside the UK are a group that needs particular attention and support,and their experiences and needs must be better un
69、derstood.And disabled doctors are more likely than non-disabled doctors to report more negative experiences across a range of measures.Evolving and developing what it means to be a leaderEnsuring leaders understand the needs of their colleagues,and have the resources and time to provide good,persona
70、lised support,can be extremely beneficial for the wellbeing of all healthcare professionals.Feedback should General Medical Council 11Executive summarybe compassionate and constructive.Learning opportunities should be built into practice,particularly after mistakes have occurred,and workplaces shoul
71、d move away from blame cultures.Clinical leaders should respond quickly to requests for advice and support and be easy to contact.Hard work should be acknowledged and celebrated.Building strong teamsStrong teams are vital for a doctors sense of belonging.They can be built in a variety of ways,such a
72、s induction for new staff members(including introduction to colleagues and explanation of team structures),ice-breaking activities for new teams,staff events that create a sense of cohesion and belonging,formal support that makes clear the roles within teams,and rota design that ensures connections
73、and relationships develop between colleagues.Developing induction and onboardingWhen a doctor joins a new workplace,it is important for there to be a thorough and ongoing induction into the new role.This should include introductions to both colleagues and systems,allowing new staff members to hit th
74、e ground running and feel confident in their role.Developing flexible rota design Rota design should be fair and flexible,and take into consideration life events and personal circumstances where feasible.Rotas should always handle individual preferences and circumstances fairly and be arranged in a
75、timely manner.Rota design should consider the latest research about fatigue,to support the health and wellbeing of doctors.Effective rota design could also enhance the development of teams.Providing workplace rest and refreshment facilities Relatively straightforward changes could be made,including
76、providing space for meaningful rest breaks,facilities for hot drinks and food(including during night shifts),facilities and information for parents and carers,and safe car parking facilities that are subsidised or free(especially for late shifts).Longer-term changes could include providing childcare
77、 facilities near workplaces,having rooms or dorms for naps during nightshifts,and making arrangements for safe transport home after late shifts.Our research,including interviews with various senior stakeholders,highlights the value of these changes,which were not seen as especially expensive,particu
78、larly given their potential benefits.However,these changes should be developed alongside and simultaneously with longer-term changes that likely require more time and perhaps investment.These are described in chapter 3.General Medical Council 12Executive summaryChapter 3:Looking ahead reflections fo
79、r the health sector to consider when looking to the futureTo maintain patient safety and the wellbeing of the workforce,there are several long-term strategic needs that the wider system should consider in view of our new evidence.This chapter sets out the areas which our evidence suggest would be be
80、neficial to tackle,for consideration by leaders and policymakers.Long-term strategic prioritiesIt is necessary to address difficult and interconnected challenges around work intensity,primary care,and training capacity.It is crucial to provide support and protected time to enable trainers to deliver
81、 training,trainees to build competencies and confidence,and all doctors to train and develop.Making work intensity more sustainableMuch of the intensity of doctors work is due to demand for care services outstripping the capacity to deliver it,particularly in primary care,but impacting all areas.The
82、re is a clear need to increase overall capacity to deliver patient care.But ways are needed to reduce the impact of high work intensities on staff wellbeing and patient safety.This should take into account that work intensity may have different drivers.Working to increase training capacityDoctors wh
83、o take on the role of trainer report more negative workplace experiences,and describe challenges in finding time to dedicate to training and teaching.Training capacity needs to increase,given the intention to increase the number of UK training posts.Doctors need to be encouraged and motivated to tak
84、e on training responsibilities.Trainers need to be supported,have protected time to train,and have flexibility in their service delivery and supervisory responsibilities.Building trainees confidence and autonomyThe future of the workforce depends on trainees,and it is critical that they are well pre
85、pared for their role to avoid medium-term capacity issues.How trainees are supported,and whether training experiences fully prepare them for practice,is a concern.Dedicated time for training may not be sufficiently valued,due to a drive to prioritise clinical time.Trainees need time set aside for th
86、em to develop their competencies and confidence,and need to be able to reflect on learning,receive and consider supervisor feedback,and prioritise time to implement their learnt skills.Trainees cannot be constantly relied on to plug gaps in a struggling workforce to the detriment of their developmen
87、t,and therefore to the detriment of future service capacity.General Medical Council 13Executive summaryEnhance development opportunities for all doctorsMany doctors feel under pressure and unable to commit time to training and development,and use their own time to meet this requirement.All doctors a
88、nd healthcare professionals need to be able to ring-fence training and development time.The existing pressures on doctors may mean that such ring-fencing takes time,but it needs to be worked towards.Strengthen support for primary careThe particular pressures in general practice need to be addressed
89、to protect patient safety and staff wellbeing.Consideration should be given to how links between primary and secondary care can be improved,how trainee doctors can be encouraged to choose primary care as a specialism,and how community and social care capacity can be increased to enhance care for pat
90、ients before,during,and after their treatment.Greater use of other healthcare professionals,such as physician associates,anaesthesia associates,and advanced healthcare practitioners,should be considered to help improve productivity,increase capacity to provide care,and improve patient access to care
91、.ConclusionOur research and analysis about the challenges facing the UKs medical profession paint a stark picture.What we have learnt from doctors and senior stakeholders across the UK health sectors should bolster resolve to tackle both the immediate and longer-term challenges the profession and he
92、alth system face.We have outlined the challenges and suggested approaches to begin to address them in this report.We will continue to work to better understand and accurately report on the state of medical education and practice in the UK by seeking ongoing input and dialogue from and with doctors,p
93、atients,and our partners.Doctors workplace experiences in 2022General Medical Council 15Chapter 1:Doctors workplace experiences in 2022 Summary Our evidence shows the resurgence of a vicious cycle of workplacepressures,with increased workloads,lower levels of satisfaction,higher risk of burnout,and
94、more doctors taking steps to leave the UKprofession,ultimately putting patient safety in jeopardy:2021 12022Doctors working beyond their rostered hours at least weekly59%70%Doctors at high risk of burnout17%25%Doctors dissatisfied22%43%Doctors taking hard steps to leave7%15%This has a negative impac
95、t on patients.44%of doctors reported findingit difficult to provide a sufficient level of patient care at least once a weekin 2022,up from 25%in 2021.Perceived inability to provide adequatecare and ensure patient safety puts doctors at risk of moral injury.Pressures experienced in certain parts of t
96、he workforce have thepotential to jeopardise long-term workforce planning unless appropriateaction is taken to support existing staff.GPs reported worse workplace experiences in a range of areas andonly 38%of GPs were satisfied in their work,compared with 50%ofall doctors.Half(49%)of trainers descri
97、bed at least three-quarters of their daysas high intensity,compared with 40%of non-trainers.47%of disabled doctors were categorised as struggling with theirworkload,compared with 37%of non-disabled doctors.Fewer non-UK graduate doctors(65%)said they were part of asupportive team than UK graduates(78
98、%).General Medical Council 16Chapter 1:Doctors workplace experiences in 2022 Introduction We have used The state of medical education and practice in the UK Barometer survey to track doctors workplace experiences since 2019.2 Over this period,we have reported significant changes in the ways doctors
99、work and the environments they work in.In 2019,our analysis of the Barometer survey findings highlighted a vicious cycle of unmanageable workloads,low satisfaction,burnout,and doctors leaving UK practice putting more pressure on remaining doctors.Figure 1:Vicious cycle affecting doctors Changing wor
100、king patterns,careers or locationleading to fewer working hours and doctors leaving UK practiceUnmanageable workloads High levels of burnoutLow workplace satisfactionIn 2020,the health systems focus shifted to dealing with the coronavirus pandemic.This had a significant effect on UK health systems,a
101、s they responded at pace to caring for patients in a new working environment.However,doctors reported a range of surprisingly positive changes to how they worked during the pandemic.For example,in 20204 54%of doctors reported that the response to the pandemic had improved knowledge sharing,while 38%
102、said that the visibility of leaders had increased.Some doctors may also have had a temporary reduction in their workload because appointments and procedures were postponed.But these positive perceptions were short-lived,as the UKs health systems began to deal with the considerable backlog of patient
103、s in the wake of the pandemic.Compared with 2020,the 2021 Barometer survey found higher risks of burnout among doctors,alongside declining levels of General Medical Council 17Chapter 1:Doctors workplace experiences in 2022 job satisfaction and growing workloads.At the same time,the longer-term effec
104、ts of pressures that were building before the pandemic began to emerge.These included lengthy waiting times for treatment referrals in England 6 and significant challenges recruiting to vacancies in the growing workforcedriven to a large extent by increased demand for healthcare from an ageing popul
105、ation with more complex health needs.Concerningly,in 2022,doctors workplace experiences continued to deteriorate sharply.Figure 2 shows the general trend,which saw some improvement from 2019 to 2020,followed by a notable decline from 2020 to 2022.The result of built-up pressurescaused by the coronav
106、irus pandemic as well as longer-term challengeswas an increasingly fatigued and burnt-out profession in 2022.Our analysis shows how multiple and complex pressures are manifesting in different ways.Senior clinical leaders often receive little support,early career medics are juggling work and catching
107、 up with assessments,while trainers are under increasing pressure from several directions.The Barometer survey data suggest that unmanageable workloads lead to low job satisfaction and burnout,which ultimately change working patterns.Some doctors reduce their hours(in some cases due to stress or poo
108、r mental health)or leave UK practice entirely,either to practise abroad or change careers.The hard steps shown in the figure above include actions such as contacting a recruiter,applying for a clinical job abroad,and applying for posts outside the medical profession.In 2021,7 around 10,000 doctors l
109、eft UK practice,while around 21,000 doctors entered it.These issues are not confined to the UKs workforce of doctors.Leaving rates in other health professions have increased.Nurses are leaving in record numbers.More than 40,000 nurses left the NHS in England in the year to June 2022,8 and almost 7,5
110、00 left in Scotland over a similar period.That is equivalent to one in nine nurses leaving.Figure 2:Percentage of doctors at high risk of burnout,regularly finding it hard to provide sufficient care to patients,and taking hard steps to leave,2019 2022 n=3,876(all doctors),the Barometer survey 2019 Q
111、D1/D2/D3-9/B3.n=3,693(all doctors),the Barometer survey 2020 QD1/D2/D3-9/B3.n=3,386(all doctors),the Barometer survey 2021 QD1/D2/D3-9/B3.n=4,269(all doctors),the Barometer survey 2022 QD1/D2/D3-9/B334%25%25%44%20022Regularly found it hard to provide sufficient care to patients16%10%17%25
112、%2019 22020 42021 12022High risk of burnout4%7%15%2019*202020212022Hard steps to leaveComparable data for this metric not available in 2019*General Medical Council 18Chapter 1:Doctors workplace experiences in 2022 Care often requires multidisciplinary teams,so this high rate of turnover,and related
113、shortages,add to the pressure on doctors and other healthcare staff.Professor Jeremy Farrar,Chief Scientist of the World Health Organization,said in 2023 that healthcare workers around the world were absolutely shattered.9Summarising the challenges facing the healthcare system in England,in February
114、 2023 the House of Commons Public Accounts Committee said that plans to reform healthcare in England will not succeed if major systemic problems in the NHS at a national level werent tacklednamely,the record treatment backlogs,high vacancy rates,growing demand for care,a crumbling NHS estate,and a d
115、ifficult financial outlook.10Against this worrying backdrop,the Barometer survey data trends suggest that doctors may be at heightened risk of moral injury.This is psychological distress caused by engaging in or witnessing behaviours that go against an individuals values and moral beliefs.In our 202
116、1 report,we highlighted the traumatic effects of the pandemic on doctors.Despite the pandemic easing,we remain concerned that doctors who feel unable to meet the needs of their patients may experience detrimental psychological effects.This could play into the vicious cycle depicted in Figure 1 and i
117、s especially important given the close association between doctors risk of burnout and perceived failures in patient care.Examining each part of the vicious cycle in turn,in this chapter we look at how clinicians responded to very high patient demand in challenging circumstances.We analyse doctors d
118、ay-to-day satisfaction,workloads,stress levels,risk of burnout,and perceptions of patient care.Doctors experiences of many of these issues have become increasingly negativewe explore what drove this in 2022.Where appropriate,we make comparisons across doctors of varying registration types,as well as
119、 how experiences varied by personal characteristics such as ethnicity and disability.Following this,in chapters 2 and 3,we set out some of the things our evidence suggests would help the situation,for the consideration of stakeholders.Box 1:Evidence sources used in this chapter The Barometer survey
120、2022 explored doctors workplace experiences,with many questions kept consistent since 2019 to enable tracking.The survey asked about doctors experiences,views on patient care and safety,career intentions,day-to-day satisfaction,workloads,and burnout indicators,perspectives on patient safety,and futu
121、re career plans.A representative sample of 4,269 doctors was surveyed in September and October 2022.This chapter also includes insights from commissioned,follow-up qualitative research exploring specific aspects of doctors workplace experiences.This involved 20 in-depth interviews with a range of do
122、ctors,and ten further interviews with trainers.Participants were recruited from the sample of doctors who had completed the Barometer survey 2022,and had indicated that they would be willing to participate in further research.Further information on these evidence sources and the research methods app
123、lied is set out in the Note on research and data section.General Medical Council 19Chapter 1:Doctors workplace experiences in 2022 Doctors workloads are increasingFindings from the Barometer survey 2022 show an increase in all elements of workload pressure since 2021.Figure 3 shows that more doctors
124、 worked beyond their rostered hours,found it difficult to take breaks due to workload intensity,and reported that they felt unable to cope with their workload.Looking at the percentage of doctors experiencing these pressures at least once a week,Figure 4 shows that all three of these metrics have wo
125、rsened in the period from 2021 to 2022.Figure 3:How frequently doctors experienced workload pressure in 2022 How frequently,if at all,over the last year have you experienced the following?n=4,269(all doctors),the Barometer survey 2022 QC1_1/C1_5/C1_2.Excluding dont know and prefer not to say.16%4%39
126、%18%5%30%27%9%8%27%13%16%32%38%15%Worked beyond my rostered hoursFelt unable to cope with my workloadFound it difficult to take breaks due to the intensity of my workloadNeverOccasionallyOnce a monthOnce a weekOnce a day202121%19%12%Percentagepoint change202249%59%30%68%70%42%Figure 3:How frequently
127、 doctors experienced workload pressuren=3,386(all doctors),the Barometer survey 2021 QC1_1/C1_5/C1_2.Excluding dont know and prefer not to say.n=4,269(all doctors),the Barometer survey 2022 QC1_1/C1_5/C1_2.Excluding dont know and prefer not to say.Figure 4:Doctors experiences of workload pressure at
128、 least once a week,20212022Worked beyond my rostered hoursFelt unable to cope with my workloadFound it difficult to take breaks due to the intensity of my workload202121%19%12%Percentagepoint change202249%59%30%68%70%42%n=3,386(all doctors),the Barometer survey 2021 QC1_1/C1_5/C1_2.Excluding dont kn
129、ow and prefer not to say.n=4,269(all doctors),the Barometer survey 2022 QC1_1/C1_5/C1_2.Excluding dont know and prefer not to say.How frequently,if at all,over the last year have you experienced the following?202121%19%12%Percentagepoint change202249%59%30%68%70%42%Figure 3:How frequently doctors ex
130、perienced workload pressuren=3,386(all doctors),the Barometer survey 2021 QC1_1/C1_5/C1_2.Excluding dont know and prefer not to say.n=4,269(all doctors),the Barometer survey 2022 QC1_1/C1_5/C1_2.Excluding dont know and prefer not to say.General Medical Council 20Chapter 1:Doctors workplace experienc
131、es in 2022 In 2022,on average doctors described their workload as highly intense on almost two-thirds of working days(63%).This was a slight increase from 60%in 2021.Doctors described just under a third of days(29%)as moderately intense in 2022similar to 2021 when the figure was 30%.Doctors consider
132、ed fewer than one out of ten(8%)days as low intensity,down from 10%in 2021.More than four out of ten doctors(45%)described the intensity of their workload as high on at least three-quarters of their working days,up from 35%in 2021.General practitioners(GPs)reported more high-intensity days(78%)than
133、other doctors and fewer low-intensity days(3%).Doctors who participated in the follow-up qualitative research said that they were expected to deliver more work than previously but were not given additional time.They said that they often felt pressured to work through their breaks to reduce the backl
134、og of care.Several reasons were cited for this increased intensity,including the ongoing effects of the coronavirus pandemic,a lack of staff,and patients ability to contact doctors through multiple channels.The return to in-person appointments and the tendency for patients to present with multiple p
135、roblems at once also intensified the demand on clinicians.In 2022,over half(53%)of doctors were asked to undertake tasks usually completed by doctors in a more junior role at least once a month,compared with 46%in 2021.These extra responsibilities added to doctors overall workload intensity.This tre
136、nd raises questions about efficiency and productivity in the workforce.Figure 5:Intensity of workload by registrant typeOver the last year,on roughly what percentage of your working days would you describe the intensity of your workload as high,moderate and low?8%29%63%3%19%78%9%31%60%10%31%58%10%33
137、%58%All doctorsGPsSpecialistsDoctors in trainingSAS/LELow intensityModerate intensityHigh intensityn=4,269(all doctors),the Barometer survey 2022 QC8.Excluding dont know.General Medical Council 21Chapter 1:Doctors workplace experiences in 2022 More doctors are struggling with their workload Since 20
138、19,we have used data from the Barometer survey to analyse the relationship between doctors working hours and whether they feel able to cope with their workload.In the analysis,we split doctors into four groups.Doing well:not regularly working beyond rostered hours and feel able to cope with workload
139、.Normalised:regularly working beyond rostered hours,but not regularly feeling unable to cope with workload.In other words,long hours are a normal part of their working life,which they have learnt to cope with.Issues unrelated to working extra hours:not regularly working beyond rostered hours,but not
140、 feeling able to cope with workload because of other factors.Struggling:regularly working beyond rostered hours and not feeling able to cope with workload.The decrease in the proportion of doctors doing well,from just over a third(35%)in 2021 to a quarter(25%)in 2022,is concerning.There was an assoc
141、iated rise in the proportion of doctors who were struggling.Nearly four out of ten doctors(38%)were in this group,an increase from around a quarter(26%)in 2021.Figure 6:Doctors working beyond rostered hours weekly and feeling unable to cope with workloads at least once a weekDoing wellIssues unrelat
142、ed to workloadNormalisedStrugglingDidnt workbeyond rosteredhours weeklyWorked beyondrostered hoursweekly25%31%38%4%n=4,269(all doctors),the Barometer survey 2022 QC1.How frequently,if at all,over the last year have you experienced the following?Worked beyond rostered hours/felt unable to cope with w
143、orkloadUnable to cope weeklyAble to cope weeklyGeneral Medical Council 22Chapter 1:Doctors workplace experiences in 2022 In 2022,more GPs were categorised as struggling than doctors of other register types.Over half(55%)were in this category,compared with 38%of all doctors.Only one out of ten GPs(10
144、%)were doing well,compared with a quarter(25%)of all doctors.Fewer of both doctors on the specialist register(32%)and specialty and associate specialist(SAS)and locally employed(LE)doctors(27%)were struggling than all doctors(38%).And more SAS and LE doctors were doing well37%were in this category,c
145、ompared with 25%of all doctors.In this section,and throughout most of this chapter,SAS and LE doctors are considered together as this allows time series comparisons,but changes in the Barometer survey in 2022 mean that we can use those results to look at SAS and LE doctors separately.We will publish
146、 a fuller analysis using this approach later in 2023.The section on SAS and LE doctors at the end of this chapter contains more details on this,including our initial analysis of SAS doctors and LE doctors as separate groups.Looking in greater detail at those doctors who were struggling reveals some
147、notable differences by ethnicity.38%of all doctors surveyed were categorised as struggling.42%of White doctors were struggling,compared with 34%of Asian/Asian British doctors and 27%of Black/Black British doctors.Overall,34%of ethnic minority doctors were struggling.This patterna higher proportion o
148、f White doctors struggling than their ethnic minority peerswas evident among GPs and SAS and LE doctors,but the differences were not notable among specialists and trainees.47%of disabled doctors were struggling,compared with 37%of non-disabled doctors.This pattern was seen in all registration types
149、except GPs,in which no notable difference was found.There were also differences by speciality area.The proportions of doctors who were struggling in the following specialty areas were below the average for all doctors(38%):Psychiatry:29%Paediatrics:28%Radiology:23%Anaesthetics:13%Doctors working in
150、these four speciality areas also tended to report higher levels of satisfaction and were less likely than the average(42%of all doctors)to have felt unable to cope with their workload.However,GPs(58%),those working in acute medicine(50%),and doctors working in emergency medicine(48%)were more likely
151、 than the average to have felt unable to cope with their workload.Doctors under 30 years of age were more likely than older doctors to be struggling.44%of doctors in this age group were struggling,compared with 38%of those aged 30 to 49 years and 34%of those aged 50 years and over.General Medical Co
152、uncil 23Chapter 1:Doctors workplace experiences in 2022 Risk of burnout is increasingIn 2022,over half of doctors(57%)found their work emotionally exhausting to a high degree.Close to half(45%)found it frustrating,and four out of ten(40%)reported that they felt burnt out because of their work.Doctor
153、s interviewed as part of the Barometer survey follow-up research spoke of the major negative impact of stress on their personal and professional lives.Twelve months ago I was in a hospital job where the idea of going to workI had to physically drag myself there I remember working a full day and then
154、 getting called back in for the evening shift on my fiances birthday because someone didnt turn up.”Doctor in training,Barometer survey 2022 follow-up interviews Seven out of ten doctors(70%)and more than eight out of ten GPs(82%)always or often felt worn out at the end of the day.Half(50%)of GPs sa
155、id that they always felt worn out at the end of the day,compared with 33%of all doctors.Doctors burnout risk was categorised based on their responses to the burnout indicator questions.In 2020,one out of ten doctors(10%)were at high risk of burnout.In 2021,this went up to 17%,and by 2022,a quarter o
156、f all doctors(25%)were at high risk of burnout.At the same time,the percentage of doctors at very low risk of burnout has dropped from 60%in 2020 to 32%in 2022.This is a cause for concern.In 2022,more than one out of five doctors(22%)took a leave of absence due to stress in the last yeara higher per
157、centage than in 2021(17%).Nearly three out of ten doctors in training(29%)and SAS and LE doctors(28%)took time off due to stress in 2022.Notably,a smaller proportion of GPs(17%)did so,despite reporting more negative experiences in response to other questions in the survey.Figure 7:Proportion of doct
158、ors at risk of burnout,from 20192022HighModerateLowVery lown=3,876(all doctors),the Barometer survey 2019 QD1/D2.n=4,269(all doctors),the Barometer survey 2022 QD1/D2.Figure 6:Proportion of doctors at risk of burnout,from 2019 to 2022 25%Down from 25%in 2019Down from 42%in 201920%22%32%Up from 18%in
159、 2019Up from 16%in 2019General Medical Council 24Chapter 1:Doctors workplace experiences in 2022 Trainers face added pressuresTrainers play an essential role in supporting and developing the next generation of doctors.But in 2022 they had more negative workplace experiences than non-trainers in seve
160、ral areas.Doctors who were trainers were more likely to work beyond their rostered hours once a week(78%,compared with 67%of non-trainers)and were more likely to describe three-quarters or more of their days as high intensity(49%,compared with 40%of non-trainers).Across all doctors,a lower proportio
161、n of trainers(19%)were doing well than non-trainers(27%).However,there was no notable difference in the proportion of trainers and non-trainers who were struggling(40%and 37%respectively).Within both GPs and specialists,trainers were more likely than non-trainers to be struggling.63%of GPs with a tr
162、aining role were struggling compared with 53%of GPs who did not hold such a role,while 35%of specialists who were trainers were struggling compared with 26%of specialists who were not trainers.This pattern was not evident for SAS and LE doctors,though relatively few doctors in this group have a trai
163、ning role(11%,compared with 65%of doctors on the specialist register and 28%of GPs).Trainers were also more likely to have seen patient safety compromised in the year leading up to the Barometer survey 2022 (51%,compared with 39%of non-trainers),and they were more likely to find it difficult to prov
164、ide sufficient care to patients at least once a week(49%,compared with 43%of non-trainers).Across all registration types,trainers were more likely to carry out tasks usually completed by a more junior doctor at least once a month(64%of trainers,compared with 49%of non-trainers).Out of all doctors su
165、rveyed,those who were trainers were more likely to disagree that they were supported by their senior medical staff(18%)than non-trainers(10%).Doctors on the specialist register who were trainers were more likely to disagree that they were supported by their senior medical staff(22%,compared with 15%
166、of non-trainers).Specialists who were trainers were also more likely than specialists who were not trainers to disagree that they were supported by non-clinical management(43%compared with 35%).This could indicate that,across the board,there is a lack of support in place for doctors with training re
167、sponsibilities.A future increase in the number of trainees,which appears likely given current plans to increase medical school places,could add to the pressure on trainers.Our data suggest that these greater workloads will be detrimental to trainers wellbeing,patient safety and care,and the quality
168、of training that trainees receive.General Medical Council 25Chapter 1:Doctors workplace experiences in 2022 Spotlight on trainers:developing and supporting the workforce What does the national training survey(NTS)tell us?The NTS is an annual survey of all trainees and trainers on the medical registe
169、r.It forms a core part of our work to monitor and report on the quality of postgraduate medical education and training in the UK.The findings from the 2022 edition11 shine a light on some of the challenges trainers face.Most trainers(90%)enjoyed their role,but those with higher numbers of trainees s
170、truggled to use the time allocated to them only for training purposes.Only 38%of those with more than five trainees said they could do this,compared with 50%of those with just one trainee.Similarly,and perhaps unsurprisingly,the more trainees a trainer was assigned to supervise,the less positive the
171、 trainer was about being able to meet with their trainees as frequently as needed.Experiences of delivering training varied by specialty.61%of trainers in anaesthetics felt they were able to use their allocated training time specifically to deliver training,compared to only 34%of trainers in medicin
172、e and 32%in radiology.A quarter of trainers(25%)who had a PMQ from overseas said that incidents of rudeness and incivility among doctors or healthcare staff were negatively affecting their experience in their role.This was higher than the proportion of trainers with a UK PMQ(18%).When asked if their
173、 employer or practice provided a supportive environment for everyone regardless of background,beliefs,or identity,79%of ethnic minority trainers agreed with this,compared with 84%of White trainers.Qualitative interviews with trainers 12We commissioned follow-up qualitative research with a small numb
174、er of trainers that took part in the Barometer survey 2022 and opted into further research.Ten one-to-one interviews were held in March 2023 with doctors working across the UK.The purpose was to understand the positive and challenging aspects of the role,including the support available to trainers.T
175、rainers typically enjoyed the role and cited benefits such as career development and enhanced professional variety.They were often motivated by a desire to give back to the system that they had benefited from and to improve the quality of the workforce and therefore patient care.Types of supervision
176、,and the exact focus of training,varied from trainer to trainer.Some focussed more on clinical skills and addressing knowledge gaps,whereas others took a more General Medical Council 26Chapter 1:Doctors workplace experiences in 2022 informal,whole-person approach that emphasised personal wellbeing a
177、nd work-life balance,as well as professional competence.Participants spoke of the need to boost trainees confidence in applying the skills they had acquired,through years of training,in real-world situations.To get this far,most of them are pretty competent and I am not going to start teaching them
178、basic stuff.What Im teaching them is you have the knowledge,you have the skills,you have the aptitudethis is how you use it.”GP,Barometer survey 2022 survey follow-up interviewsParticipants views varied about whether they had sufficient time to fully meet their training responsibilities.They tried t
179、o plan and protect their time where possible,collaborated with colleagues to manage the training workload and worked flexiblyincluding outside regular hoursduring busy periods.There was a general sense that training had become less valued over time.System pressures,such as the coronavirus pandemic a
180、nd high patient demand,had led to training being deprioritised.The result was dissatisfaction and a weakening of trainees skills.There is always pressure to provide more and more,and that will chip away at training time,and the only way to continue to provide quality training is to recognise that we
181、 need to train professionals,or they will leave.”GP,Barometer survey 2022 follow-up interviews Trainees were perceived as having a different perspective on the profession than their predecessors.They were seen as more motivated to achieve a good work-life balance and put clear boundaries around thei
182、r job.These changes were not necessarily seen as negative,especially if they prevented burnout among trainees,but participants felt they had put more pressure on a health system already under strain.Views on the effect of the pandemic on trainees varied.According to participants,many trainees had ex
183、perienced trauma in the workplace,weakening their confidence and morale.In some cases,this led them to take a break from practice entirely.However,the system-wide response to the pandemic also meant that there had been fewer opportunities for some trainees to gain clinical experience,including conta
184、ct time with patients.This meant that they were less prepared and experienced than they ordinarily would have been.Trainers generally felt supported by their peers and colleagues,though views were mixed on support from management.Participants valued the opportunity to collaborate with peers in simil
185、ar roles and thrived in environments in which training was valued,and time for it was protected.But they were sometimes held back by a lack of capacity to meet their trainees needs as well as to engage in their own learning and development.Working cultures that generally deprioritised training exace
186、rbated this issue.We examine these issues in more detail in chapters 2 and 3.General Medical Council 27Chapter 1:Doctors workplace experiences in 2022 Implications of workload pressure for doctors and their patients Doctors wellbeing has been negatively affected by a marked increase in workloads.Thi
187、s heightens the risk of burnout among doctors,causing some to reduce their hours or even leave the UK profession completely.In this section,we analyse our data about the effects of these trends on patient safety and care.Doctors ability to provide good patient care is at riskIn 2022,most doctors(88%
188、)reported having positive relationships with their patients.However,more than two-fifths of doctors(44%)found it difficult to give their patients the care needed at least once a weekand 21%struggled daily.This was a considerable increase since 2021,when 25%faced this challenge at least once a week,a
189、nd 9%daily.Figure 8:Doctors who found it difficult to provide a patient with the sufficient level of care they need in 2021 and 2022How frequently,if at all,over the last year have you experienced the following?Found it difficult to provide a patient with the sufficient level of care they need.28%33
190、%16%11%9%25%15%23%13%21%2021At least once a week202225%44%NeverOccasionallyOnce a monthOnce a weekOnce a dayn=3,386(all doctors),the Barometer survey 2021 QC1_4.Excluding dont know and prefer not to say.n=4,269(all doctors),the Barometer survey 2022 QC1_4.Excluding dont know and prefer not to say.Ge
191、neral Medical Council 28Chapter 1:Doctors workplace experiences in 2022 In 2022,the proportion of doctors who frequently found it difficult to provide patients with sufficient levels of care rose in all registration types.GPs had the most difficulty providing patients with sufficient care,with 62%fi
192、nding this difficult at least once a week,up from 45%in 2021.There were notably large increases among trainees and SAS and LE doctors.45%of doctors in training experienced this at least once a week in 2022,compared with 13%in 2021.30%of SAS and LE doctors experienced this at least once a week in 202
193、2,compared with 9%in 2021.These trends suggest doctors may be at heightened risk of moral injury,the psychological distress caused by engaging in or witnessing behaviours that go against an individuals values and moral beliefs.In the 2022 survey,we used an open question to ask doctors what the main
194、barriers were that prevented them from providing good patient care.Doctors most commonly identified inadequate staffing(33%),pressure on workloads(24%),and delays in providing care or treatment(16%)as the main barriers to providing good patient care.Figure 9:Percentage of doctors who found it diffic
195、ult to provide a patient with the sufficient level of care they need at least once a week by registration type in 2021 and 2022n=3,386(all doctors),the Barometer survey 2021 QC1_4.n=4,269(all doctors),the Barometer survey 2022 QC1_4.25%44%45%62%31%42%13%45%9%30%All doctorsGPsSpecialistsDoctors in tr
196、ainingSAS and LE doctors20212022How frequently,if at all,over the last year have you experienced the following?Found it difficult to provide a patient with the sufficient level of care they needGeneral Medical Council 29Chapter 1:Doctors workplace experiences in 2022 Figure 10:Barriers to providing
197、good patient caren=4,269(all doctors),the Barometer survey 2022 QC9.What would you consider to be the main barriers,if any,to providing good patient care that you have observed or experienced over the last year?Inadequate staffingPressure on workloadsDelays to providing care,treatment,or screeningsP
198、oor organisationalmanagementPatient flow/bed pressuresLack of timeExpectations of patientsLow staff moralePoor working conditionsTime spent on bureaucracy/adminNot observed or experiencedany barriers33%24%16%11%9%9%9%7%7%7%5%There was some variation in the barriers observed by registration type.Doct
199、ors in training were more likely to cite inadequate staffing(44%)than GPs(19%).GPs were much more likely than all doctors to cite the following barriers:pressure on workloads(41%,compared with 24%)delays in care(32%,compared with 16%)lack of time(20%,compared with 9%)patient expectations(22%,compare
200、d with 9%).General Medical Council 30Chapter 1:Doctors workplace experiences in 2022 Risks to the provision of safe patient care are growingOver four out of ten doctors(42%)experienced a situation in which they believed patient safety or care was compromised in the year leading up to the Barometer s
201、urvey 2022.This was a much higher proportion than in 2021(29%),2020(26%),and 2019(32%).Specialists(47%)and GPs(45%)were most likely to see patient care compromised,while SAS and LE doctors were least likely(34%).Compromises in patient care were generally attributed to resource pressures.Four-fifths
202、of doctors(80%)who had observed compromises in patient care blamed them on heavy workloads.Nearly two-thirds(64%)cited delays in treatment and over half(56%)highlighted rota gaps.Roughly half(52%)cited a lack of appropriately qualified staff.A man had a blood pressure check at work and he came to me
203、 and had a tremor in his hand,he burst into tears and was suicidalbecause he told me that he was suicidal I could make a plan with the mental health team.If I had been running late with other people in the waiting room I would not have asked about the tremor.”GP in training,Barometer survey 2022 fol
204、low-up interviews While more than six out of ten doctors(62%)felt confident raising concerns about patient care,almost one out of five did not(18%).Specialists were particularly likely to not feel confident in raising concerns(23%).This further adds to the risk of moral injury.A substantial minority
205、 of doctors may feel not only that they are unable to provide sufficient care to patients,but are also hesitant about voicing concerns.Rising pressures lead to lower satisfaction in day-to-day workThere has been a downward trend in satisfaction since 2020,when three-quarters(75%)of doctors were sati
206、sfied.By 2021,this had dropped to 70%and,in 2022,only half of doctors said they were satisfied(50%).In 2022,around two-fifths of doctors were dissatisfied(43%),nearly double the proportion in 2021(22%).More than one out of ten(11%)doctors described themselves as very dissatisfied.This was an increas
207、e from less than one out of 20(4%)in 2021.General Medical Council 31Chapter 1:Doctors workplace experiences in 2022 Satisfaction decreased across all registrant types from 2021 to 2022.GPs continued to be less satisfied than other doctors,with fewer than four out of ten(38%)stating they were satisfi
208、ed in 2022,down from 51%in 2021.SAS and LE doctors reported the highest levels of satisfaction in 2022(59%).Around half of doctors in training(50%)and specialists(52%)said they were satisfied in their work.Doctors in training and SAS and LE doctors were notably more satisfied than GPs and specialist
209、s in 2021.However,experiences in 2022 were more uniform across all doctors,which was largely due to steep drops in satisfaction among SAS and LE doctors and doctors in training from 2021 to 2022.Doctors in training saw a very large drop of 33 percentage points in this period,from 83%expressing satis
210、faction in 2021 to exactly half(50%)in 2022.The decrease for SAS and LE doctors was 23 percentage points,from 82%in 2021 to 59%in 2022.Figure 11:Proportion of doctors satisfied with their day-to-day work,20192022To what extent are you satisfied or dissatisfied with your day to day work as a doctor?n
211、=3,876(all doctors),the Barometer survey 2019 QA1.n=3,693(all doctors),the Barometer survey 2020 QA1.n=3,386(all doctors),the Barometer survey 2021 QA1.n=4,269(all doctors),the Barometer survey 2022 QA1.DissatisfiedNeither satisfied nor dissatisfiedSatisfied6%7%7%8%2002231%63%17%75%22%70%
212、43%50%General Medical Council 32Chapter 1:Doctors workplace experiences in 2022 While satisfaction has decreased,unsurprisingly,dissatisfaction has grown across all registrant types.GPs were the most dissatisfied(57%in 2022,up from 39%in 2021).Just over one out of four specialists(42%)were dissatisf
213、ied,up from 23%in 2021.Doctors in training were equally dissatisfied(42%),a major increase from 2021(13%).SAS and LE doctors were the least dissatisfied(31%),though their dissatisfaction had also increased by a large degree,from 10%in 2021.The ability to provide patients with sufficient levels of ca
214、re is associated with doctors satisfaction.A higher percentage of dissatisfied doctors(64%)struggled to provide adequate patient care once a week or more compared with satisfied doctors(27%).Figure 12:Overall satisfaction by registration type,20192022To what extent are you satisfied or dissatisfied
215、with your day to day work as a doctor?n=GPs(1,079),specialists(2,188),doctors in training(269),SAS/LE doctors(325),the Barometer survey 2019 QA1.n=GPs(1,001),specialists(1,917),doctors in training(493),SAS/LE doctors(278),the Barometer survey 2020 QA1.n=GPs(895),specialists(1,759),doctors in trainin
216、g(337),SAS/LE doctors(366),the Barometer survey 2021 QA1.n=GPs(995),specialists(1,270),doctors in training(1,055),SAS/LE doctors(869),the Barometer survey 2022 QA1.20022Year20%50%60%70%80%40%30%90%Proportion of doctors satisfiedGPsSpecialistsDoctors in trainingSAS and LEGeneral Medical Co
217、uncil 33Chapter 1:Doctors workplace experiences in 2022 High proportions of doctors who found it difficult to provide patients with sufficient care were also at high risk of burnout(70%)and felt unable to cope with their workload at least once a week(also 70%).Providing care mostly or all face-to-fa
218、ce is associated with higher levels of satisfaction.Just under three-quarters(73%)of doctors who were satisfied provided care mostly or all face-to-face,compared with just two-thirds(66%)of doctors who were dissatisfied.Figure 13:Overall dissatisfaction by registration type,20192022To what extent ar
219、e you satisfied or dissatisfied day-to-day in your work as a doctor?20022Year0%30%40%50%60%20%10%Proportion of doctors dissatisfiedn=GPs(1,079),specialists(2,188),doctors in training(269),SAS/LE doctors(325),the Barometer survey 2019 QA1.n=GPs(1,001),specialists(1,917),doctors in training
220、(493),SAS/LE doctors(278),the Barometer survey 2020 QA1.n=GPs(895),specialists(1,759),doctors in training(337),SAS/LE doctors(366),the Barometer survey 2021 QA1.n=GPs(995),specialists(1,270),doctors in training(1,055),SAS/LE doctors(869),the Barometer survey 2022 QA1.GPsSpecialistsDoctors in trainin
221、gSAS and LEGeneral Medical Council 34Chapter 1:Doctors workplace experiences in 2022 Drivers of doctors day-to-day satisfactionIn 2022,50%of doctors reported being satisfied in their day-to-day work as a doctor,while 43%were dissatisfied.As part of the Barometer survey,doctors are given the opportun
222、ity to state in their own words the reasons that they are satisfied or dissatisfied,with responses being coded as part of the survey analysis.These are open questions,and the responses are therefore top-of-mind thoughts from the doctors,providing a unique insight into drivers of satisfaction.Interes
223、tingly,the main reasons doctors state for being satisfied all relate to the feeling that being a doctor is a vocation which requires strong professional values.Therefore,it is very concerning that the overall proportion of satisfied doctors has decreased,and that the proportion of doctors giving the
224、se vocation-driven reasons for satisfaction has dropped since 2021.The most common reason doctors stated for their day-to-day satisfaction in 2022 was that they found their work enjoyable,fulfilling,and rewarding.A quarter of all doctors(25%)who said they were satisfied gave this as a reasondown fro
225、m 37%in 2021.The next most cited reasons for satisfaction were that doctors did interesting or varied work(14%),and they enjoyed patient contact(14%).The proportion of doctors who cited feeling in control of their daily routine as a reason for satisfaction(9%)increased by six percentage points,from
226、3%in 2021.A smaller percentage(7%)said it was because they had a good work-life balance,which was also an increase from 3%in 2021.There were also small increases in the proportions of doctors citing an organised/wellfunctioning department(from 4%in 2021 to 6%in 2022,supportive management(from 4%to 6
227、%),and having taken on less responsibility(from 1%to 4%).On the other hand,in 2022,increasingly high workloads or long hours remained the most common reason given for dissatisfaction,with around four out of ten(39%)dissatisfied doctors highlighting these issues.Around a quarter(26%)cited problems wi
228、th the recruitment and retention of doctors and a similar proportion(25%)said they were unhappy with their remuneration.General Medical Council 35Chapter 1:Doctors workplace experiences in 2022 More doctors plan to leave UK practice and have taken hard steps towards leaving From 2021 to 2022,the pro
229、portion of doctors who said they were likely to make a career change1 in the next year grew significantlyfrom 58%of doctors to more than three-quarters(77%).This included a large increase in those likely to leave the UK profession permanently.In 2021,only around one out of ten(11%)said they intended
230、 to do this.By 2022,this rose to nearly one out of five(18%).1 Career change is broadly defined in this report as changes to working practices,including reducing hours and taking a career break.Doctors may have intended to make career changes but then not carried them out.Similarly,some doctors may
231、have made career changes that were unplanned.No attempt is made in the analysis to compare doctors subjective views with documented changes in the medical workforce.Figure 14:Reasons for satisfaction Why do you say that you are satisfied?I enjoy my work/find my job fulfilling and rewardingInterestin
232、g/varied workI enjoy the patient contactI like and respect my colleagues/the team I work withFeel in control of my daily routineGood work life balanceOrganised/well functioning departmentManagement are supportiveTaken on less responsibilityn=2,131(all satisfied doctors),the Barometer survey 2022,QA2
233、.Open response.n=2382(all satisfied doctors),the Barometer survey 2021,QA2.Open response.25%Down from 37%in 2021Down from 17%in 2021No change from 2021Down from 16%in 2021Up from 3%in 2021Up from 3%in 2021Up from 4%in 2021Up from 4%in 2021Up from 1%in 202114%14%13%9%7%6%6%4%General Medical Council 3
234、6Chapter 1:Doctors workplace experiences in 2022 There is variation in the most likely career changes by type of registration,with doctors in training more likely than others to be considering taking a break from the profession.This is in line with previous years.Among doctors who said they were lik
235、ely to leave the UK profession,but who were not at retirement age,over half(56%)had discussed their plans with others,and over four in ten had researched either alternative career paths(44%)or career opportunities abroad(41%).Just over four in ten(43%)had taken hard steps towards leaving the UK prof
236、ession.The most common hard step taken was contacting a recruiter(21%).Around one in ten had applied for a new role abroad(14%)or outside medicine(12%).A similar proportion(13%)had applied for or attended training to prepare for a new role.15%of all doctors reported having taken a hard step towards
237、leaving,a notable increase from 7%in 2021.New response options that are considered hard steps were included in the 2022 survey.However,analysis shows that there has still been an increase,even excluding the steps introduced in the 2022 survey.Figure 15:Career change doctors are most likely to make 7
238、%n=4,269(all doctors),the Barometer survey 2022 QB1a.Reduced contract hoursMove to a role with less clinical workloadSwitch to locum workMove to private practice or increase proportion of time spent working privatelyRetire and return to working on a sessional/contracted/locum basisDefer/take a break
239、 from training but continue to work as a doctorIncrease contracted hoursMove to practise abroadRetire and leave the medical professionLeave the medical profession(for a reason other than retirement)Planned parental or caring leaveTake a career break15%9%6%3%3%3%10%4%4%5%2%24%reducing hours23%other c
240、hange18%leaving permanently7%taking a breakGeneral Medical Council 37Chapter 1:Doctors workplace experiences in 2022 Among those likely to leave the medical profession for reasons other than retirement,the adverse effects on wellbeing of the demands of the job influenced three-quarters(75%)of doctor
241、s.Reasons for wanting to move to practise abroad were most frequently related to the perceived better treatment of doctors outside of the UK(80%),as well as a desire for higher pay(66%).The risk of burnout may continue to push doctors away from full-time practice,or out of the UK profession complete
242、ly.Doctors who were at higher risk of burnout were more likely to be planning to reduce their hours or to undertake any other career change,including leaving the UK medical profession.Figure 16:Steps doctors have taken towards leaving the medical profession Discussed it with othersResearched alterna
243、tive career pathsResearched careeropportunities abroadResearched retirementContacted a recruiterApplied for a clinical job abroadApplied for or attending training to prepare for a new roleApplied for other role(s)outside of medicineApplied for retirement/pensionI have not taken any steps so farn=1,4
244、97(those likely to leave the UK medical profession,excluding retirement age retirees),the Barometer survey 2022 QB3.56%44%41%9%21%14%13%12%4%14%What steps,if any,have you taken towards leaving the medical profession?of all doctors15%7%43%any hard step taken towards leaving profession=increase from 2
245、021General Medical Council 38Chapter 1:Doctors workplace experiences in 2022 In 2021,around 10,000 doctors left UK practice,while around 21,000 doctors entered it.7 The exact relationship between doctors intentions to leave the profession and then doing so is unclear.But we are concerned the data su
246、ggest a heightened risk of doctors leaving.Our 2023 Workforce report will examine this in more detail.In 2022,we published research13 into doctors decisions to migrate from the UK.This identified a range of push and pull factors.Negative experiences,burnout,and frustrations with UK health systems we
247、re cited,as well as the prospect of adventure,better treatment,and higher salaries abroad.Table 1:Likelihood of doctors making a career change and their risk of burnout Very low risk of burnoutLow risk of burnoutModerate risk of burnoutHigh risk of burnoutDoctors likely to make any reduction in hour
248、s working in UK practice49%68%81%90%Doctors likely to make any career change60%75%85%93%n=4,269(all doctors),the Barometer survey 2022 QB1/D1/D2The provision of remote care is decliningFrom 2021 to 2022,there was a major shift back to pre-pandemic medical working practices.In 2021,46%of doctors prov
249、ided mostly remote care.By 2022,this had reduced to 8%.At the same time,face-to-face care increased significantly.In 2021,only around a third of doctors(31%)said the care they delivered was mostly face-to-face.By 2022,this had increased to 70%.General Medical Council 39Chapter 1:Doctors workplace ex
250、periences in 2022 The percentage of doctors who delivered all,or nearly all,of care face-to-face also markedly increased,from 16%to 45%.GPs were much more likely to deliver remote care than other registrant types.19%of GPs delivered mostly or all remote patient care,compared with 8%of specialists an
251、d 3%of doctors in training.Around half of GPs(51%)provided an even mix of remote and face-to-face patient care,a much greater proportion than other registrant types.Figure 17:Amount of doctors care that was provided remotely in 20212022Roughly,how much of your patient care has been provided remotely
252、 and how much face-to-face during the last year?n=3,386(all doctors),the Barometer survey 2021 QI6.n=4,269(all doctors),the Barometer survey 2022 QI6.Mostly or all face-to-face careEven mix of remote and face-to-face careMostly or all remote care20%21%2021202231%46%70%8%Figure 18:Proportion of docto
253、rs who provided care remotely and face-to-face in the year leading up to autumn 2022Roughly,how much of your patient care has been provided remotely and how much face-to-face during the last year?Figure 12:Amount of Doctors care that was provided remotely in 2021 and 2022n=3,386(all doctors),the Bar
254、ometer survey 2021 QI6.n=4,269(all doctors),the Barometer survey 2022 QI6.Mostly or all face-to-face careEven mix of remote and face-to-face careMostly or all remote care20%21%2021202231%46%70%8%n=4,269(all doctors),the Barometer survey 2022 QI6.8%70%19%29%8%76%3%86%4%89%All doctorsGPsSpecialistsDoc
255、tors in trainingSAS and LE doctorsMostly or all remoteMostly or all face-to-faceGeneral Medical Council 40Chapter 1:Doctors workplace experiences in 2022 Variation of experiences across the workforceThis section explores differences in perceptions and experiences across the UK medical workforce.Ther
256、e is a focus on areas where outcomes and experiences diverge.This includes the specific issues faced by GPs,variations by disability status and ethnicity,and how the experiences of non-UK medical graduates compare with UK graduates.Finally,we briefly explore the experiences of SAS and LE doctors as
257、separate groups.For each of these groupsGPs,ethnic minority doctors,doctors with disabilities,and doctors with a non-UK PMQtheir workplace experiences are important for several reasons.In some cases,these patterns may indicate direct or indirect discrimination and so require addressing in line with
258、the 2010 Equality Act.In addition,where doctors have less support from peers or management or have worse workload issues,these issues happen alongside worse patient safety and care and may be amenable to intervention.Over time,doctors may gradually struggle to maintain their continuous professional
259、development,or through lack of appropriate feedback and support,may increase their risk of being complained about or referred to the GMC.14However,GPs reported better-than-average experiences of feeling supported by non-clinical management,with 67%of GPs feeling supported by their non-clinical manag
260、ement compared with 42%of all doctors.A slightly larger-than-average proportion of GPs also reported that they felt supported by their immediate colleagues(85%,compared with an average of 82%for all doctors)and part of a supportive team(80%compared with an average of 73%).This shows that although we
261、 generally see correlations between good levels of support and wellbeing,this is not always the case for all groups of doctors.The Barometer survey 2022 results show that,as in previous years,GPs experienced the highest intensity of work.68%of GPs reported that three-quarters or more of their days w
262、ere high-intensity,compared to an average of 43%of all doctors.This extreme intensity is likely to be the driver of the high risk of burnout and the high number of GPs who were struggling.It is likely that if GPs had worse experiences of support,their risk of burnout would be even higher.The high le
263、vels of support reported by GPs may help them manage their high workloadsand if so,there may be useful insights for others to take away from examining how GPs build strong teams.GPs are struggling with high workloads,but feel well supported GPs had the highest risk of burnout(31%were at high risk of
264、 burnout compared with the average of 25%)and were the register type with the highest proportion of doctors who were struggling(55%of GPs were struggling,compared with an average of 38%).General Medical Council 41Chapter 1:Doctors workplace experiences in 2022 Disabled doctors have a less positive e
265、xperience across multiple measures As in previous years,disabled doctors were less likely to be satisfied in their work(44%)than non-disabled doctors(51%).In 2021,54%of disabled doctors were satisfied,compared with 72%of non-disabled doctors.While the difference in satisfaction between the two group
266、s has narrowed,this is largely due to the large decrease in the satisfaction of non-disabled doctors.Disabled doctors were more likely to be struggling with their workload(47%)than non-disabled doctors(37%).They also felt less supported than non-disabled doctors.While 74%of non-disabled doctors felt
267、 they were part of a supportive team,69%of disabled doctors felt this way.This is the third year in a row we have seen this trend.The disparity based on disability was found in all registrant types except GPs,where there was no statistically significant difference between the proportion of disabled
268、and non-disabled doctors that were struggling.Non-UK medical graduates mostly reported more positive experiences than UK graduates In line with 2021,the 2022 survey data show that graduates with a PMQ from outside the UK(non-UK graduates)were more positive than UK graduates about certain aspects of
269、their work experiences.58%of non-UK graduates were satisfied with their work,compared with 45%of UK graduate doctors.UK graduates were more likely to be at high risk of burnout(27%)and more likely to be classed as struggling(44%)compared with non-UK graduates(22%at high risk of burnout and 29%strugg
270、ling).Figure 19:Doctors struggling with their workload,by disability statusn=4,269(all doctors),the Barometer survey 2022 QC1Disabled doctorsNon-disabled doctors37%47%Figure 20:Satisfaction in day-to-day work,by country of PMQn=4,269(all doctors),the Barometer survey 2022 QA1Non-UK graduatesUK gradu
271、ates45%58%General Medical Council 42Chapter 1:Doctors workplace experiences in 2022 The data show that PMQ was typically a strong driver of participants responses,and that the pattern of non-UK graduates generally reporting more positive experiences than UK graduates was found across the sample,irre
272、spective of ethnicity:Both White non-UK graduates(55%)and ethnic minority non-UK graduates(60%)were more likely to be satisfied than UK graduates of all ethnicities(45%).Both White UK graduates(43%)and ethnic minority UK graduates(44%)were more likely to be struggling than non-UK graduates of all et
273、hnicities(29%).More than half of UK graduates(54%)found it difficult to provide a patient with sufficient care at least once a week,compared with fewer than a third of non-UK graduates(29%).However,while 87%of UK graduates felt supported by immediate colleagues,only 75%of non-UK graduates felt this
274、way.Similarly,fewer non-UK graduate doctors(65%)said they were part of a supportive team than UK graduates(78%).Ethnic minority doctors report higher satisfaction but less supportAs highlighted above,it is important to bear in mind the close relationship between ethnicity and place of PMQ when explo
275、ring differences in ethnicities.In 2022,across the entire sample,more than half of ethnic minority doctors(54%)were satisfied in their work,compared with less than half(47%)of White doctors.Looking at specific groups,62%of Black/Black British doctors were satisfied in their work while 52%of Asian/As
276、ian British doctors were satisfied.Doctors from Mixed or multiple ethnic groups did not have a notable difference in their level of satisfaction(49%)when compared with the White group(47%).Around a third of ethnic minority doctors(34%)reported that they were struggling with their workload compared w
277、ith 42%of White doctors.A similar proportion of ethnic minority doctors(36%)said that three-quarters or more of their working days had been high intensity compared with almost half of White doctors(48%).Ethnic minority doctors(35%)were much less likely than White doctors(52%)to have found it difficu
278、lt to provide their patients with the care needed at least once a week.Ethnic minority doctors were also less likely than White doctors to have witnessed a situation in which they believed patient care was compromised.Roughly a third of ethnic minority doctors(35%)had witnessed this,compared with ar
279、ound half of White doctors(49%).General Medical Council 43Chapter 1:Doctors workplace experiences in 2022 Despite this,ethnic minority doctors(78%)felt less supported by immediate colleagues than White doctors(87%).The lack of support from immediate colleagues was felt particularly acutely by Asian/
280、Asian British doctors(77%felt supported).Black/Black British doctors and those from Mixed or multiple ethnic groups had no notable difference from the proportion of all doctors that felt supported(82%).It is encouraging that,despite some differences by ethnicity,a clear majority of doctors in all et
281、hnic groups felt supported by immediate colleagues.Figure 21:Satisfaction in day-to-day work and support from immediate colleagues,by ethnicityn=4,269(all doctors),the Barometer survey 2022 QA1/D3-1 Base:all doctors(4,269).Ethnic minority doctorsWhite doctorsEthnic minority doctorsWhite doctorsFelt
282、supported by immediate collaguesSatisfied.47%54%87%78%SAS doctors and LE doctorsSAS doctors*and LE doctors are two distinct groups of doctors,with differing experiences and challenges.Limitations in available data sometimes mean that SAS and LE doctors are analysed as a single group.Changes to the a
283、pproach in the Barometer survey 2022 have enabled us to report on SAS and LE doctors separately for the first time,though it should be noted that comparison with past findings is not possible because previous Barometer surveys grouped SAS and LE doctors together.This section provides a summary of ou
284、r main findings relating to SAS and LE doctors based on the Barometer survey 2022.As well as looking at SAS and LE doctors as separate groups,both SAS and LE doctors have been analysed based on where they gained their PMQ.We will publish a fuller analysis of the working experiences of SAS and LE doc
285、tors later in 2023.SAS doctors and LE doctors are together the fastest-growing part of the UK medical workforce.The SAS and LE doctor group grew by 40%7 from 2017 to 2021,just under four times the rate of growth of doctors on the specialist register in this period(11%),and about six times that of GP
286、s(7%).This is one of the most rapid shifts in the composition of the workforce since analysis was enabled by the digitisation of the*Before 2008 SAS doctors were those appointed to staff grade or associate specialist posts.Since 2008 these appointments are specialty doctor posts or,since 2021,specia
287、list grade.SAS doctors generally require four years postgraduate training and are a diverse group,spanning many skills and specialties.LE doctors are employed with locally defined terms and conditions,often in non-permanent posts.Unlike SAS doctors there is no nationally recognised career,contract,o
288、r pay structure.General Medical Council 44Chapter 1:Doctors workplace experiences in 2022 medical register.The growth is mainly driven by doctors from overseas joining the UK workforce.Doctors from overseas who are unable to join the specialist register directly may work as a SAS or LE doctor and ap
289、ply to join the specialist register via the Certificate of Eligibility for Specialist Registration(CESR)or the GP register via the Certificate of Eligibility for General Practice Registration(CEGPR).A SAS or LE role can be a positive career choice for a doctor,but if a doctor is unable to successful
290、ly apply for a CESR or CEGPRparticularly SAS doctors with substantial overseas experience as specialists which they could not use to demonstrate CCT equivalencethey may remain in a SAS or LE role in which they feel unrecognised and underutilised.Analysis of our 2019 survey15 of SAS and LE doctors co
291、rroborated this difficulty.16 It revealed a group of experienced,international medical graduate(IMG)SAS and LE doctors having a very negative experience of UK practice.The survey found many SAS and LE doctors had negative experiences of their working environments,including bullying and lack of suppo
292、rt.Qualitative research on doctors decisions to migrate from the UK13 in 2022 found that SAS and LE doctors appeared in groups with negative experiences of UK practice,and whose reasons for leaving included lack of promotion and unpleasant work interactions,including bullying.Diversity of SAS and LE
293、 doctors and their experiencesSAS and LE doctors are not a homogeneous group in terms of their background and experiences.Exploring SAS doctors and LE doctors as separate groups,and further splitting by where doctors gained their PMQ,groups emerge with distinct characteristics and experiences that s
294、hould be understood separately.The categorisation of different groups of SAS and LE doctors by whether they worked beyond rostered hours weekly and felt unable to cope with workloads weekly is set out in Figure 22.The results for all doctors surveyed,SAS doctors,and LE doctors,are included for compa
295、rison.The characteristics of the groups of SAS and LE doctors analysed,and findings relating to them,are summarised in Figure 23.Figure 22:Analysis of doctors working beyond rostered hours weekly and feeling unable to cope with workloads weeklyn=4269(all doctors),the Barometer survey 2022,QC1_1/2Str
296、ugglingNormalisedDoing wellTotaldoctorsAll SAS doctorsUK PMQ.Non-UKPMQNon-UKPMQSAS doctorsAll LE doctorsUK PMQLE doctors40%29%24%31%36%28%44%26%22%35%27%30%28%30%37%38%26%26%38%31%25%General Medical Council 45Chapter 1:Doctors workplace experiences in 2022 SAS doctors 43%of SAS doctors were categori
297、sed as having a very low burnout risk,compared with 32%of all doctors surveyed.More SAS doctors carried out both work usually done by more senior doctors(14%,compared with 5%of all doctors)and work usually done by more junior doctors(27%,compared with 21%of all doctors)every day.Many SAS doctors sai
298、d that they were satisfied in their work.36%of SAS doctors were in the most satisfied category,compared with 23%of all doctors surveyed.37%of SAS doctors with a non-UK PMQ and 36%of SAS doctors with a UK PMQ were in the most satisfied category.Many SAS doctors with a non-UK PMQ are doing well,but of
299、ten carry out work usually done by more junior doctors and feel less supported by senior doctors40%of SAS doctors were doing well in terms of workload,compared with 25%of all doctors surveyed(Figure 22).SAS doctors with a non-UK PMQ were more likely to be doing well than UK PMQ(44%compared with 31%r
300、espectively).27%of SAS doctors reported undertaking tasks usually carried out by a more junior doctor every day,compared with 21%of all doctors surveyed.Three out of ten(29%)SAS doctors with a non-UK PMQ reported this,compared with 23%of SAS doctors with a UK PMQ.62%of SAS doctors said they felt sup
301、ported by senior medical staff,compared with 63%of all doctors surveyed.57%of SAS doctors with a non-UK PMQ felt supported by senior medical staff,compared with 73%of SAS doctors with a UK PMQ.These findings could indicate that the skills and experience of SAS doctors with a non-UK PMQ are not being
302、 recognised and fully utilised by senior medical staff.The growth in IMG joiners means it is particularly important to allow this group to function at the top of their skillsets,enable them to progress and develop,and encourage them to stay in the workforce.General Medical Council 46Chapter 1:Doctor
303、s workplace experiences in 2022 Figure 23:Diversity of SAS and LE doctors and their experiences are specialty doctorsacted as a trainerare from an ethnic minorityare maleare femalehave a disabilityare specialty doctorsacted as a trainerare Whiteare maleare femalehave a disabilityof SAS doctorsof SAS
304、 doctors33%65%14%88%Relatively few experienced compromised patient safety/care Relatively few had difficulty providing sufficient care each week had taken steps to leave theUK profession,similar to doctors overallexperienced compromised patient safety/care,similar to doctors overallhad difficulty pr
305、oviding sufficient care each week,similar to doctors overallhave taken steps to leave theUK profession,similar to doctors overall32%21%14%45%38%13%59%38%7%72%20%78%28%70%18%SAS doctors with a non-UK PMQWho are these doctors?Who are these doctors?Doing well but underutilised?Many have normalised a he
306、avy workloadSAS doctors with a UK PMQ27%50+Ages:59%30491%3033%50+Ages:57%30495%30 Many had a normalised heavy workload over a third(36%)often work beyond their rostered hours but seldom felt unable to cope Few were likely to move to practise abroad(12%)37%were satisfied or very satisfied(with 26%dis
307、satisfied)44%doing well(22%struggling)BUT:29%undertake tasks usually done by junior doctors every day Relatively few felt supported by senior medical staff(57%)and said their team was supportive(61%)78%General Medical Council 47Chapter 1:Doctors workplace experiences in 2022 Clinical fellows Trust d
308、octorsacted as a trainerare from an ethnic minorityare maleare femalehave a disabilityClinical fellows Locumsacted as a trainerare Whiteare maleare femalehave a disabilityof LE doctorsof LE doctorsRelatively few experienced compromised patient safety/care Relatively few had difficulty providing suff
309、icient care each week have taken steps to leave theUK profession,similar to doctors overall24%23%13%Many experienced compromised patient safety/care Many had difficulty providing sufficient care each week A quarter have taken steps to leave the UK profession58%60%25%More prone to taking leave due to
310、 stressMultiple areas of concern4%50+Ages:29%304959%308%88%55%42%4%37%23%42%25%7%65%53%45%14%LE doctors with a non-UK PMQWho are these doctors?Who are these doctors?LE doctors with a UK PMQ71%28%45%dissatisfied and 37%struggling with their workload 19%felt supported by management 45%said not enough
311、development/learning 32%had taken a leave of absence due to stress 11%had taken stress related leave each month6%50+Ages:68%304918%30General Medical Council 48Chapter 1:Doctors workplace experiences in 2022 Many SAS doctors with a UK PMQ have a normalised heavy workloadSAS doctors with a UK PMQ appe
312、ar to be a relatively settled part of the workforce,with few saying they are likely to move to practise abroad(12%,compared with 25%of all doctors surveyed and 32%of SAS doctors with a non-UK PMQ).But over a third(36%)have a normalised workload,meaning they often work beyond their rostered hours but
313、 rarely feel unable to cope,compared with 31%of all doctors surveyed and 26%of SAS doctors with a non-UK PMQ.Though this group is managing their day-to-day work,normalising a heavy workload may have negative effects on their wellbeing and patient safety and care.LE doctors 39%of LE doctors said they
314、 were likely to move abroad,compared with 25%of all doctors.One out of ten(9%)LE doctors reported that they had taken leave due to stress at least once a month,compared with 4%of all doctors.More LE doctors with a non-UK PMQ take frequent stress-related leave11%of LE doctors with a non-UK PMQ report
315、ed that they took a leave of absence due to stress each month,compared with 4%of all doctors surveyed and 4%of LE doctors with a UK PMQ.By other measures LE doctors with a non-UK PMQ do not appear to have had particularly negative experiences,so this might be the result of their roles having flexibi
316、lity that enables them to take stress-related leavewhile the roles of other types of doctors do notwhich may be a protective factor.Many LE doctors with a UK PMQ have difficulty providing patient care,have taken steps to leave,and feel less supported,alongside other concernsIn the 2022 Barometer sur
317、vey,4%of all doctors were LE doctors with a UK PMQ.This group of doctors is relatively young,with three-fifths(59%)under 30 years old and includes doctors who have completed their foundation training but stepped away from the training pathway while continuing to work in UK practice.Such breaks in tr
318、aining are increasingly prevalent and are now perceived as standard by many.This means it is particularly important to recognise and urgently address the poor experiences of LE doctors with a UK PMQ set out here given the plans to increase UK training places.LE doctors with a UK PMQ reported negativ
319、e experiences in multiple areas.Many were dissatisfied(45%)and struggling with their workload(37%),and relatively few had a very low risk of burnout(29%),though these levels are in line with those of doctors in training.More strikingly,LE doctors with a UK PMQ fare worse than other SAS and LE doctor
320、s,and doctors in training,in the following areas.Most had experienced compromised patient safety or care(58%,compared with 43%of doctors in training)and most had regularly had difficulty providing patient care(60%,compared with 45%of doctors in training).A quarter had taken hard steps to leave the U
321、K profession(25%,compared with 18%of doctors in training).Few felt supported by non-clinical management(19%,compared with 29%of General Medical Council 49Chapter 1:Doctors workplace experiences in 2022 doctors in training),and many did not agree they had enough development and learning opportunities
322、(45%,compared with 33%of doctors in training).Summary of findings relating to SAS doctors and LE doctorsSAS and LE doctors are the fastest-growing part of the UK medical workforce.They face particular challenges and are not a homogeneous group in terms of background,skills,and experiences.The Barome
323、ter survey 2022 enabled us to explore SAS doctors and LE doctors as separate groups,but we cannot make comparisons with survey results from previous years.Compared with all doctors surveyed,more SAS doctors had a very low burnout risk,and more were satisfied in their work.However,more SAS doctors sa
324、id they carried out both work usually done by more senior doctors and work usually done by more junior doctors every day.Compared with all doctors surveyed,more LE doctors said they were likely to move abroad,and more reported that they had taken leave due to stress on a monthly basis.We also looked
325、 at SAS and LE doctors based on where they gained their PMQ and found that these four groups had distinct characteristics and experiences.SAS doctors with a non-UK PMQ:many were doing well,but reported often carrying out work usually done by more junior doctors and feeling less supported by senior d
326、octors.SAS doctors with a UK PMQ:many had a normalised heavy workloadwhile they rarely felt unable to cope,they often worked beyond their rostered hours.LE doctors with a non-UK PMQ:more of these doctors took frequent stress-related leave,though by other measures they do not appear to have had parti
327、cularly negative experiences.LE doctors with a UK PMQ:many had difficulty providing patient care,have taken steps to leave the UK profession,and feel less supported,alongside a range of other concerns.This group includes doctors who have completed foundation training and are working in UK practice w
328、hile not currently training.Some concerns stand out even in comparison with doctors in training,a group with similar characteristics.General Medical Council 50Chapter 1:Doctors workplace experiences in 2022 Chapter conclusionThe UK health system has been under sustained pressure for a considerable p
329、eriod,and the Barometer survey 2022 findings make for uncomfortable reading.Healthcare staff workloads have expanded in the wake of the coronavirus pandemic,and doctors have made huge efforts to deal with the backlog of care.But many doctors are now struggling to cope and are at greater risk of burn
330、out than previously.A growing number of doctors also feel concerned that they have been unable to provide sufficient patient care,risking increased moral injury.This context creates the vicious cycle described earlier in this chapter.Dissatisfied,overworked doctors are more likely to seek opportunit
331、ies elsewhere,putting further pressure on existing staff,and ultimately jeopardising patient care and safety.While doctors across the register are feeling the strain,GPs have been particularly badly hit.More than half(55%)were struggling,compared with an average of 38%of all doctors.There are major
332、disparities between GPs and groups in other areas too,notably workload intensity.Solutions must be found to address the unsustainable pressures on the whole system,and especially on general practice.In the following chapters,we explore some of these potential solutions.The survey results also give c
333、ause for concern about doctors facing barriers due to their protected characteristics,particularly disability.These issues may exacerbate the vicious cycle if doctors feel their workplace is not welcoming or inclusive.The next chapters introduce the concept of a virtuous cycle that could help counteract this vicious cycle,and explore changes that our evidence suggests will help put this concept in