With an estimated shortfall of 50,000 doctors ahead of what is expected to be one of the worst winters on record for the health service in terms of demand and backlog of care, England just 2.8 doctors per 1,000 people, in comparison to an EU average of 3.7.
A recent survey of BMA members in England found that significantly more doctors worked extra unpaid hours (45%) than paid (24%) in August, and nearly two-thirds of respondents feel the NHS is heading in the wrong direction.
Dr Chaand Nagpaul, BMA council chair, said that the NHS is heading in the wrong direction is unsurprising and the current draft of the Health and Social Care Bill carries significant risks and fails to properly address the problems the NHS is currently facing. He also mentioned that many now considering leaving the NHS, further depleting the NHS of expert talent.
“Winter is an incredibly difficult time for the health service, and we just about made it through last year with the demands of Covid-19 on top of usual pressures. With flu season on the horizon and even fewer staff this time round, it’s a total unknown as to how well our services will cope – if they even cope at all. And this is before we even consider the enormous backlog of care generated by the pandemic,” Dr Nagpaul said.
NHS backlog and work pressure
There are two types of backlogs. One is an elective backlog, which includes all those procedures which have been postponed for a long time. The other backlog means cases of diabetes, cataract, chronic diseases, and those routine checks, which were stopped during the pandemic. For instance, there'll be people with diabetes who haven't been checked for two years.
Speaking to Asian Voice about the backlog and its impact on ethnic minority doctors of Asian origin, Dr Partha Kar, NHS England’s Diabetes lead and National Advisor for Medical Workforce based on Racial Equality said, “There is a huge amount of work pressure coming. One of the issues with the people who come from our community is there's no risk fight. There's been no break, people have fought with Covid, and suddenly, they have to deliver amid the backlog and work harder. But I think the added focus for people from our community is that they haven't been home for nearly two years. Breaks are going to be quite important for their own mental health. The risk of those leaves being cancelled is going to cause a pretty big issue. With the continued added pressure, there is a possibility that winter might be quite hard for us.”
Addressing how this backlog may impact trainee doctors, he said, “When you talk about trainees, one of the big things for them is direct training has anyway slipped away, because of Covid,” and they have not been able to operate in a supervised atmosphere because in urgency, seniors need to take charge and trainees can only stand and watch.
“There is a degree of concern amongst trainees, about how will this actually translate into actual practice. I think there is a huge period of uncertainty at the moment,” Dr Kar said.
Training and career progression take a hit
He also mentioned that there's no clarity about the training and career progression. “It is an added double whammy where there is differential attainment based on where you come from. Ethnicity does tend to drive where you get to. So does this push things back? Or is this an opportunity for people to say, well, here's a reset? You can use this opportunity to make it a little bit more level playing field. I would be interested in interacting with the colleges to especially when the plan comes out to see how it translates to make sure you're not perpetuating the problems that have been there. There are other issues when you are under pressure, that this doesn't translate into any form of bullying of your juniors. The idea would be not to do it to anybody and make sure that everybody is protected,” Dr Kar explained.
Dr Chandra Kanneganti, GP, BIDA Chair, Conservative Councillor, Lord Mayor of Stoke-on-Trent City told Asian Voice, “The backlog in NHS is affecting everyone. GPs are overwhelmed with patients waiting for their appointments. The UK has the sedans worst doctor numbers in Europe, and we are short of doctors in every speciality. As the number of immigrant doctors has come down due to Covid, we are seeing more problems with the backlog. The UK may have to step up increasing medical students’ places and encouraging doctors to come here by streamlining the immigration process and examinations for them to practice here.”
Commenting on the backlog, Dr Ashraf Chohan MBBS FRCS, Chairman Conservative Friends of NHS, told us, “The UK is facing severe shortages of doctors at all levels. The government has announced a 5.4 billion pounds injection which will go to social care. The government has announced another boost of 8 billion that will address the backlog. The backlog unfortunately hasn’t been defined yet. I have heard that Orthopaedic and Trauma and Ophthalmology only constitute 900,000 patients waiting for appointments. Cardiology and gastroenterology make up 500,000. The National Foundation has assessed that to deal with this backlog, an extra 4000 full-time doctors may be required.
“Surgical specialities are the worst affected in terms of piling up a backlog because of cancellations of routine surgeries. Cancer Care has also been affected to some extent. the government is now paying due attention. Racial attacks on BAME doctors are not common but must be condemned. Racial discrimination should be considered a crime and dealt with by criminal law; that’s the only way to stop it. The government’s steps by boosting money injection for social care and NHS to deal with backlog are in the right direction and Boris Johnson must be praised for his bold and unpopular steps.”
Terrible pressure on the acute sector
In a detailed conversation with Asian Voice, Dr Rahul Mukherjee, Lead Consultant Physician for Respiratory Medicine and Honorary Senior Clinical Lecturer, University Hospitals Birmingham, explained that there is a big move on prioritising the acute sector, with the government's long-term strategy of trying to privatise a large part of the NHS GP, under which, a hospital will basically provide acute and emergency care as a priority. Everything else can wait.
He said, “Covid-19 has created terrible pressure on the acute sector. For example, this winter can be terrible, again. The biggest issue is that the government is wanting to say that we will have to now create bespoke arrangements.
“I'm a respiratory physician. The number of patients I can see in the clinic is half because I only see right relatively complex respiratory patients and they all need Lung Function tests. Whenever they have a Lung Function Test and a machine trial, that room must be left empty and needs to be sanitised.
“GPs are being expected to do as many consultations as possible over the phone. That will mean is there will be even bigger waiting lists for hospitals because patients are now not being able to see a GP.
“There are ambulance queues, even in the peak summer and not being able to deliver patients,” he mentioned.
Foreign v/s British
Addressing how immigrant doctors will survive this backlog, Dr Mukherjee, said that Asian doctors must make a very clear distinction between overseas graduates and British graduates.
“If you look at the 28% overseas qualified Asian doctors like me, they are three times more likely to be working in hospitals or in inner-city GP areas. The concentration of Asian doctors in London as GPs will be much higher. That would give you the picture that wherever there is deprivation, higher disease burden, you have got much more Asian GPs. So Asian doctors who qualified overseas, are absolutely at the frontline, and they are disproportionately represented.
“So, if you hypothetically, find 20 out of 200 qualified Asian GPs online, you will find 90 out of 200 Asian doctors who will deal with acute diseases. So, the proportion of Asian doctors in the undesirable specialities is higher and this is exactly what happens in any society,” Dr Mukherjee added.
He went on to say, “I landed in this country 27 years ago. The number of medical school seats between then and now has gone up by 250%. Despite this increase, they still have to massively import doctors.”
UK will have to continue employing immigrant doctors
Speaking to the newsweekly, Dr Thomas John, Locum Consultant in Acute Medicine, said, “I am not sure if they (Asian doctors) have been affected any differently from other doctors. Those who tend to avoid work get away with less, whereas those who are willing to work get piled on with more work.”
When asked if the UK has trained enough people to clear this backlog amid news of not absorbing more immigrant doctors from foreign countries, Dr John said, “No. Not at the moment. They are increasing the intake of medical students so in the long-term things might change. There is a shortage of doctors and I think that they will have to continue employing immigrant doctors in the short to medium term. Employing more immigrant doctors won’t help this winter anyway as they are unlikely to move to the country and be fully ready by this winter.
“The backlog mainly is in clinics and with surgeries, which are managed by consultants/registrars. Immigrant doctors from abroad are usually employed at more junior levels. So, the question of employing immigrants is not really for this winter, but for the next few years.”
“Racist attacks can be quite demoralising. However, we do receive a lot of negative reactions from patients, racist and otherwise. I am sure that if someone has been a victim of a racist attack, they are far less likely to be motivated to go the extra mile in service provision, but I am not certain to what extent that will have a bearing on helping clear the backlog,” he added.
