Exploring the challenges facing the health workplace - Professor Wendy Reid

In the first of a series of lectures from Health Education England, Professor Wendy Reid, Medical Director and National Director for Education and Quality, addressed Royal Society of Medicine members and associates on the challenges facing the current and future healthcare workforce. In this blog, Professor Reid reflects on her career to date in medicine and the challenges ahead for healthcare professions.

It was an honour to give the first in a series of HEE thought leadership talks recently at the Royal Society of Medicine. The event provided a multi-disciplinary forum for discussion and debate – an exchange of information and ideas on the science, practice and organisation of medicine, in a building seeped in history.

For this blog, I’ve recounted some of my thoughts and reflections around what has changed in my 34 years as a doctor, as well as some of the more radical changes I think we need to introduce to promote flexibility and innovation in training to ensure we achieve the best quality of care for patients.  

In the 1980s, postgraduate medical training was pretty similar to what it had been at the beginning of the NHS. I worked around 100 hours a week and there were no scheduled breaks. College exams were mysterious and, for many, the viva was a test of nerves rather than knowledge. Many of my colleagues and I felt, as Sir John Temple has said, like ‘mushrooms’; infrequently fed, poorly trained and expected to mature into well rounded clinicians somewhat randomly. We often felt that we were apprentices, with a considerable degree of similarity to the medieval guilds…the ridiculous hours, the isolation from friends and family, the all-consuming power of medicine to pull us into its orbit whilst threatening our humanity. There was a real ‘sink or swim, tough it out and survive even if you lose empathy’ mentality. Allowing doctors their humanity is surely vital for patients?? Surely one measure of the quality of training is how we face up to the needs of doctors as people as well as professionals?

One of the greatest challenges of my time has been the European Working Time Directive – something that led to huge disquiet within the medical profession and public. The response was to ‘throw more doctors’ at the problem to fill new rotas and replicate traditional ways of working. We now find ourselves in the position where we talk about ‘rota gaps’ and offer doctors jobs ‘to fill rotas’. How’s this a reasonable, professional offer to a young doctor? Have we contributed to doctors’ no longer feeling valued by our relentless focus on those doctors within CCT training programmes?

I often muse over the challenge made to me whether the training tail is ‘wagging the service dog?’ Could our training programme directors or other leaders individualise training for units as well as for trainees, by taking a more comprehensive, inclusive approach? Why can’t doctors pause and gain experience without a myriad of rules and regulations? For example there is no reason why doctors must rotate annually. Why not change the offer and allow them to stay where they are as long as they need to and move when their training needs change, provided the service to patients is maintained?

And on the matter of regulation….doctors in training are the most assessed group of healthcare professionals in the NHS. I do wonder if the complaints we read about from Chief Executive colleagues about the burden of regulation can be reflected in postgraduate medicine all too readily? Is it time to review the assessment and the relentless documentation in training, particularly for senior doctors in training who are, of course, delivering the front line of care every day?

The need to shift our philosophy of healthcare into a health system with the emphasis on delivering in primary care and through community services is inarguable – yet we have no proposal to significantly change the culture of doctors. The majority of undergraduate training takes place in hospital settings, and the shift to all doctors getting time in primary care or General Practice as part of the foundation programme by 2017 is to be welcomed. However, changing culture is difficult – do we need a more radical change to drive understanding of ‘community’? Can we envisage a time where all doctors have worked for a year or so in General Practice or in community settings? I suspect the dominance of secondary care will continue regardless of structure or financial reorganisation, if we don’t think about a new mind set for all doctors.

Thanks to everyone who came along to the lecture. My career has been full of surprises and I’m sure there are more to come but I truly believe being a doctor is a great job.

About Wendy Reid

Professor Wendy Reid is Health Education England's first Medical Director and National Director for Education and Quality, joining from her role as postgraduate dean in London where she had led the Hospital at Night national team and worked as the clinical advisor to the Department of Health on the European Working Time Directive.

Her undergraduate training took place at the Royal Free Hospital, where she continues to practice as a consultant Gynaecologist. She was the Vice President for Education at the Royal College of Obstetrics and Gynaecology and was responsible for significant innovations ranging from the implementation of new examination techniques to being the primary author behind the report ‘Tomorrow’s Specialist’ which addresses the issue of generalism in the context of high quality care for women. She holds an honorary chair at Barts and The Royal London.