Why we need a chief registrar

The Salisbury NHS Foundation Trust's Dr Susan Hayward highlights the key reasons for having a chief registrar.

I was asked recently if doctors’ lives were different now than they were 10 years ago. I would say categorically yes. For me, it is about the loss of community, of knowing and supporting each other, of feeling like part of a team, of belonging.

We need to change that culture. We need to focus on wellbeing and morale not just to improve a survey score, but because improving doctors’ working lives is vital. There is evidence that patient care improves with happy staff[1]. This is not surprising when you consider Maslow's Hierarchy of Need[2] is grounded in meeting basic needs and a sense of belonging.


    Maslow's Hierarchy of Needs


    There has been a lot of attention on wellbeing and morale in the NHS workforce, particularly in relation to junior doctors. The recent ‘eight high impact actions to improve the working environment for junior doctors’ highlights important areas for improvement, such as:

    • safe travel and rest breaks
    • access to food and drink
    • engagement and communication between doctors and management
    • rotas that promote work-life balance
    • support and mentoring
    • rewarding excellence, and
    • tackling work pressures.

    The Royal College of Physicians (RCP) and Royal College of Anaesthetists picked up similar themes in recent reports, while the Institute of Healthcare Improvement focused on the importance of increasing joy in the workplace in their recent white paper.  

    Improving welfare

    When thinking about how we can improve welfare and morale amongst doctors, it is important to consider why doctors are different from other NHS staff, and how the situation has changed over time. Junior doctors nowadays have to deal with constant change, centralised and repeated application processes, a lack of job security and a reduction in choice of jobs and location. Stressful episodes including moving house, changing jobs and exams, occur frequently.

    Staff changes, especially at senior level, can lead to unclear expectations and having to work out what is required in the new team.  There is a regular requirement to change hospitals or wards (sometimes monthly) which means learning new skills and meeting new people, but can also mean losing your support network and not knowing where to go for help and support. This may be compounded by a requirement to move house or endure a long commute, which may impact the ability of family and friends to provide support.

      In a job which has always had the high pressures of exams, uncertainty, and high expectations of others and themselves, some doctors may not realise the need for self-care

      Dr Susan Hayward

      In a job which has always had the high pressures of exams, uncertainty, and high expectations of others and themselves, some doctors may not realise the need for self-care, with the resulting higher chance of stress and illness. The fact that many persist nonetheless, shows how resilient doctors are. However our ability to watch out for colleagues is impacted by the circumstances of constant change. If we do not know our colleagues, it is more difficult to notice if they are not themselves.

      What can we do?

      So what can we do? To improve morale, a good place to start is with meeting basic needs (like access to food and drink) and increasing a feeling of belonging. Other ideas include offering more opportunities to pursue areas of interest, forums to share concerns or ideas for improvement, increased flexibility in work or training, or providing someone to talk to. It may be that a hospital already provides this level of support, but frequent rotations could mean that junior doctors are not there long enough to find out about or take advantage of it.

      I think it is vital to support and encourage work to improve junior doctor welfare and morale. The chief registrar scheme is an outstanding example of providing someone like me, with primary insight into issues affecting junior doctor working lives, with the time and resources to do something about it.

      Dr Susan Hayward works at the Salisbury NHS Foundation Trust.

      1. Pinder et al. (2013) 'Staff perceptions of quality of care: an observational study of the NHS staff survey in hospitals in England.' BMJ Quality & Safety doi:10.1136/bmjqs-2012-001540.
      2. Maslow, A.H. (1943). "A theory of human motivation". Psychological Review. 50 (4): 370–96. doi:10.1037/h0054346 – via psychclassics.yorku.ca