Throughout this work we have focused on what the future could be, rather than saying what it definitely will be. By doing this, we are aiming to highlight what needs to happen to make our dream for the future working life of a paediatrician possible. We do not believe we have necessarily got this ‘right’ but hope we have delivered enough thought-provoking material to help individuals and institutions work towards a better future.

All the enablers we have suggested will need to be trialled and tested and a combined approach might be needed. More research and evidence is constantly emerging and needed.

Our vision for 2040

In 2040 we hope to see….

• Doctors working remotely with multidisciplinary and global teams to support clinical decisions, sharing their knowledge, guidance and research
• Doctors having knowledge and understanding of new medical technology and data interpretation, to benefit and create personalised health care, working in partnership with patients
• Stronger links between paediatrics and other specialties, with paediatricians and GPs finding ever closer ways of working together
• Increased consideration of the whole child and a focus on making every contact count, for medical and social care, health promotion and teaching and training
• Flexible and progressive rotas which allow doctors to deliver high quality patient care, not impeded by excessive workload, allowing for both continuity of care and attention to sleep, as appropriate.
• Staff wellbeing being at the forefront of institutions, with attention to taking proper breaks to refuel on nice, healthy food, the ability to rest and recharge and initiatives to promote health and balance
• All staff feeling like they are part of a cohesive team, with true inclusivity, attention to diversity and modern leadership
• Inclusion of different working models within paediatric teams and inclusion of more varied multidisciplinary team members to support patients
• Trainees who are supported to obtain the best career fit, with flexible training options
• A paediatric workforce that is involved and influences global health, climate changes and inequality

Enablers

In order to achieve our vision for 2040, we think the following needs to happen…

Flexibility

• Departments should aspire to approve as much long-notice leave as possible, whilst also allowing flexibility for short-notice leave.
• Shift allocation should consider educational opportunities, team composition and continuity of care.
• Training Programme Directors should consider how to better enable trainees to be equal partners when planning their portfolio of rotations.
• Deaneries should consider university-style open days and publishing reviews/ feedback on their programmes to support informed career decisions.
• Increased opportunities for career breaks and flexible working patterns should be available to clinicians at all stages of their careers.
• Deaneries should consider participating in regular rotation “swap-shops” to match trainees who want to work elsewhere.
• Consideration should be given to building greater flexibility within the path to graduating as a doctor.
• More links should be established between paediatricians and foundation doctors to expand the “shop window” to a career in paediatrics.
• Pathways should be established for motivated clinicians to enter paediatrics and move between sub-specialities at any stage of their career.

Looking after each other

• Wellbeing should be made a Key Performance Indicator within organisations.
• Rotas should be standardised, and consideration should be given to annualising them to have extra staff in winter and reduce/restrict residency duty hours.
• Departments should invest in pleasant facilities for staff to take breaks during shifts.
• Consideration should be given to protecting more time for peer support and mentoring.
• Departments should invest in provision of mental and physical wellbeing services for staff,
• Further research around wellbeing should focus on attitudes towards different wellbeing initiatives.
• Departments should use feedback from staff surveys relating to wellbeing as key metrics indicative of quality and safety of care, acting on them with appropriate initiatives for improvement.
• Managers and leaders should ensure the working environment doesn’t just allow but encourages staff to stay hydrated, eat and take a break, and consider role modelling this in their own schedule.
• Managers and leaders should ringfence resources for wellbeing initiatives and consult with their staff on what they would like to see more of in their workplace.
• Managers and leaders should use lessons learned techniques to share positive practice examples relating to the investigation of adverse events to shape the way the process evolves to reduce impact on wellbeing and morale.
• Regional training programs and individual trusts should ensure that their policies and processes truly allow inclusivity.
• All paediatric departments should set up EDI initiatives and groups to provide constructive challenge in ensuring the workforce and leadership reflects the diversity of the paediatric population that it serves.

Knowledge, skills and experience

• The NHS needs investment and focus in providing equitable access to technology for all.
• Departments should look at offering training to improve skills in management, business and finance to ensure paediatricians can help plan, prioritise and influence decisions on investment.
• Paediatricians should be offered training in how to use technology and social media to do health promotion, advocacy and health prevention.
• Training in using new technology to making safe assessments and effectively communicate in remote consultations should be prioritised for all paediatricians.
• Increased teaching in role of genetics and personalised and precision medicine should be built into paediatric training programmes.
• Psychological training should continue be part of paediatric training and this should be expanded. Trainees, SAS doctors and consultants alike should have the skills to understand and help children with the psychological consequences of chronic disease, life-style related disease and the physical presentations of mental health problems.
• All paediatric schools should implement the 11 principles outlined in the RCPCH document “Paediatrician of the Future”.[1]
• Paediatricians should be better able to retrain, specialise and learn new skills throughout their career, not just through paediatric speciality training.

Working together

• Remote and online working should be encouraged, with ongoing evaluation of its impact on services, workers and services users.
• RCPCH should work with RCGP to encourage more paediatric training among general practice trainees and increased their exposure to acute paediatrics and for paediatricians to have more understanding of primary care.
• Consideration should be given to how patient information can be better shared, securely, across networks, facilitated by better technology.
• Consideration should be given to how virtual learning practices can be better used to build up collaborative cross-working both within the UK and in a global community of practice.
• Training bodies should consider how working together across professions can be facilitated in paediatric training, for example shadowing nursing colleagues.
• Consideration should be given to how paediatricians can collaborate and share learning with other business sectors.
• Departments should consider how the ergonomics of day to day jobs can be improved, including handovers.
• Departments should support a diverse workforce by establishing inclusive working models for those who have physical and/ or hidden disabilities and reducing the barriers to develop their career in paediatrics.
• Consideration should be given to working better with overseas colleagues, including opportunities for role swapping for trainees.
• Departments should seek to continually review and improve their multidisciplinary teams, especially considering which professionals should be co-located, and where stronger links need to be built with local organisations.

Final words

Through this work, we hope that we have given you a flavour of what paediatricians would like their working lives to look like in 2040. It’s not rocket science, and most of what we have shared here could and should be achievable much before we get to 2040.

We wanted to end on a note to our members. We hope that we have inspired you to reflect on your own working life, and to consider the ways you can push for change. There are a number of reports out there which we would encourage you to read.[2], [3], [4]  We’d also encourage you to find time where you can for QI projects, research work, and engaging with RCPCH committees – and maximise any opportunities you have to support and enable change. COVID-19 has been a disruptive enabler for many of the things we’ve covered in this work, but it has also shown us what we can achieve if we come together.

We are very grateful to the members who have, despite the challenges of 2020, still given up their time to input into this work. Through our collective voice, we hope to see our vision of 2040 made reality.