In a speech to fellows and guests at the RCP tonight, RCP president Professor Jane Dacre talks about values - valuing junior doctors, valuing patients, valuing the NHS, physician support for a 7-day service and the support needed to make this happen.
Excerpts from the speech include:
My theme tonight echoes that of the Oration - values. Those of you who work in the NHS will recognise from recent publicity, that, although it is still a tremendous source of national pride, it is not feeling that great at the moment. As the President of one of the oldest Colleges, I feel a responsibility to do my best to improve that situation.
One way to do that, is to focus on value. Our core values, the value we place on each other, and the value others place on us. We need to value ourselves as physicians, our roles, our achievements, our abilities and our vision. Values are at the heart of the current political situation affecting the future working and training patterns of our trainees, and consequently their morale. To provide great patient care, we need our trainees to be valued, supported and motivated.
As a medical Royal College, we are not able to become directly involved in contract negotiations, but… as a medical Royal College of more than 30,000 with around 5,000 junior doctor members, we are concerned about the impact that a perceived lack of value has on our trainees, who we know are striving to provide excellent care for patients, while passing exams, starting families, and planning their futures. They are the jewel in our crown and need to be nurtured and valued. It is disappointing that this week we have reached an impasse, but we still hope for a negotiated and fair solution as the best way forward. We still support a return to negotiation.
The RCP’s report published earlier this year on work and wellbeing in the NHS shows that doctors own health, wellbeing and engagement is intimately linked to our ability to provide safe, effective patient care, so we must Value our trainees to allow them to value their patients better, and to value the NHS.
On valuing the NHS...
Although the NHS is not as old as the RCP, it has still had time to bed in and to become a National treasure. The concept of universal healthcare that is free at the point of delivery is at the heart of the NHS. But, recent financial constraints have made life very difficult. Will it really be possible to value our doctors, deliver integrated care, 7-day services, world beating IT, and sort out childhood obesity, smoking, alcohol, with no more money?
As I mentioned, we physicians want to be valued, but the organisation we work in needs to be valued too. We want the government’s support to remove the barriers to joined up care, invest now to deliver good care in the future, prioritise what works and improve what doesn’t, and, promote public health through evidence based policy.
That is an example of valuing the NHS.
On 7-day services…
One of the major drivers for changing doctor contracts is the need to provide a 7-day service for patients. As our politicians often say, let me be very clear about this. The RCP has long supported 7-day services for acutely ill patients, and our Fellows and Members are definitely in work, Jeremy, 67% of our consultant physicians are already working weekends and evenings.
But 7-day services may not be possible everywhere or immediately – we have difficulty recruiting consultants in many specialties, especially in acute medicine and geriatric medicine, with huge amounts still spent on locums by the Trusts that can least afford it.
A 7-day service may also lead to fewer services in the week, with fewer outpatient clinics leading to longer waiting times. We will need more doctors with the general skills to help patients with common and multiple illnesses, but must not diminish the availability of our extraordinarily high quality specialist services. We must not allow the inevitable changes from the Shape of Training plans to compromise standards of training in either generalism or specialism.
Doctors covering evenings and weekends in hospitals, often physicians, sometimes find it a very lonely place, without the usual diagnostic and support services, and with reduced junior doctor cover. We cannot transfer patients if there is no-one to assess them, no way of transferring them outside of normal working hours, or no suitable community or step down services to transfer them to. Our recent commissioning report shows that services are still commissioned separately and tariffs are not designed to support seamless care or 7-day services. We need joined-up commissioning that enables patients to enter pathways of care through primary, secondary, community and social care, and for those services to also adopt a 7-day approach.