Working lives: The future

We have identified four themes that we believe are essential ingredients for the future working lives of paediatricians in the UK.

Much of the Paediatrics 2040 project is about forecasting and shaping scenarios of what might happen. The plausible vs the possible, the ideal vs the unjust.

We have identified four themes that we believe are essential ingredients for the future working lives of paediatricians in the UK. Below, members of our working lives project group – from medical students right through to retired consultants – have shared their views on why this is an essential part of the future paediatric working life.

Central to all of this is patient safety. Although we haven’t included this as a theme, it is core to the aims and objectives of the Paediatrics 2040 project and has been considered throughout our work.

Flexibility

Flexibility. Everyone wants it, but what exactly is it?

Undoubtedly flexibility for you looks different to flexibility for your colleagues. How do we achieve flexibility without compromising job security, educational achievement, and the high-quality healthcare provision that we all aspire towards?

We explore flexibility within day-to-day working, post-to-post rotations, training programmes and wider careers. One size can never fit all, and – as we have seen this year – flexibility for the unforeseen must be a cornerstone of planning for the future.

Departments should aspire to approve as much long-notice leave as possible, whilst also allowing flexibility for short-notice leave. We welcome the BMA Good Rostering Guide [1] – an important step towards flexible rostering. Examining departments who “Just Say Yes”, without fixed-size leave pools, may show greater worker loyalty to pick up unfilled shifts and may impact desire for less than full time (LTFT) working.

Shift allocation should consider educational opportunities, team composition and continuity of care. What shifts should we be working? Twenty-four-hour shifts offer advantages in care continuity, sleep pattern disruption and supervision opportunities. However, busy workloads in many departments would make longer shifts unbearable, and runs counter current to emerging thoughts on staff rest. Longer shifts may benefit some departments (for example, 09:00-17:00, 17:00-09:00), and others may find success with shorter, overlapping shifts (for example, 07:00-17:00, 13:00-23:00, 22:00-08:00).

Many departments are affected by seasonal workload variation. They may benefit from systems that allow increased staffing during busier periods.

Fixed-pattern rotas can allow more continuity of team-mates – a factor rated highly by clinicians during the COVID-19 crisis – but should come with non-judgemental pathways to change assignments when personality clashes occur. Self-rostering makes it harder to keep teams together but allows greater autonomy over work-life balance.

The trainee should be an equal partner when planning their portfolio of rotations. Current training pathways involve frequent rotation between posts. Longer postings allow trainees and departments to become more invested in each other. This improves learning opportunities, skill development, opportunities to engage in research/ QI/ audit/ education/ etc, and a sense of belonging among staff.

However, it gives fewer opportunities to see alternative working practices, and can be daunting if the “fit” between the worker and department isn’t right.

The opportunity to make provisional plans early in training is important, without disadvantaging those who become embroiled in exams or have individualised needs. Freedom to review and adjust plans as life circumstances or clinical passions evolve is also crucial. Trainees with specific or broad aspirations may benefit from increased flexibility to redefine careers after CCT.

Imagine you are renting a house. You have a six-month contract. The house is nice and you want to stay, so you agree with your landlord on a contract extension. Now apply the same system to training posts. Each post has a minimum term, then during the post the trainee and supervisor choose to end or extend the post based on both objective and subjective criteria. A suitable deadline to agree post extension would allow time for both training programmes and trainees to plan for future rotations.

This training scenario creates potential for rota gaps. Departments would require systems to ensure adequate staffing – such as incentivisation, or by increased service cover by non-rotational-trainee staff. Providing healthcare to patients is a vital training objective which should be prioritised with appropriate oversight and encouragement of trainee autonomy.

Possible recruitment and retention incentives for hard-to-fill posts:

  • Financial
  • Flexible day-to-day working patterns
  • Annualised flexibility (eg around school holidays/seasonal work pressures)
  • Posts incorporating non-clinical objectives (eg Bangor & Brighton A&E fellowships)
  • Posts incorporating higher qualifications (eg. Masters in Medical Education)
  • Posts incorporating international work
  • Co-recruitment of partners, assisting non-medical partners to find local employment
  • Resources to help struggling departments become more attractive places to work (e.g. building on successes of other improving departments) [2]

Deaneries should consider university-style open days and publishing reviews/ feedback on their programmes to support informed career decisions (eg Messly).[3] Medical training focuses on informed clinical decision-making, yet we lack resources to support informed career decisions. Standardised job applications have made the process fairer but removed an opportunity to meet prospective employers/colleagues.

Paediatrics has a progressive approach to LTFT, Out Of Programme, and Inter-Deanery Transfers, and this should be applauded. The flexibility offered by these rigid frameworks should be available to all staff regardless of their justification and a postcode lottery should be avoided. Increased opportunities for career breaks and flexible working patterns should be available to clinicians at all stages of their careers, along with re-entry paths at every level for those taking training or career breaks. Regular rotation “swap-shops” – within and between deaneries – would match trainees who want to work elsewhere.

Greater flexibility within the path to graduating as a doctor may translate into a broader talent pool from which to recruit the paediatricians of the future. At present the early years of a paediatric career are perhaps some of the most inflexible. High competition ratios for medical school places mean diminished choice of location of study and style of learning for students. Barriers such as the requirement for five- or six-years full time study alongside other societal barriers contribute to a lack of diversity amongst doctors and subsequently paediatricians.

One example of such innovation is the University of Edinburgh who now offer a postgraduate MBChB for healthcare professionals to retrain as doctors, where the first three years of five are undertaken part time.

The Foundation Programme is similarly inflexible with very limited opportunity for exposure to paediatrics. Forging more links between paediatricians and foundation doctors in person and across virtual platforms could help to bridge this gap and expand the “shop window” to a career in paediatrics. The option of more flexible working patterns in foundation years through category 3 LTFT working (as exists in specialty training) could help prevent junior doctors being put off from secondary care-based careers.

The changing workplace over the coming decades will demand increased up-skilling for clinicians,[4] and much work is being done on improved career flexibility. Burn-out and rust-out[5] are significant risks – especially as the retirement age recedes – and the potential to regularly retrain or reinvent one’s career will be an important facet in keeping the workforce motivated and engaged. Flexible working, job sharing, and sabbaticals or out-of-programme-style opportunities are as important for consultants and other staff as they are for trainees.

GMC credentialing proposals[6] – a regulated framework for skill development – are a welcome addition. Pathways for motivated clinicians to move between sub-specialities at any stage of their career would maximise this system’s potential and address unfairly restricted application windows by career stage. Movement between specialist and generalist roles would help to improve inter-speciality links, facilitating holistic patient care. Frameworks for moving between disciplines should recognise clinical and non-clinical skills attained in other areas.

There is lively debate about the implications of age on the anaesthetist.[7] All of us hope to become – at least a little – older, and the journey towards retirement deserves active management. Flexibility in job planning, to accommodate strengths, chronic health limitations, and maintaining job satisfaction is paramount to retaining a productive older workforce – particularly as hazards including burnout and fatigue are more common in older practitioners. Working into old age is more common in America, where challenges such as increased risk of litigation and the need to ensure practice remains safe add to the complexity of retaining older staff. Solutions including retire-and-return, flexible rostering, job shares, altered responsibilities, and greater emphasis on team-working should all be actively encouraged.

A desire for flexibility affects all stages of job and career planning. It offers potential to recruit paediatricians who better represent their patients, keep more clinicians working at more stages of their career, and to ameliorate burn-out and rust-out risks. Delivering flexible working will bring challenges for workers, employers and regulators, but we hope flexible working will improve care for workers and patients alike.

However, flexibility within paediatric careers can only be delivered in sufficiently resourced working environments, with opportunities and choices becoming more limited for those who work within systems that become stretched. Inadequate workforce planning and failure to expand healthcare professional numbers in line with population need poses a real threat to the delivery of flexibility for paediatricians as we look towards 2040.

Looking after each other

Between 2011 and 2018, more than 56,000 people left the NHS, citing work-life balance as the reason.[8] Burnout is defined as a feeling of emotional exhaustion, depersonalisation and (a feeling of) reduced personal accomplishment.[9] It is often triggered by sources of chronic stress in the workplace, including incivility, staff shortages and austerity measures. Consequences of burnout are widespread to individuals, patients and society, and can include problems with mental health, reduced quality of patient care, and reduced healthcare productivity.

When Paediatrics 2040 launched in Autumn 2018, nobody could have envisaged the rollercoaster of events that would ensue between launch and publication. Working lives have been transformed and the wellbeing of paediatricians and those delivering care to our children has become a number one issue, which needs to be pushed to the forefront of all future plans. Health is not just the absence of disease. Wellbeing is not just the absence of burnout. To deliver the best care, we need to be the best versions of ourselves and create an environment that not just acknowledges this but actively promotes it.

Improving wellbeing in the workplace is not a one-size-fits-all exercise but involves many different approaches and initiatives. This summary of ideas is based on a literature review of relevant papers and reports about improving wellbeing and health for health professionals.

The diversity among the paediatric healthcare professional workforce is fantastic and needs to be celebrated.

While there are undoubtedly wider issues that need addressing at the systemic or institutional level, numerous initiatives have focused on an individual level. Interventions need to allow for pre-existing traits and experiences which cannot be changed and have been widely researched to impact on individual risk of poor wellbeing. For example, evidence suggested that there is potential to identify those at increased risk of developing burnout and put in additional personalised tailored protective measures to minimise risk.[10], [11], [12]

Balance between unnecessary intrusive questions to delineate risk requires an extremely sensitive approach and is it recommended that professionals are supported to self-identify and acknowledge their own potential for increased predisposition.

Recent statistics have highlighted that many staff are prevented from looking after their basic needs, such as nourishment and hydration. This included reports of 40% of NHS doctors feeling unable to take a break during the day to eat and drink, and 45% of clinical staff were dehydrated by the end of their shift with associated impaired cognition.[13] As obvious as lunchbreaks sound, this is not something paediatricians enjoy on a daily basis, yet we know that patient safety and wellbeing are negatively impacted if we don’t take our breaks. Departments should invest in pleasant facilities for staff to take breaks during shifts. Managers and leaders need to 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.

There are many other evidence-based interventions that can be invested in to boost wellbeing and morale at an individual level, and departments should invest in provision of mental and physical wellbeing services for staff. Using creativity engages a different part of the brain, which is not a regular part of the day to day for paediatricians, and our literature review showed a number of ways to fit this into a day – from introducing hip-hop dance, yoga, and running into a wellbeing programme to making time for art therapy or massage. Workshops teaching self-compassion are positively associated with resilience amongst trainees and are inversely related to burnout amongst medical professionals. Mindfulness training can reduce emotional exhaustion and depersonalisation, increased resilience to stressful work environments and enhance work engagement.

More detail on all of these is available in our supporting report.

Although a lot of this may not seem like rocket science, it’s surprising how many of our members report it lacking from their working lives. In 2040, we’d like to see staff feeling able to take proper breaks to refuel on nice, healthy food, and rest and recharge. 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.

Increasing the resilience of our workforce as an offered solution to the burnout epidemic will not solve the problem. If a bath is overflowing, no matter how good your mop is, you’re going to continue mopping until someone turns off the tap. Better metaphorical mops are essential in the form of wellbeing interventions at individual levels to bide time, but wider tap-turning changes will be necessitated to prevent the roof caving in.

Fortunately, there is a growing number of people in positions of power able to convey this message and implement change with some of the evidence and interventions discussed below.

Adverse events can impact on individual wellbeing – procedures of investigating events can be drawn out and people feel blamed, even if not intentional. We need a strong awareness of the presence of a ‘blame culture’ and need to avoid the negative consequences of the good practice of investigating adverse events, including speeding up the process. 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.

Interventions that foster communication between the healthcare team cultivating a sense of team cohesion and job control have been found to be the most effective in reducing burnout. Flexibility in work schedules, ability to take time out of work schedules, feeling in control of work and being governed by good leadership all have the potential to improve our health and enjoyment in work. Rotas and wellbeing are intricately linked. Improving rotas will improve wellbeing: rotas and shift patterns should reflect clinical working patterns, including need for continuity, sleep disruption and supervision. Consideration should be given to annualising rotas to have extra staff in winter and reduce/restrict residency duty hours.

Although we still have a long way to go with technology use, 2020 has seen a host of virtual improvements that have impacted on our working lives. While the social networking benefits of face-to-face events and audience interaction have been missed, there are significant advantages in terms of international reach, cost-saving and environmental considerations. The #FOMO (fear of missing out) component has diminished. That teaching session you really wanted to go to that’s been scheduled during your annual leave can now be recorded on various platforms and watched at your convenience. Consideration should be given to how this can be expanded upon to build up collaborative cross-working both within the UK and in a global community of practice.

There is lots more evidence for what works in our supporting report on wellbeing, some of which are listed here:

  • Learning from excellence, with a refocus on when things go ‘right’
  • Debrief sessions to support teams with difficult clinical and ethical decisions
  • Emphasis on reflection and reflective learning
  • Investment in medical student and foundation trainees: career days, conferences, taster days
  • Helping doctors who have left training to return
  • High quality workplace-based assessments, time and energy into giving feedback, and supporting reflective learning
  • Innovative teaching technology, like podcasts and internationally available short talks
  • Ways to monitor and respond to morale changes; awareness of the large worldwide issues affecting our (working) lives, like climate change, political change, economic uncertainty and of course pandemics
  • Having a voice to be heard collectively though our College

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.

With so many references to inadequate job satisfaction and pride in practice correlating with burnout and impaired wellbeing, it is essential to ensure those with disabilities have every effort made to mitigate these.

Feedback from a forum of healthcare professionals with disabilities was collated by one of our working group members, with the results broadly grouped into five themes:

  1. Disability awareness and tangible support
  2. Change in attitude to those with disability
  3. Supporting safe practice
  4. Occupational health and returning to work processes
  5. Flexible training

We know that not all disabilities are visible and the cultural change in embracing these differences in a way that allows the individual to flourish and be their best self has been a slow burner. Changes are required across an institutional level alongside an up-skilling and increased awareness from those in leadership and educational roles. Feedback calls for an open culture whereby help can be requested and adjustments can be made to working lives to account for a disability without judgement.

Flexibility is key and relies on a wider consideration of occupation health to ensure adjustments to working environments and patterns can be individualised. Nobody likes taking time off and everyone wants to fit in. Creating additional hoops for people to jump through for those with additional hurdles in life is unjust and people want to feel valued not a burden.

Communication is key with those with disabilities wanting to be asked what help they need but also what skills they might have to augment services.

Experience of disability can offer a unique perspective, additional empathy and better care. Most importantly, all individuals are unique and the wants, needs and desires will vary from person to person. Whilst RCPCH guidance can likely ensure EDI training is mandated, regional training programs and individual trusts will need to ensure that their policies and processes truly allow inclusivity.

By truly tackling issues with equality and diversity, we will improve the wellbeing of large groups of paediatric doctors: with the support of frameworks and tools for those with disabilities and with understanding of inclusivity, we can promote inclusivity and wellbeing. The recently established RCPCH Equality Diversity and Inclusion (EDI) Reference Group is working to ensure EDI is ingrained into every aspect of RCPCH work and child health. We would encourage all paediatric departments to set up similar initiatives and groups to provide constructive challenge in ensuring the workforce and leadership reflects the diversity of the paediatric population that we serve.

It is clear that there is a growing body of evidence supporting many wellbeing initiatives and with the problem getting worse, rather than better, there is a thirst for things to be fast-tracked and the lag between evidence to implementation needs to be dramatically shortened. However, for effective evidence-based interventions, studies need to be robust and many studies have short follow-up periods when long-term thinking is essential. Wellbeing is also unlikely to be fixed completely with one intervention as implied by the narrow focus of impacts of single interventions. It’s a multi-factorial problem requiring a combined approach and structural or organisational need to utilise though-through detailed methodology.

Attitudes to wellbeing initiatives need more research. One size might not fit all but what are the barriers to those who don’t engage? Are they the group more or less likely to burnout? How do we ensure that what’s offered does not create inequality? In a world where there is a widening gap between the haves and have nots, artificially introducing wellbeing fundamentals into select centres only will create disparity

The COVID-19 pandemic has spearheaded a move to virtual meetings, surgeries, clinics and conferences. Much needed flexible platforms have been created, with enormous potential for virtual and home working, sharing practice and protocols, collaboration with far away colleagues and reducing stress through reduced commuting. This shift to online working means we need to increasingly consider ways to work on our wellbeing outside work in a way that is less digital, including more manual and natural activities like gardening, walking, reading and singing.

We need to use the momentum created by COVID-19 to ensure wellbeing becomes further ingrained into any and every organisational plan and KPI moving forward. It seems all the big governing and executive medical bodies within the UK are on the same page. Recent documents such as the NHS People Plan,[14] the GMC’s “Caring for doctors, caring for patients”[15] and the King’s fund report, “The courage of compassion”[16] unite in supporting the workforce and make a number of recommendations for employers, which we have written out in more detail in our supporting report.

To make paediatrics sustainable, physical, mental and psychological sustenance is essential. Defining individual wellbeing is a challenge and creating it is not a recipe that requires the same ingredients to make for all individuals. It is however clear from the literature that there are certainly overlapping, fundamental principles which are required for people to not just survive but thrive. We think these fundamental principles that are essential to ensure universal wellbeing neatly fit within the mnemonic, PAEDIATRICS:

Physical health
Autonomy
Equality
Diversity
Inclusivity
Adaptability/ flexibility
Team (sense of belonging)
Rest
Individualised
Culture (open)
Safety

Knowledge, skills and experience

In this section, we have chosen to focus in particular on the way that changing use of technology will impact the skills, knowledge and experience a paediatrician will need to have in the future, as this is relevant to members at all stages of their paediatric career journey. This section is slightly shorter than the previous two themes, largely because we have not gone into detail on paediatric training. We felt that this has already been discussed recently in detail in the RCPCH “Paediatrician of the Future: Delivering really good training” document,[17] which sets out the RCPCH philosophy for training in the future. The same document also outlines the 11 underlying RCPCH principles of excellent training, with recommendations that all paediatric schools should implement.

For paediatricians at all stages of their career journey, we have identified four key areas for focus in the future: using technology, communication at scale, evolving clinical skills, and non-clinical skills development.

The NHS needs investment and focus in providing equitable access to technology for all. As paediatricians, technology is important to every aspect of our working lives; patient care, teaching and training and innovation. Technology advances already exist and need to be incorporated to improve our daily working lives – paperless departments, rotas, sharing guidelines, mandatory training, shared patient records and more integrated working between primary, secondary and tertiary care.

Technology advancements also have huge role to play in improvement of patient care. Patients and parents of patients will become ever more involved and knowledgeable about their condition. Implantable technology will provide data and feedback on many different aspects of disease health. They will use these data to monitor, make changes to medication and improve health, through diet and exercise. This knowledge will be highly personalised.

Whether it is monitoring blood sugars and allowing parents to ensure patient safety or using virtual reality for fracture manipulation and not needing a general anaesthetic, technology has an ever-increasing presence in paediatric practice. Paediatricians need opportunity to collaborate and innovate alongside business and technology specialist to ensure new developments are taking the direction we feel are useful and beneficial and not just driven by commercial markets. Events such as the Welsh Health Hack, where there is opportunity for NHS Staff, universities and industry to collaborate and network to develop early-stage ideas that might solve operational health challenges need be offered to all paediatricians. Opportunities like this allow to collaboration and learning about new technology- for example artificial intelligence and allowing us to have some insight in to how we may utilise it.

Social media and the changing ways of communication in society need to be addressed and incorporated in to how be interact with families, and tackle health promotion and advocacy. We need some training on how to use technology and social media for health promotion, advocacy and illness prevention.

The global pandemic has provided opportunities to increase technology use and find new ways of working (virtual clinics), virtual teaching (both locally, nationally and internationally) and sharing of research via virtual conferences. COVID-19 has already showed us a future where we will learn how to be telemedicine experts and how to triage patients remotely. The development of genomics will revolutionise patient care, with whole genome sequencing made available to all. This will lead to genetic conditions being identified at birth and the need for us paediatricians to be able to discuss and communicate risk with our patient families. Technology will help share research, guidelines, and teaching. UK paediatric training bodies need to keep abreast of technology development, and ensure paediatricians are adequately trained in virtual working and able to share those skills through virtual teaching.

We should aim to be truly global paediatricians that are aware of global events and part of helping and creating change globally – whether that is supporting healthcare teaching or developing systems internationally, supporting development of knowledge about clinical conditions, or advocacy on climate change.

While technology is increasing our accessibility and is constant in our lives, we also need to safeguard our wellbeing and have clear parameters about work and home life (and perhaps and different systems/apps/programs for home life). As our ability to communicate and be communicated with is never ending, we will also need ways of switching off and not being virtually present or in ‘doctor-mode’.

In the future, paediatricians will need to continue to acquire clinical and non-clinical skills to look after acutely unwell children, children with complex medical conditions and safeguarding. We also expect they will need analyse and review these skills alongside using new technology – and making safe assessments and communicating effectively when using technology for remote consultations with families and other professionals.

However, the clinical skills needed will need to evolve alongside changes in technology and delivery of care. Remote consultation will incorporate health promotion and health prevention, as well as co-managing medical conditions, using the personalised data collected by the patient. Our knowledge of the personalised and precision medicine we will want to practise will need to move in line with the progress of the technology in this field. Increased teaching in role of genetics and personalised and precision medicine should be built into paediatric training programmes.

As an example, in the future, we expect paediatricians to learn about genomics (the study of whole genomes of organisms), proteomics (the large scale study of proteins) and the microbiome (the genetic material of all the microbes – bacteria, fungi, protozoa and viruses – that live on and inside the human body) to help us provide a more personalised medicine. Doctors will need to help families understand disease risk and respond to risk profiling. They will also need to work in partnership with patients, who will become experts on their condition through advances in data linkage and technology that gives feedback directly to the patient rather than the doctor.

We will also need to acknowledge the changing health patterns of children and young people, which may lead to shifts in the need for different paediatric specialties. For example, in 2040 we consider it likely that adolescent medicine will exist as a distinct sub-specialty, with most hospitals having a ward for adolescents up to 25 years olds, paediatricians need to be involved in shaping and caring for these patients and transforming services. We would like to see paediatricians better able to retrain, specialise and learn new skills throughout their career, not just through paediatric speciality training.

Today’s children suffer increasing psychological stress and need attention to their wellbeing as well as their physical health to be as healthy possible. Children’s wellbeing-needs have been heavily affected by the COVID-19 pandemic, with anxiety and depression seen in higher proportions.[18] Children in 2040 will likely have similar if not larger psychological needs and doctors will need to be able to recognise, understand and support. 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. This would fit with our recommendations to have closer working and training relationships with primary care, including primary care mental health teams and child and adolescent mental health services.

We need improved skills in management, business and finance to ensure we can help plan, prioritise and influence decisions on investment. There is reciprocal benefit to both industries with such an arrangement. The entire health and care system would benefit from this greater flexibility. This also needs to be reflected in our training with joint medicine and MBA programmes collaborating with our excellent business schools

We look forward to a truly paperless future, with patient data safely secured and used, between primary, secondary and tertiary care. With the potential of large data production, particularly through personalised devices, departments should make sure they are giving their paediatricians adequate training in governance, data protection and sharing, and confidentiality, which will be crucial as technology and innovation develops further.

We also want to have our feet on the (global) ground and have knowledge about climate change, pandemics and refugee health, and use this knowledge to be responsible and contributing paediatricians, as well as citizens.

Working together

Although our work focuses on paediatricians, there are so many other professionals involved in paediatric care.

This section was put together via zoom by a group of paediatricians (working together!) across the UK.

Remote and online working should be encouraged, with ongoing evaluation of its impact on services, workers and services users. Online working has allowed paediatricians to work and learn from home, which has led to improvements in work/life balance, broader teaching opportunities for trainees, and better MDT, for example allowing greater attendance at children protection strategy meetings, which involve a range of professionals. In addition, working with children and their families remotely helps families living in remote locations to access services, and reduces their travel time or time taken off work.

In the future, we expect that collaborative working with other specialties (e.g. mental health and primary care) will be the norm, particularly working closer with partners in the community to prevent unnecessary admission and referrals to hospital. RCPCH should work with RCGP to encourage more paediatric training among general practice trainees and increase their exposure to acute paediatrics. Paediatricians should learn with and within primary care. We’d also like to see increased communication across networks in information sharing about patients, including radiology information or clinic letters, facilitated by better technology.

Working together should start in training. Future paediatric training should be focused on patient population needs, but also have a portfolio component, allowing trainees to have special interests and expertise. Trainees early on in their training should shadow and work with nursing staff, to understand the running of a ward, patient flow and patient care.

There should be an increased focus on learning from other business sectors on how to improve our team building. Working creatively and collaboratively with other sectors would mean that they can help us design QI projects, and we can offer learning back to them.

There are also adjustments we think paediatric departments can make to improve our ways of working. Ergonomics of the job should be improved, for example making handovers more efficient – e.g. using a traffic light system – so that everyone can leave on time, promoting work-life balance. Departments should also 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.

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. In an ideal imagined world in 2040, we would like to see all paediatric teams incorporating the following ingredients into their multidisciplinary team:

  • Psychologists and youth workers – who could be based on the ward and emergency department to support children and young people with chronic illness and during acute admissions
  • Social workers – all paediatric departments should have an in-house social worker given the increase in admissions to hospital that are related to social/mental health issues and not directly medical
  • Music/ arts therapy/ dance – collaborative work with the arts could help with developing reflective practice and morale initiatives. We have seen this with projects in hospitals that encourage staff to dance together during lunchtimes, paediatricians working with poets to write reflective poetry to children – just imagine having the opportunity to include poetry in your treatment plan!
  • Physician associates and advanced clinical practitioners, especially those who specialise in paediatrics specifically and can offer longevity to a department and support SHO training and support.
  • Stronger links with local schools via a network of school nurses and health visitors.
  • Stronger links with colleagues in health and fitness- (not just dieticians)- to enable social prescription for free gym membership, cookery classes, money off fruit and vegetables.
  • Local community groups and lists should be available to trainees- sometimes trainees are working in very different areas to where they live so don’t have institutional/ local knowledge.
  • Working with our nursing colleagues in new ways – see Mitra and Bramwell for an example in a neonatal unit[19]
  • Better networks across specialities – e.g. multidisciplinary acute teams (paediatricians/ anaesthetics/ ED staff) – to prevent siloed working and losing sight of having the child/ young person/ family at the centre.
  • Joint teaching days with nursing and allied health professionals and the multidisciplinary professional networks – these can be great for teamwork and fantastic for morale.

We also want to work better with our overseas colleagues. The Medical Training Initiative offers international experience of paediatricians from abroad. We should utilise their expertise and share it back with our teams. We should also promote more opportunities for role swapping where trainees can go abroad to their hospitals and join them for a period of shared learning.

Our ‘leadership-look’ for the future will be accessible, approachable, involved, and not afraid to get hands dirty in the clinical arena and advocate for trainees.

Our leaders will be passionate advocates for children and young people; they will be life-long learners. All paediatricians will continue to embrace reflection as a way of learning, incorporating an attitude that promotes wellbeing and understands that it is ‘ok not to be ok’. People’s achievements will be celebrated, and good practice emphasised and promoted.

References

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