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Care Under Pressure

Posted on November 10th 2017

The National Health Service (NHS) needs healthy, motivated doctors to provide high quality care for patients. Unfortunately, being a doctor is a challenging job in a pressurised work environment, so doctors are more likely to suffer from mental ill-health than other working adults.

A recent survey of doctors who were members of the organisation Medical Protection suggested that 85% had experienced mental health issues, including stress (75%), anxiety (49%), depression (32%) and suicidal feelings (13%). In November 2015, the Head of Thought Leadership at the King’s Fund said stress levels among NHS staff are “astonishingly high”.

When they become ill, doctors often continue to work because they don’t want to let colleagues and patients down and/or worry about the impact on their career. Many doctors also feel the benefits of their job do not make up for the workload and risk to their health. Doctors often retire early and/or work part -time or abroad. Data indicates that 61% of GPs aged 50 and older intend to quit direct patient care in the next five years and around half of junior doctors two years into practice are choosing not to progress directly on to their next stage of training.  This has led to shortages of doctors in some areas.

The Care Under Pressure study uses a literature review method called ‘realist review’ to gain insights on how to reduce doctor’s mental ill-health.  A realist review uses the published literature to understand and explain a given problem (in our case doctors’ mental ill -health).  It can answer questions such as: How? Why? For whom? To what extent?  In what circumstances?  Although other literature reviews exist, they do not take sufficient account of the complexity of the problem, are not focussed on the NHS and/or are out of date.

Therefore, this research aims to:

1) Understand when and why doctors develop mental ill-health, and which strategies to reduce doctor’s mental ill-health are effective and in what circumstances;

2) Make practical recommendations about strategies to reduce doctors’ mental ill -health and retain them within the NHS.

To do this, we have brought together a team of experts who have already collaborated successfully on other projects, and created a Stakeholder Group who can help us interpret the findings and make recommendations.  The research team will search the literature and make sense of it, using a range of strategies including drawing on our knowledge of the NHS.  At regular intervals in the process we will share our progress with the Stakeholder Group, which will include patient and public representatives and doctors who have suffered mental ill-health. 

The Stakeholder Group meetings will usually start with a progress report from the research team, followed by discussion and feedback where people can share their unique viewpoints and help us to design solutions that will work for the NHS.  As well as the reports and publications that are typically produced by research projects like ours, we will also use more innovative approaches such as cartoons, animations and plain English summaries to help our work reach a wider audience.

Professor​ Karen Mattick, Professor of Medical Education, Co-Lead for the Centre for Research in Professional Learning at the University of Exeter, and Director of the Postgraduate Certificate in Academic Practice, is the Principal Investigator for the programme. Professor Mattick is "delighted" to begin work on the NIHR funded programme, and has commented upon the ways in which Care Under Pressure is expected to improve mental health strategies for medical practitioners:

“ The NHS needs healthy, motivated doctors to provide high quality care for patients but being a doctor is a challenging job and mental ill-health can often result.  Our project will look across the continuum from medical student to senior doctor, and across medical specialties, in order to understand when and why doctors develop mental ill-health.  In doing this we will seek to understand which strategies are effective in reducing mental ill-health, and in what circumstances, so that we can make practical recommendations that can benefit the NHS, doctors and patients”. 

To keep updated on reports and publications, or to read more about the project, please visit the Care Under Pressure project page