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It goes without saying that morale within the medical profession in the UK is not great. I am being polite when I say not great; I think the majority of us would agree that morale amongst doctors in this country is pretty poor, some would argue it is worse than that.
Junior doctors are threatening strike action due to falling earning levels. Consultants are facing sub inflation pay rises plus potentially high pension tax charges that may encourage some consultants to leave the NHS, earlier than perhaps they planned.
The GP workforce is also under strain and many want to leave due to the huge pressures on the GP service.
It is not just financial pressures that are crushing the medical profession in the UK. There is the ever-increasing workload (a huge problem and for some people, the biggest problem), greater hostility from the public (contrast that with the clapping of the NHS staff on the early days of Covid), lack of political support and a recruitment and retention crisis that not only affects doctors but other frontline staff.
Another important issue that does not get the recognition it deserves, is the corrosive effect and personal impact on doctors who are the subject of a complaint.
Doctors must practice to the highest level possible
Before I go any further, complaints (and other regulatory investigative processes by bodies such as the Care Quality Commission, the General Medical Council as well as litigation) are legitimate and important methods of holding doctors to account, provide learning for the affected doctor and other healthcare staff and offers the public confidence in the healthcare system.
Doctors should not get away with substandard or negligent care and must practice to the highest levels possible and if not, must be held responsible. The NHS complaint system is just a part of this mechanism, but is it fit for purpose?
If there is a NHS Complaint then this is separate from any disciplinary action (sometimes from a regulatory body). If you are seeing patients in a clinical capacity, no matter how good you are, how caring and compassionate, or how senior or knowledgeable, there is a high risk that at some point you will face a NHS complaint. This could happen at any point in your career, be unexpected or you can have a run of complaints. In practice, they are hard to avoid.
The vast majority of doctors when receiving notification of a complaint, will have a sinking feeling in their stomach, may express fear, anxiety and stress or even anger. It is likely that receiving a complaint will result in a strong and upsetting emotional response. After all, the vast majority of doctors take pride in their work and try hard for their patients and to receive a complaint can be seen as a body blow as well as a personal insult to a doctor who has tried their best when their working conditions are currently so difficult.
In my medical career, like the vast majority of doctors, I have been at the receiving end of complaints and no matter how upset I was (and I was always upset), I always reflected on it. I never responded straight away (though critical never to ignore complaints and respond efficiently and in a timely manner), and I tried to see the complaint not through my eyes, but put myself in the position of the complainant and try see the problem from their perspective.
I also found it very helpful to discuss with colleagues and close family and friends. Occasionally, I took professional advice from my medical defence union and always found it useful.
Often the reason for a complaint is outside the doctor’s direct control
The cause of complaints may be down to one single event but often it is multifactorial and it could be as a result of sequence of events. Some of these events may be outside the doctor’s direct control such as a problem with a hospital system, waiting lists or access to services. Although the GP practice or hospital may face a complaint, it is more often a named individual.
Often a doctor will face a complaint alone and be left to deal with the consequences. This leaves the doctor in a highly vulnerable situation, which can be very stressful and can lead to mental health problems. It can even impact on their future clinical practice making them more fearful or practice defensive medicine.
Complaints can be highly personal, sometimes written or expressed in aggressive language and the whole process can be highly stressful for the doctor. A doctor has to respond fully and in a timely manner to a complaint, coupled with a kind and sympathetic manner to the complainant whilst adhering to the principles of the duty of candour.
A doctor needs support in this kind of situation and often it is not forthcoming. They can feel isolated, especially if the compliant drags on for some considerable time adding to the stress. This is where I feel that the informal network (if it exists) of friends and family can be critical. If not, there are support services for doctors.
A complaint can be made in a variety of ways. As well as a written or oral complaint, it can come under the auspices of NHS authorities, via the CQC, the GMC or even through litigation (though litigation does carry more support through medical defence unions or legal support through NHS authorities such as NHS Resolution) and these tend to have more bite.
They can even have career ending consequences which is emotionally devastating for a doctor. It is easy for a complaint to spiral out of control in a doctor’s mind causing deep mental anguish.
The current system of complaints is damaging morale within the medical profession, and I am sure the whole system needs an overhaul. Of course, the system has to be fair to all sides, an aim that is difficult to achieve. However, doctors should not have to live in fear and dread of complaints and both doctors and patients should be adequately supported.
Such investigations should be embraced as a learning exercise to improve clinical practice. However, with a hostile climate amongst politicians. the general public and the media, doctors can be seen as an easy target. This kind of scenario does no one any good and I feel something must be done. But is there a will to reform the complaints system?
This kind of problem is a contributory problem to a depleting medical workforce that is already low on morale. The corrosive effect of a complaint can be a nasty personal experience for a doctor resulting in changed practice, (not always for the better, for example more defensive medicine) and a more anxious and stressed doctor. Worryingly, I don’t see the system changing in the near future, compounding the problems that doctors currently face.
Dr Harry Brown is a retired GP, Leeds and medical editor of GM Journal.