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President’s Bulletin: “Lining up the ducks” – why we need workload data

Updated on: 21 Mar 2022   First published on 16 Mar 2022

Author:  Dr Alastair McKinlay 

COVID liberation day has come and gone.  In England at least, all COVID restrictions have been lifted and the public is expected to “do the right thing”.

Unfortunately, nobody seems to have informed the virus.  Thankfully, COVID-19 does appear to be in retreat but it is not over.  In Scotland, the number of hospital cases due to COVID is actually rising again, although thankfully the number of deaths remains low.

In the Health Service, however, we now face the daunting process of having to clear up.  A bit like exhausted parents trying to restore normality after a teenager’s party.  The whole event didn’t seem much fun at the time, we didn’t get much sleep, and in the cold light of the following morning, it looks like there is a lot of washing up and possibly some re-decorating to be done.  Teaching lists, clinics, enhanced senior triage, all seem to be adding to our woes.  It is not as if the patients are being unreasonable.  Many have waited months, and some years, to get an appointment.

Most consultants, many of our nursing colleagues, and virtually all of our trainees accepted changes to their job plans or timetables at the height of the crisis, that kept the service afloat.  The pandemic may be in retreat but normality has not been restored.  Many people have not got back to their previous hepatology or gastroenterology job plan.  The price of COVID has been lost time to do the gastroenterology or hepatology “day job” and an increasing intrusion of work at home, and out of hours.

In November, we carried out a field trial of the BSG workload app.  The data are limited and have to be treated with caution.

We had 37 useable datasets of which 38% were completed by women.  78% came from England, 16% from Scotland, 3% from Wales, and 3% from Northern Ireland.  92% of the respondents held substantive appointments.

The average working week, in this small sample, was 45 hours.  Not all the respondents, of course, were employed to work full time.

37% of the recorded time was spent working from home.  25% on direct clinical care, and 12% on supporting professional activities.  So this is not simply “doing the extras” from home.  It is a direct movement of clinical care from the office to home, with all of the unintended consequences for quality of life and time with families.

Of more concern, however, 51% of the work done by women was from home, as opposed to 23% for men.  This is a very significant burden and it has huge implications for young consultants, their families, and their future resilience to cope with an increasing workload.

The medium length of a day was nine hours.  The medium length of a day without a break, however, was 10.3 hours and only 19% of working days actually gave the consultant a break.  In any other industry, this would be considered unacceptable on health and safety grounds.  Would we really want long-distance lorry drivers driving for 10 hours without rest?

When it comes to ward rounds, 38% of these were concerned purely with gastroenterology and 41% with gastroenterology and some general medical input.

So whilst gastroenterologists continue to support general medicine, despite the pressing need to get the GI backlog cleared, our data show that 90% of Health Boards and Trusts are outsourcing work to external companies.  Responsibility for those patients still frequently remains with the overworked NHS gastroenterology teams.  I suspect that a lot of the monotonous but essential work, of notifying results and deciding on patients’ management, is increasingly conducted out of hours.  I “suspect” – but I cannot prove.

This is a tantalisingly stark snapshot of our working lives, but the sample size is too small to allow us to use it effectively.  I am very grateful to Charlotte Rutter for her dedicated and tireless work as our Workforce Lead, from which she steps down in June 2022.  Her 2021 report is available to read here, and it confirms that the workforce has expanded in all areas, with the exception of Scotland, where it has actually fallen. The workforce may be larger, but the waiting lists and the workload data suggest it is struggling to cope with the demand, which seems insatiable.

The W³ programme, Workforce, Workload, Worklife, is more necessary than ever.  If we do not do something, our working lives will slowly take over every moment of our day.  Many colleagues feel that this has happened already.  Gastroenterology has the highest burnout of any medical specialty.

We have learned from our first attempt to gather real-time workload data – incidentally no other specialty has seriously attempted this before.

  • We will re-run the workload app in April of this year.
  • The census time has been shortened to seven days.
  • We have reviewed the app and the work category headings, to make them as simple as possible.
  • We have attempted to remove all the glitches we can.

Now we need our members to provide us with some hard data.  This is not just for the current generation of gastroenterologists, 51% of whom may retire in the next 10 years, it is for our trainees and the generation of BSG members to come.  If we are to engage with the Government and the Devolved Administrations in the UK, we need hard data.  If we are to make a sound case, we need to “get the ducks in line”.

Please, therefore, sign up for the workload app and give us a few minutes of your time, every day for one week, so that we can make some meaningful statements about our current condition.  It is always difficult to do something extra when you are already hard pushed and at breaking point.  Without a combined effort, however, I fear that our specialty will gradually sink.

Of course, the process still requires some personal time to enter the data, but not a lot.  The individual data is, needless to say, very useful for individual job planning, but the main motivation for doing the workload census is altruistic. It is to help other members.

  • Those still in training.
  • Those still to start their families.
  • Those who one day, we will have to call on and trust, when we become ill, or need a colonoscopy, or find that our hepatocytes are not as happy as we thought!

As Dame Parveen Kumar reminded us at BSG Virtual; altruism is good for you, and for your personal wellbeing.  So give us a little of your time, and feel a bit better in the process!

Please click here to register.


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