Giving junior doctors a voice: lessons learnt by a chief registrar

As she nears the end of her year as a chief registrar at Aneurin Bevan Health Board in Wales, Dr Sabreen Akhtar recounts her experiences and highlights what makes a good leader, how to engage trainees in quality improvement, and why the NHS community is so important to her.

There are some fantastic, sustainable improvement initiatives in the NHS that improve care for patients, boost staff morale and provide opportunities for learning and development for trainees. As trainees, we already work above and beyond to cope with the pressures facing the NHS. Finding the time to reflect on service improvement, and share successful initiatives with colleagues, isn’t always possible.

When I started as a chief registrar in September 2016, staff morale was extremely low, particularly among trainees who were going to be affected by the incoming junior doctor contract in England. When I spoke to my peers and the trainees I was supervising, there was a common feeling: they didn’t have a voice.

It’s imperative we empower those on the front line to offer their ideas and concerns to management.

Dr Sabreen Akhtar, chief registrar, Aneurin Bevan Health Board

Open communication with trainees across the organisation was lacking. Teaching sessions were poorly attended and junior doctors rarely engaged with managers’ attempts to hear their ideas or concerns. As chief registrar, it was important to me to address this cycle and encourage my peers to be the drivers of change.

I decided to lead regular meetings with the trainees. I wanted to hold these sessions in a more casual setting, not a formal meeting room or in the postgraduate centre. After agreeing budget with the medical director, I led the refurbishment of the doctors’ mess to be the place for trainees to meet.

The 'mess meetings' are led by trainees and I use our time together to find out which issues are most important to them. I usually circulate a loose agenda and chair the meeting but it is understood we can be flexible around the needs of attendees. I want to know their ideas for solutions, and whether they are prepared to take them forward. Junior doctors understand front-door systems and patient safety concerns; it’s imperative we empower those on the front line to offer their ideas and concerns to management.

Some battles have proved to be challenging; others are surprisingly easy. For example, the health board has two acute hospital sites and they had different pay rates for locums. Wales is a small place, so all trainees knew about the issue but no one felt empowered to raise it with managers. Instead, the rota gaps on one site went unfilled.

I knew there would be mutual benefit to staff and managers to have the problem resolved. I gathered feedback from trainees and took it to management. I thought raising issues of pay would be really challenging, but it was actually an easy win. Trainees now have fair pay on both sites, rota gaps are filled and staff feel valued. Having a chief registrar who was able and empowered to intervene was crucial.

The chief registrar role is absolutely essential in a busy hospital and I want to see one in every health board in Wales.

Dr Sabreen Akhtar, chief registrar, Aneurin Bevan Health Board

The 'mess meetings' highlighted patient safety concerns raised by trainees. Junior doctors wanted to be competent at practical procedures, yet were struggling to achieve and maintain these competencies. The solution provided, implemented and driven by one of the trainees was the introduction of a procedures bleep which I secured funding for. This is now carried by each of the trainees for one week and they are made aware of all the practical procedures available during that week. This ensures that our trainees meet their training requirements, achieve and maintain competencies and safeguards patient safety.

The chief registrar role is absolutely essential in a busy hospital and I want to see one in every health board in Wales. My job is a conduit between trainees, managers and clinicians; it is a link that wasn’t there before. The role has also allowed me to introduce trainees to the people who can influence change. It’s easy to say ‘we value trainees’ in a logo or a poster. Showing trainees that they are valued is another thing entirely.

Since I first became a doctor, I’ve been sad to see medicine losing its sense of community and togetherness. We can find innovative solutions to challenges and work through problems together. It is up to us – as future consultants – to turn the NHS around while we have the opportunity.

If you’re interested in leadership and management, and you care about making real change in the NHS, become a chief registrar. It is a unique opportunity because you can combine working to improve the NHS with your training.

I’ve learnt a lot about myself from being a chief registrar, particularly how I respond when I’m faced with a challenge. A good leader is prepared to listen, take on board concerns, and is interested in solutions. A leader isn’t someone with a clipboard. It’s someone like me, a passionate doctor with young children, who empowers colleagues and strives every day for improvements to patient care.

Dr Sabreen Akhtar, chief registrar

Sabreen was a chief registrar in the first cohort of the Future Hospital chief registrar scheme. Recruitment for the 2017/18 cohort is now closed but information on the next stages of the scheme will be available soon.