Working lives: Summary

A summary of our work looking at shaping the future working lives of paediatricians.

What our members said

We asked 294 members the question, “In 2040, what is the top thing you want to be different about the working lives of paediatricians?”

The top things they said were working hours, flexibility, better treatment and protection of paediatricians, and more staff.

What our dedicated research into working lives says…

In 2020, paediatricians have shown extraordinary resilience, and we now need to think about how to continue that support for each other into the future. COVID-19 has reminded us that it is more important than ever to take care of ourselves, so alongside this report, we’ve also published a detailed report on wellbeing and looking after each other.

Paediatricians are concerned about their working lives. Every day, they feel the impact of the lack of staffing. They reflect on how the change of paediatric working conditions impacts their clinical practice. Morale can be low and they are aware of changes in society having an impact on their way of working, with concerns of wider social issues, including inequality and poverty impacting on child health. These challenges are not going to go away overnight.

Despite all this, we remain optimistic for a brighter future, and much of this dedicated report on working lives is about celebrating the successes of news ideas from around the UK that our members want to see more of. Although we want to be aspirational in our vision for the next 20 years, we also need to be practical in recognising what there is to do in order to achieve what our members want to see.

Our working group identified four themes as the essential “ingredients” for the future working lives of paediatricians in the UK: flexibility, looking after each other, knowledge skills and experience, and working together.

1. Flexibility

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

The changing workplace over the coming decades will demand increased up-skilling for clinicians, and much work is being done on improved career flexibility. 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. Burn-out and rust-out 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. Increased opportunities for career breaks and flexible working patterns should be available to clinicians at all stages of their careers.

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.

2. Looking after each other

Between 2011 and 2018, more than 56,000 people left the NHS, citing work-life balance as the reason. 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.

Improving wellbeing in the workplace is not a one-size-fits-all exercise but involves many different approaches and initiatives. 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. For example, 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.

To make paediatrics sustainable, physical, mental and psychological sustenance is essential. 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, leaders and deaneries (or UK training bodies) should ringfence resources for wellbeing initiatives and consult with their staff on what they would like to see more of in their workplace.

3. Knowledge, skills and experience

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.

COVID-19 has already showed us a future where we will learn how to be telemedicine experts and how to triage patients remotely. 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.

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, children’s mental health 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.

With the potential of large data production, particularly through personalised devices and genetic testing and screening, 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 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.

4. Working together

The last year (2020) has taught us so much about how we work and how we work together and doing so successfully has been more important than ever. When working together, we can better consider the whole child and make every contact count.

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. In the future, we expect that collaborative working and training with other specialties (for example, mental health and primary care) will be the norm, particularly working more closely with partners in the community to prevent unnecessary admission and referrals to hospital.

Top three messages

Workforce management and planning are central to the overall planning process of transforming the way the NHS works. The current workforce is changing: younger doctors are choosing different career paths; there is a staffing shortfall, which is set to increase; wellbeing is now an essential part of improving our current workforce, retaining and attracting doctors and managing the future workforce; and technology is present and will continue to grow significantly.

Flexibility – Looking after each other – Knowledge, Skills and Experience – Working Together - it’s not rocket science, and most of what we have shared here could and should be achievable much before we get to 2040.

COVID-19 has been a disruptive enabler for many of the things we’ve covered in this report, but it has also shown us what we can achieve if we come together. 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.

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