Poor handovers and rota gaps are a sign of problems with training, says GMC

Junior doctors who experience problems with handovers and rotas may not be getting the quality of training and support that they should be, the General Medical Council has said.

The two aspects of work were highlighted in the GMC’s 2018 national training survey as pressure points which were signs of heavy workloads and could affect patient care.1

The survey was sent to all doctors in foundation, core, and higher specialty training programmes and 51 956 trainees responded (a 96% response rate).

It found that of the 4712 (9.1%) trainees who said that their daytime workload was very heavy, 13% felt that handover arrangements did not always ensure continuity of care for patients between shifts. This was three times higher than for trainees who thought their daytime workload was about right (4.9% of 28 370).

The survey also found that over half (52.8%) of all doctors in training got less than six weeks’ notice of their roster and one in five (20.6%) felt that they were not given enough notice about the rota in advance of starting their post.

Inductions also varied, with more than 4000 trainees (8.1%) reporting that they didn’t get an explanation of their role and responsibilities at the start of their most recent post.

Commenting on the findings, Charlie Massey, the GMC’s chief executive, said, “Handovers, inductions, and well organised rotas are indicators of workplaces where teamwork and positive cultures are fostered, and where trainees feel well supported. But where these aspects run less well, doctors more commonly report poor experiences.”

He added, “Proportionally more doctors who feel unsupported at work with high workloads tell us they experience exhaustion and burnout. That can erode the quality of their training as well as potentially putting patients at risk. These warning signs must not be ignored.”

Earlier this year the GMC said that employers needed to tackle the high level of burnout among trainees.2 The survey found that 23.9% of trainees felt burnt out to a high or very high degree because of their work, as did 28.6% of trainers and 27.4% of GP trainers. Over half (56.7%) of trainees also said that they felt worn out at the end of the working day, as did 49.8% of trainers and over two thirds (67%) of GP trainers.

Royal College of Physicians president Andrew Goddard said the NHS could not risk losing more doctors because they were experiencing burnout or feeling discontented because they haven’t been properly supported. “The NHS can’t afford to not take wellbeing of staff seriously,” he said. “It is time to act upon these warning signs to protect the wellbeing of doctors, and also the patients on whose behalf they are working so hard.”

Jeeves Wijesuriya, chair of the BMA Junior Doctors’ Committee, said it was concerning but no surprise that a large number of junior doctors were burnt out given the intense workload pressures they experienced.

“These statistics lay bare the real terms impact of poor planning; if a doctor is working in an understaffed department, not getting a rota until two weeks before they are to begin a new role, and, even when they do start, are receiving no proper induction, this is bound to be detrimental to their wellbeing and affect how they feel about the quality of their training,” he said.