Royal College of Physicians President: 8 Questions to Prof Andrew Goddard

Edna Astbury-Ward


April 29, 2019

MANCHESTER - Royal College of Physicians (RCP) President Prof Andrew Goddard has told delegates at its annual conference that they should stop using the word 'burnout' in relation to doctors because it implies individuals may have failed.


Prof Andrew Goddard

"What we call burnout, that sense of despair, hopelessness and loss of joy is not due to a failure of the individual," he said. "It is a failure of the environment they work in, the culture of the workplace, the workload imposed on them. Some, particularly in the States, have started to call this process 'moral injury' as it puts the onus back on the system."

He said that since he became a consultant in 2002, the number of emergency admissions has increased by over 50% but with a reduction in bed numbers of more than 25%.

"The only reason the NHS house of cards has not collapsed is that we as a health service have been working harder and harder to get length of stay down," he said.

"We feel busy, not just because the admissions are going up but because there are not enough doctors. The number of consultant posts we have been able to recruit to has fallen year-on-year over the past decade. The maths is simple. Last year just under 1400 consultant physician posts were advertised and we recruited to 800. The number of medical registrars gaining their Certificate of Completion of Training (CCT) was, you’ve guessed it, 800. Worse still, we probably lose 25% of all doctors between entering medical school and becoming a consultant, let alone the large number that retire early due to pressures of work and perverse financial incentives."

Prof Goddard spoke to Medscape UK about his presidency and his vision for the organisation.


When you became President last September, you said that your priorities were workforce issues, well-being of staff, the need to double the number of medical students and to make it easier for overseas doctors to work in the UK. What progress has been made in these areas?

I think we are making progress, you have to remember, I'm only 212 days in, and it's quite hard to get things changing, when there's been so much debate about Brexit, and there have been other diversions. I think we mustn't underestimate that Government has been rather destructive over the past 6 months. However, having said that, the College has been engaged and part of the drawing up of the new NHS People Plan that we are expecting to be released in interim form within the next week or so. I don't know what that's going to say, but I hope it will talk about medical student numbers. It is clearly going to talk a lot about nursing and GP's and I fully accept that. The big challenge, though, I think, is all about retention if we are not worried about losing 25% of our workforce, from medical school to when they actually become a consultant, then we've got a problem, and therefore, we have to think about why people leave the NHS, and that's as much because of the challenges of doing the job in a difficult environment, in a difficult culture. So we have to address that we have to make medicine an attractive career for the NHS and an attractive place to work in.

There's lots that's fantastic about medicine. I often get asked would I become a doctor again? Absolutely, no doubt, best job in the world to me. It's got some really tough bits and it's really hard but I'm lucky where I work, I've got great colleagues, I've got supportive management, it is a good place to work. I know many colleagues who do work don't work in such supportive environments and we've got to tackle that, and that comes from the top, that comes from leadership of organisations. It comes from leadership of departments,

and it comes a lot from the workload, talking to trainees, talking to consultants. It's the business of the job that stops them doing things that they want to do, spending time on training, either as a trainee or as a trainer. It stops doctors spending time with patients and it really saps the energy. So doing something about the workload is important and we can only really do that if we have more people. We can't just focus on doctors. We have to look at the whole professional team, but we have to accept that if we don't share the workload, people will get ground down and want to leave.

How much of your time as president has been spent dealing with Brexit-related issues?

About 10%. It's hard. It's become a really big thing. People are very concerned about it, clearly. The biggest concern for us about Brexit is the no-deal because that will have a huge impact on the NHS, both from the point of view of the impact on the economy and therefore the funding available to the NHS but a lot to do with the work itself. If the UK is not an attractive place for people to come and work from the rest of the world, we will really struggle. We know that 8% of consultant positions are from the EU. But more importantly 15% are from the rest of the world. What brings them into the UK? It's the quality of training, it is the quality of the system. But it is also that the UK is an attractive place to work, a no-deal Brexit will make the UK a very unattractive place to work.

Can the NHS survive and thrive after Brexit?

It will survive after Brexit, it's unlikely to thrive in the immediate future. No doubt Brexit is going to have an impact on workforce. It's going to have an impact on research. Research is one of the things that keeps our NHS vibrant and takes us forward as a health care system. We must be very aware of the damage that Brexit will do to research…we will get through it, but I think it would be wrong to say the NHS is going to thrive after Brexit and anybody who says that I think is deluded.

You said that nursing and GPs are a big part of the new NHS People Plan and that these are the sectors that are really strained. You said that we are working harder and harder to "keep the hamster wheel going", and that in 15 years, there will be double the number of people retiring and we have no plan for this. You said that you "foresaw a tsunami on its way". How do you see that we may turn that tide?

We've got time. That's why I talk about medical student numbers. Increasing numbers of medical students is not going to solve the problems that we have today but it's going to help temper the problems that we have in 15 years' time. We can see this wave coming, a wave of retirement, we can see the change in demography. We know that 41% of consultant positions who are women, work less than full time. So you have to calculate that into our workforce planning, decide how many people are going to work less than full time and how many people are going to work full time. We've never done that before, for some reason, in our workforce planning. So you can be very clear that the number of doctors we need in 15 years' time is much higher than the number we need now, let alone then adding into the calculation, the shortages we've currently got, 45% of consultant physician appointments are unsuccessful because there are no people to fill those jobs. 1400 consultant posts are required by the NHS as new jobs per year…we can only fill 800 of those because we only produce 800 registrars at the end of training. And that's saddening, really, isn't it? But it gives you a challenge within your presidency.

Your second priority is staff well-being and the need to improve the morale of doctors, especially trainees suffering from heavy workloads, high levels of stress and burnout, what progress has been made in your 212 days?

I think that in the past 2 years well-being has gone from being a bit of a niche, occasionally talked about topic to becoming one of the main topics. Everybody in the NHS has woken up to the fact that looking after your staff is in the interests of the NHS, and in the interest of good patient care. The trouble is that a lot of people do seem to be on the 'well-being stage', lots of actors, not much plot, and certainly not many people taking a leading role. We the College need to be one of those lead actors and start to set things straight. I've always said that well-being would be one of our main strategies for the next 4 years. How we engage with the leadership of the NHS, but within hospitals themselves within teams is going to be critical to the success.

I think we do tend to focus on the negatives and that's sufficient to wake people up to say there's a problem, but we suffer a bigger problem if we focus completely on the negatives, if we don't start to think about solutions and what we can do either as a profession, or as a system to try and address those problems, we won't get anywhere.

So much has been said about you being the youngest president in 400 years. Do you attach much importance to this yourself?

Nope, not as much importance as other people have attached to it! I have been told by a couple of people that I'm too young to do the job, which I found very amusing. You have got to remember, I've been working in the College for many years. working in senior roles for 10 years, and you know, I am a jobbing NHS consultant and that is probably the most important experience that I need to do my job well to know what's happening in the real world to be able to relate to consultants and trainees and other healthcare professionals. But also, when I'm talking to politicians, I can say how it is on the ground and I think that's very, very important.

You've already said that you do on-call, and you're very much an on the ground physician, and so you can tell it as it is. You're also famous for saying "medicine is brilliant", and the BMJ has referred to you as a 'brilliant dreamer'. Do you like that title?

It makes me sound a bit like my head's in the clouds but I know what I dream of, even though everybody may think medicine is broken. That's my dream. I do believe that you think about the advances that we've made in medicine. You think about, what you love the most is doing a clinic and having somebody with a complex set of problems that has really upset them and stressed them to talk them through and to come up with solutions. So they walk away feeling better, you know, doing challenging endoscopy and talking to relatives and just making people's journey through the NHS easier but I also love teaching, and seeing trainees grow from people who, who didn't know much about something to becoming an expert in it. I did a lot of clinical research when I was a younger man, and you know, it's exciting. There's lots of brilliant stuff in medicine. As a 'medical politician' for want of a better phrase, as President, I have to act in that role. I have to put pressure on the system, I have to raise the issues that need addressing. But the bottom line is I still think medicine is a brilliant career. And there's lots for everybody.
And I think that's a dream that actually, you know, you hope to build global relationships, and that we have much more in common than we think. And that we're all hoping to achieve the highest quality care for our patients, but also to look after each other.

Would you say you came into your presidency at a turbulent time?

Interesting. I believe it's interesting.

Image Credit: Lettie Pattinson 


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