Advancing 'medical professionalism' vital for doctor satisfaction and high-quality health care

The government's Long Term Plan for the NHS, published earlier this month, sets out its vision for a quality health service able to cope with an ageing and expanding population. But, as many commentators point out, without the workforce it needs to support it, the plan will not meet its objectives.

More than 100,000 healthcare posts are currently vacant across the NHS and the number is likely to rise after Brexit. Indeed, the difficulty of recruiting, retaining, and ensuring the well-being of doctors has recently been described as a 'crisis' – with health organisations warning it's a greater threat to the NHS than lack of funding.

Nationally, a quarter of doctors in training say they feel burnt out by high workloads and many are planning to reduce their hours or leave the profession early. And doctors report working in a culture of blame and fear which is jeopardising patient safety and discouraging learning and reflection.

Yet all this is set against a background of an ageing population with complex health needs – increasing the demands we put on doctors and making it even more important that they can operate at their best. Healthy life expectancy at birth is currently 63 years (against overall life expectancy of well over 80), with nearly half the population living much of their older years managing one or more chronic health condition.

Claire Pulford is the incoming Director of Medical Education for Oxford University Hospitals NHS Foundation Trust and explains the situation here. She says: 'Oxford and Thames Valley is lucky not to have some of the recruitment challenges to our medical training programmes which are faced by other parts of the country, but we still see vacancies and rota gaps in many essential specialities such as acute and emergency medicine. In recent years, there has been a marked drop-off after Foundation-level training, with doctors choosing not to move immediately into more senior or specialist training posts. And morale and engagement are adversely affected, with high levels of burn-out increasingly evident.'

Medical professionalism – part of the solution

How then should we prepare and educate students and junior doctors for modern medical practice – and enable doctors to maintain professional satisfaction throughout their careers? Advancing Medical Professionalism (AMP), argues that enabling and supporting doctors to develop their professional identities is an important part of the answer.

AMP took as its starting point the RCP's 2005 definition of professionalism as the 'set of values, behaviours and relationships that underpin the trust the public has in doctors'. It built on this with a series of workshops with healthcare staff, patients and other stakeholders to explore what professionalism might mean for doctors in 2018 and beyond.

The RCP's Dr. Jude Tweedie, co-author of AMP, says: 'Medical professionalism is extremely hard to define. As doctors, we recognise immediately when it's absent and instinctively know that it's essential to great patient care and physician satisfaction – but it can be very hard to quantify. So, we went out to talk not only to doctors, but to patients, academics, practitioners and others to find out what they thought.

'The process was really fruitful and helped us identify seven key aspects of doctor's working lives essential to professionalism, highlighting the many different roles we expect our modern doctors to fulfil. From this we were then able to develop practical strategies and approaches to promote professional values, skills and attributes in each area.'

Seven key aspects of professionalism. Doctor as:

• Healer
• Patient partner
• Team worker
• Manager and leader
• Patient advocate
• Learner and teacher
• Innovator

Claire Pulford comments: 'The General Medical Council's Generic Professional Capabilities have been adopted into the medical curriculum and give a much-needed basis for embedding professionalism in education and training. Advancing Medical Professionalism provides an excellent resource to support this – to start conversations with students, trainees and other colleagues – and help individuals, teams and institutions to reflect on, and develop, their practice. In Oxford University Hospitals NHS Trust we intend to use the AMP report as a toolkit to inform our development programmes for trainees and trainers; and to explicitly reference it in our teaching, training, research, and Quality Improvement initiatives.'

Professor Joshua Hordern, of Oxford University Theology Faculty and the Oxford Healthcare Values Partnership, sits on the RCP Committee for Ethical Issues in Medicine and co-authored the AMP report. He believes passionately that humanities disciplines can provide vital insights into the modern health care challenges we face. Hordern says: 'Most doctors go into the profession with a strong sense of vocation and commitment. But heavy workloads and the increasingly complex context in which they practice take their toll. We hope the approaches in AMP can support doctors in sustaining values of compassion, respect and integrity, developing their vocation and professional identity, and refreshing their joy and confidence in the work they do."