Junior doctors continue to hit the headlines having decided to take the drastic step of going on strike. Morale amongst doctors is said to be at an all-time low as pressures on the NHS mount and negotiations around working hours and level of pay fail to make headway.
Whilst the issue of hours and pay are hugely important, in my experience both working as a doctor myself and more recently advising those affected by medical negligence, another area that needs to be addressed just as urgently is that of the supervision of junior doctors.
Medicine as a discipline involves junior doctors learning from senior doctors on an ongoing basis. This has always been an integral part of the way medicine has evolved and has been practised. Ongoing supervision remains in place in theory but in practice, the increasing population and the burgeoning demands made on the NHS mean that doctors are working with ever decreasing levels of supervision and are unlikely to be being supervised adequately.
This is not only incredibly stressful for the junior doctors involved, it also puts patient safety at risk. Inadequate supervision is certainly one of the key factors behind many of the clinical negligence cases that I come across. I have seen mistakes made by junior doctors undertaking procedures for the very first time where the proper checks have not been made by the supervising consultants. In some cases such errors can have fatal consequences.
It is important to remember that supervision does not just apply to junior doctors. Supervision in a field like medicine, is an ongoing necessity even at senior levels. In a case before the GMC in October 2015, two EU doctors were the first to be disciplined under legal changes that require doctors practising in Britain to speak satisfactory English. Although at first glance it appears that inadequate English was the main concern, what emerged from the case which was equally if not more worrying was that one of the doctors had held a licence to practise in the UK for the last nine years. How can this have happened? One can only infer that given this particular doctor’s poor command of English was not adequately addressed for some nine years, he cannot have been adequately supervised. The GMC (General Medical Practice) guidelines put the responsibility on all doctors to ensure that they both are supervised appropriately and supervise others appropriately but it seems that these guidelines are clearly not enough.
Our junior doctors do an incredibly tough job, working long, often unsocial hours in a high pressure environment. Adequate supervision of doctors’ work is vital both in terms of professional development and ensuring quality of care. As pressures on hospitals increase and the current GP shortage worsens it is unlikely that supervision arrangements will improve unless steps are taken to review and strengthen guidelines covering both hospitals and GP surgeries.