What makes a good NHS doctor good, even great?

Key Traits That Define an Outstanding NHS Doctor

Roles in medicine continue to evolve to take account of the demands made by scientific progress and changes in societal norms, so it’s not surprising that new NHS doctors increasingly find that having great medical/technical skills is just the start of their journey.It is well documented that a significant number of medical negligence cases are not brought about due to technical, but non-technical errors, with communication issues being one of the often-cited reasons. Given that patient treatment involves more than one person, it is easy to understand why good communication skills are one of the non-technical skills essential to optimal patient outcomes.

Good doctors are able to communicate well and at all times, manage resources despite funding shortfalls, and switch effortlessly from the sharp, singular mindset needed to succeed in the more popular specialities and in competition for resources to kindness and compassion when dealing with patients and families, have good situational awareness, and can make well-informed decisions under tremendous pressure, leading themselves and their patient care teams successfully day in and day out.

How can NHS doctors acquire these non-medical/technical skills?

One way for residents to develop these skills is simply by trial and error over the course of their clinical practice; learning from their mistakes and by observing more experienced clinicians. This takes time and is no comfort to the patients and team members, who were part of this “learning curve”.  Is this prolonged on-the-job personal development approach, really sustainable? It doesn’t take many litigation cases to prove that it’s not an affordable way for junior doctors to learn either,  let alone the toll it takes on a doctor’s morale.  How can these skills be developed early on in their learning pathway?

The good news is that the necessary skills can be taught.  The timing of such training is also important.  While clinicians need this training early on in their medical career, earliest ( i.e. as undergraduates) isn’t best.  Highly focused training is best delivered as soon as possible after graduation when newly qualified doctors start putting their clinical skills into practice, and at the very least, before they take on more senior clinical leadership roles.  In this way, the non-technical skills can be more easily aligned and applied with clinical practice, keeping it relevant to modern healthcare and more easily attained, retained and implemented very quickly.

What about the content and standard of such training?

This is so much more than personal development of individual clinicians. Qualifications in non-technical skills are needed to support successful clinical practice and are increasingly sought as a pre-condition for fast-track medical training or appointment at Consultant level – communication, leadership, teaching skills, situational awareness, insight and educational skills remain key. Checking that postgraduate-level courses in clinical education and clinical leadership lead to accredited qualifications is important.

By ensuring accredited qualifications in these key areas are gained early and universally by doctors, we optimise practice, reduce litigation risk, start preparation for more advanced roles, and empower them to become involved in healthcare management in future. Ideally, doctors should revisit and build on previously gained knowledge and skills throughout their careers by having flexible courses with content adapted to the experience and problem-solving needs of individual clinicians.  Courses in clinical education and clinical leadership, for example, which upskill each individual clinician who attends, irrespective of their current stage of development, are ideal. By also linking those entering senior managerial roles with experienced and effective mentors, we show we understand that the best solutions to the worst healthcare problems emerge from a collaborative approach. By recognising the value of courses specifically designed to apply to the practicalities and pressures of acute healthcare, we demonstrate an appreciation of the difference good medical leadership may make to lifting the service as a whole.

How to fund such a framework?

The benefits to their patients and the improvement in stewardship of healthcare services at all levels of the NHS of clinically gifted doctors with optimally developed leadership, situational awareness, insight, educational and communication skills, cannot be overestimated. Improvements in clinical efficiency and savings in litigation costs would more than fund such training. A reduction in sickness rates, recruitment and retention issues (and the resulting cost of cover by agency staff), would more than fund training. The cost of salary-while-on-garden-leave and locum cover when serious clinical governance issues result in suspension of a healthcare worker would more than fund training, (because suspension in healthcare is often a failure of clinical leadership on some level – even if that level is leading one’s self). And the cost of public enquiries into systems failures and the endless (and sometimes ineffective) reorganisations that result would more than fund this training.

Now is the time for us to recognise that by creating the framework and the funding of the non-technical skills training of our qualified medical staff, the NHS would become a better performing, more effective and cost-efficient organisation on every level. Good doctors, great doctors are those doctors who have been well-trained in ALL critical healthcare skills including communication, situational awareness, clinical education, decision-making and leadership.  Patients are at the heart of everything our health service stands for. Let’s give all patients the good doctors they all need. Let’s give our doctors the full training they need to be good, to be great.   You’re worth it.  Our NHS deserves it.

References

Frequency and nature of communication and handoff failures in medical malpractice claim
https://psnet.ahrq.gov/issue/frequency-and-nature-communication-and-handoff-failures-medical-malpractice-claims

Human errors and their prevention in healthcare https://pmc.ncbi.nlm.nih.gov/articles/PMC8562433/

Communication failures contributing to patient injury in anaesthesia malpractice claims https://www.bjanaesthesia.org.uk/article/S0007-0912(21)00349-4/fulltext