0:00

We can't afford not to do this for

0:02

very clear reasons that we won't have

0:04

a workforce if we don't do it.

0:15

Good morning. Welcome to the BMJ in Nuffield

0:17

trust round table on how can we

0:19

enable truly flexible working

0:21

for the NHS work force of the future

0:24

and of today, I hope as well.

0:26

So I'm Cameron Abasiewicz and chief of the

0:28

BMJ, and we've got a

0:30

great panel here with us. I'll ask them to

0:32

introduce themselves in a minute,

0:35

but just to kind of set the scene, as demand

0:37

grows for healthcare. We're

0:39

all living and breathing that. The

0:41

NHS needs more workers to meet

0:44

that demand. And yet, the number of workers leaving

0:46

the NHS we all know is

0:48

increasing. And many

0:50

of those people are leaving because

0:53

there's a desire for a better work, life

0:55

balance, understandably. And

0:57

that may well be the biggest single reason

1:00

for people leaving the NHS at

1:03

the moment. So why

1:06

is the NHS so intolerant

1:10

towards flexible working? In many ways, it's

1:12

inflexible working. And what can

1:14

be done to enable truly flexible

1:16

working for the workforce

1:19

of today, tomorrow, and

1:22

the more distant future. So

1:25

to our panel, we have with us a

1:27

large institution ourselves, Rachel

1:29

Hutchings,

1:30

Hi, everyone. Yeah. I'm Rachel. I'm

1:32

a fellow at the Nuffield Trust and was

1:34

one of the authors of the report

1:37

and future proof exploring the impact of principle

1:39

carrying responsibilities in surgical careers.

1:43

Thank you. For Zana, who's saying?

1:45

No. Hi, everyone. Ovidiam Fazano has signed

1:48

GP in New of Middle

1:50

East, London. Theo

1:52

Stine? Hi. I'm Theo Stine. I'm

1:54

Chief Executive of Leads Community Health at Trust

1:56

Standard Trust Day of the Trust.

1:59

And Sarah Sweeney? Hello. I'm

2:01

Sarah Sweeney. I'm Interim Chief Executive of

2:03

National Voices. We're a college of over two

2:05

hundred health and care authorities working

2:07

to make what matters to

2:08

people, a matter in health and car.

2:16

So Rachel too first, I mean, you you

2:18

just published a report on the impact

2:21

of parental and caring

2:23

responsibilities on surgical careers.

2:25

It's in this week's BMJ, hot soft compresses.

2:27

Could you tell us what you found in your report?

2:30

And what the impact is on individuals

2:32

and the system. And

2:35

I

2:35

mean, I guess the topic of the moment, how does

2:37

that relate to retention.

2:40

Yeah, absolutely. So we

2:42

looked at specifically the impact

2:44

of parental and caring responsibilities on

2:46

a number of different aspects of surgical

2:49

careers. So the things

2:51

around career choice, so

2:53

choice of surgery or choice of surgical

2:55

specialty participation, so

2:58

things like working patterns, progression,

3:01

and also more generally individual experience

3:04

and well-being. Being. We

3:06

found that people

3:10

did recollect that their parenting decisions

3:12

are experiences had impacted on

3:14

their career choice. So two in five

3:17

people who responded to our survey thought

3:19

that their experiences had made them less

3:21

likely pursue a career in surgery,

3:24

over half felt that it had influenced

3:26

their decision around surgical specialty. I

3:29

think overall, we found dissatisfaction

3:32

with access to a lot of things that

3:34

can help people who have parents

3:36

in your caring responsibility, so things

3:38

like access to less than

3:41

full time working or amended working

3:43

patterns, a real consistent

3:45

lack of information. And

3:47

I think overall in terms of the question

3:50

about what this might mean for retention, fifty

3:53

five percent of people who responded to our

3:55

survey said that their experiences

3:58

around parenting had meant

4:00

that they considered leaving their role in

4:01

surgery. And we know totally

4:04

from some of the discussions we have that there are a

4:06

lot of people who've already done

4:07

that. You've been reaching one of stats in your

4:09

report is that you looked at less

4:12

than full time working. And it seems

4:14

that in other specialties, other

4:16

than surgery, there had been some changes but

4:19

surgeons remain static at about seven

4:21

percent of people working less

4:23

than full time in surgical

4:25

training posts.

4:26

Yeah. So I think in terms of the numbers,

4:29

it's sort of plateaued in surgery. So, yeah,

4:31

we've seen an increase in other specialties,

4:33

but less so in surgery. Some

4:35

of the initial work that the

4:37

Royal College of Surgeons in England who commissioned

4:40

this work did that was

4:42

published towards the end of last year. And

4:44

found that there were a number of challenges around

4:47

less than full time training and working within

4:49

surgery, which were really echoed

4:51

in the work that we did. Might

4:53

help to elucidate some of the reasons

4:56

why that might be. So we did hear of

4:58

quite a negative culture around less than

5:01

full time working. So perceptions

5:04

that people who work less than full time

5:06

were less dedicated or less committed

5:09

to their career. I

5:11

think also we heard from some of the

5:13

people we spoke to that because things

5:15

like because the surgical training pathway

5:17

is already quite long, there was a

5:19

kind of concern that actually working less than

5:21

full time would obviously add to that length

5:24

concern around people missing out on things

5:26

like training opportunities, so real kind

5:28

of practical challenges. And

5:30

think just going back to that culture point

5:32

as well, again, a real lack

5:34

of information about what people

5:37

can request and what people might be entitled

5:39

to and how organizations can

5:41

enable and support that. So

5:44

we heard that conversations offering

5:46

a bit a bit like how how am I

5:48

going to fill your slot? Rather than actually

5:51

how might an amended working pattern

5:53

work best for that individual.

5:55

Okay. We know and we know it's not just a problem

5:57

in surgery, your report is focused

5:59

on doing very helpfully, has

6:02

data and very useful insights.

6:05

The ultimate impact, of course, on any

6:08

changing workforce practice and behavior

6:10

is on patients. I went to to Sarah Sweden

6:12

now, Sarah. What do patients

6:15

feel? And I ask you to of

6:16

patients, everybody. Nuffield

6:18

about the way the NHS treats its workforce.

6:21

I can't speak on behalf of patients, but I think there's some

6:23

insights from our members. Really concerned

6:26

and statistic that you shared there around fifty five

6:28

percent of people consider leaving because of course that would

6:30

have a huge impact on patients on the ground.

6:33

Some national voices and our members every year we

6:35

do a survey to find out what the kind of biggest

6:37

issues and burden problems that they are. And

6:39

this year was the first year that we've had workforce

6:41

been one of the top rated issues within that, which

6:43

is really non traditional for coalition

6:45

of patient charities within that. So think

6:48

there's a a case there, which is that it reaches

6:50

ninety the point where the experience of

6:52

the workforce really does bleed through and

6:54

affect the experience of patients. So I think

6:56

we're at a really critical point in eye where we need to have somebody

6:58

quite helpful solutions to improve things. I

7:01

think at this point to run people with parental

7:03

and parent responsibilities, we would strongly

7:05

argue that it's really important for that

7:07

lived experience to be accessible in the workforce.

7:09

I think If people are designing and

7:11

delivering services with those lived experiences,

7:13

they're going to better cater to the needs of people

7:16

who have parental and current responsibilities, and

7:18

I think that's super important to begin with.

7:20

I think the conversations we have around the workforce

7:23

at the moment, I hear a lot of sympathy from

7:25

patient charities that we that we work with.

7:27

I think they can see some of the big shoes there.

7:30

And think Tangerine that does come through to the experience

7:33

of patients. We hear about material

7:35

deterioration in access to an experience

7:38

of health and care. And

7:40

think it's important to say that there's no one individual

7:43

to blame, that there's some systemic failures

7:45

there. And so for us,

7:47

as a coalition of patient targets, it's really important

7:50

to see this resolved. We hear about it in very

7:52

practical terms. So for example, hear about

7:54

the really significant wittingness

7:56

for endoscopies, for people with Crohn's.

7:59

And of course, that has a really big impact on that

8:01

individual's life. One of our members, Parkinson's,

8:04

UK. They're one of the company at the moment called,

8:06

we can't wait. And really

8:08

they're already concerned about access, for example, to

8:10

speech therapy. And we hear really tangible

8:12

examples all the time with the ways that

8:15

the issues faced in the workforce, impact

8:17

upon continuity of care and quality

8:19

of care. We hear very tangible examples

8:21

about the way there may be the workforce and the NHS

8:23

itself has been designed, doesn't always

8:25

best respond to people's physical and mental health

8:27

needs. We hear also

8:30

about huge geographic

8:32

in the equities for workforce and what that means

8:34

for people in particular parts of the country. And

8:36

of course, around social care shortages leading

8:39

to a breakdown and the support

8:41

available to cars and then often for

8:43

breakdowns for cars themselves. So

8:45

for me, I think it's really important, but we find

8:48

sustainable solutions for the workforce that

8:50

match the needs of the existing workforce,

8:53

the future needs of patients, and For

8:55

me, it sounds like flexible working is is one

8:57

of the case of

8:57

that. So that sounds like a good thing. I'm not an expert

9:00

on flexible working or workforce

9:02

strategies, but do think it's very important

9:04

that that's paid attention to because we

9:06

can tangibly fill it in our conversations

9:09

we have with hundreds of patient charities and

9:11

that there haven't with people that they work

9:13

with for support? Good. I mean, it's

9:15

good that there's that understanding. And of course,

9:17

we'll come back to solutions. It's not an easy

9:19

fix. In the health service to move from

9:22

where we are today, to move from,

9:24

to move to flexible working as we've

9:26

been talking about But one of the shifts

9:28

we have seen is it's

9:31

generational shift and societal

9:33

shift in the sense that younger

9:36

people for I mean, a

9:38

less tolerant of the of working practice.

9:40

I mean, the kind of hours that I worked, guess,

9:42

many people here worked and the rigid

9:45

way that we would on the rotors

9:47

and in hospitals in

9:50

particular. I mean for Zana, what's your

9:52

experience from primary care? So

9:54

I think I can come at this from so many angles

9:56

as a as a mom who's got a nineteen and a

9:58

twenty year old, but how

10:00

a very good experience of bringing them up

10:02

because of the flexibility I had at

10:04

my practice, also as a GP employer.

10:08

Employing, actually. At the moment, I have an all female

10:10

workforce in my practice. Anne

10:12

also is the mother of medical student who's the

10:14

first year and he already wants to do a three day

10:17

week. That has nothing to do with Telkonet,

10:19

your first year. But but, you know, I think

10:21

that there are differences in perceptions.

10:24

So I think so what what Rachel was

10:26

saying really hate me. think a lot of this

10:28

is culture. And I think one of the things

10:30

to remember as we come up to international women's

10:32

days, child care is not just a

10:34

woman's issue. So I

10:37

suppose my other role apart

10:39

from being a GP is I was made to a surgeon

10:41

for twenty five years. The number

10:44

of events I used to go to where everyone

10:46

said, so you chose to be a GP so you could

10:48

look after the family. No.

10:50

I chose to be a GP because I wanted to be a GP.

10:53

And what was really interesting is

10:55

when I did get divorced eighteen months ago,

10:57

operationally, my life didn't change.

10:59

It's only when it occurred to me that operationally

11:02

I've been doing all the parenting. And

11:04

I think that's something just in our giggle about

11:06

it, but it's something to think about when

11:08

we think about careers because it's not just the

11:10

person working at the impact on their

11:12

families. So I think it's

11:14

great that we're talking about this. I

11:17

think most of it is culture, and I

11:19

I I've already heard a lot about from

11:21

our politicians as well. About oferminization

11:23

of the workforce and it's the snowflake generation.

11:26

I think it's a real step forward actually.

11:29

I think because there was

11:31

less concern about child count,

11:33

perhaps we didn't value people

11:35

and their other roles. Certainly,

11:38

for me, the when I became a parent,

11:40

I think I became a much better GP when

11:42

I was doing pediatric training. I used to look

11:45

at all the months that brought in kids who'd

11:47

had little goals from their hot cup of

11:49

teas. I was like, what sort of parent is that?

11:51

When it happened to me, I realized how

11:53

how this is to do.

11:57

I mean, I think culture is something we're

11:59

all coming back to Impress. We'll discuss

12:01

that in wider conversation. But in terms

12:03

of primary care, what are the specific shifts

12:06

you're seeing in primary care?

12:08

So in primary care, obviously, as

12:10

you say, Rachel, that there is a lot more

12:12

flexibility. And I think

12:14

it's It it is a career. I mean,

12:17

I'm a big fan of, obviously, primary care.

12:19

There is a lot of flexibility. So

12:21

I've got a lot of young moms who actually want

12:23

to do even sessions, you know, they want

12:25

to put the kids to bed, and then they want to

12:27

do that for hours. That works really well for them.

12:30

Then that works really well for, you know, our

12:32

contracts with enhanced tax as being

12:35

mandatory now. A lot of young moms want

12:37

to do weekends. And then there's just

12:39

a little changes we can make. So we're small agile

12:41

organization. So as an employer,

12:44

I had a salary GP

12:46

who won her her little one went to

12:48

nursery She just needed to be

12:50

back home at five thirty to pick

12:52

up little one. Generally,

12:55

our surgeries finish at six thirty,

12:57

but I was able to make that change for her

12:59

and it she actually said I would have left

13:01

you if I couldn't have had that and I wouldn't

13:04

be working. So there's a lot of,

13:06

you know, small changes that can be made.

13:08

But I'd like to see more at scale as

13:10

well. And like Sara said, more more

13:13

more of that happening nationally. Yeah. I mean,

13:15

this is child care. I mean, you it's in your

13:17

as well, Rachel, which is that dropping

13:20

kids off a nursery picking them up. I mean,

13:23

a medical career or a surgical career doesn't really

13:25

lend itself to the to everybody

13:27

else's working times. When it

13:29

come to fear next, from an employer's

13:31

perspective, how what are you noticing

13:35

in the way

13:35

Everything that everyone has talked about,

13:37

and it's the most important I would say it's

13:40

most important thing we're doing at the moment is

13:42

besides all the rest of the health and well-being

13:44

is being able offer flexible employment. And

13:48

the figure that you talked about, fifty five

13:50

percent mentioning work life balance, we encourage

13:52

people to have what we call itchy feet conversations.

13:55

So thinking about leaving us, we

13:57

say come and have a conversation with

13:59

us first. And one of the things that

14:01

comes up from everybody

14:03

doctors, nurses, physiothers, admin

14:06

managers is usually work life balance.

14:08

It's not just Gen Z or Gen X. It's

14:10

all Gens, but it's definitely Gen Z

14:13

and Gen X. And its work life balance.

14:15

And what we can

14:17

do to help people stay, and

14:19

it can be that hour that you described, can

14:22

be different ways in which we put that flex

14:24

together is what makes people stay with

14:26

us. So we will do as

14:29

much as we can to break the mythology

14:32

that it is impossible to run a shift

14:34

system if you allow people to be flexible.

14:36

It's not. It's hard It's

14:39

really hard, but it's not impossible.

14:42

So working with managers to help

14:44

them and buddy them up with managers who

14:46

know how to run and how to

14:48

do a flexible shift system. How

14:50

to work with the team, if you think of something like health

14:52

visiting, health visiting is ninety seven percent

14:55

female. Nearly all of

14:57

them in my organization will

14:59

be relatively young and will have children. They

15:02

all want that flex. So what do you

15:04

do? We have to work collaboratively

15:07

with your service, and you have to think, well, how

15:09

are we going to manage that fairly? Can't

15:11

have everybody go at three:thirty. People still have

15:13

children that need, you know, five:thirty,

15:16

six:zero a.clock Friday afternoon. You

15:18

can do it, but you have to be very open, you

15:20

have to work collaboratively, you have to have

15:23

a culture role models help. One

15:25

of my directors is a jobshare director,

15:28

so my HR director is two women

15:30

who jobshare that role, who both have young

15:32

children. We have

15:35

doctors who job share a role, who

15:37

both women, who have young children. There

15:39

are role models that are incredibly important.

15:43

And it's also very important final point in

15:45

the way you recruit. Go out

15:48

very obviously and up

15:49

front. We welcome flexible working.

15:52

That's what we want and that's what we'll encourage.

15:54

Is this something that you're particularly strong

15:56

one? Or are you noticing other trust also

15:59

behaving the way that you are?

16:01

We are strong on it. We're very keen

16:05

to be clear about it, but everybody's

16:08

looking at this because it's it's

16:10

the thing that all retain and grow the workforce.

16:12

Yeah.

16:18

Okay. We're going to talk a little bit about

16:20

solutions, Rachel first. What

16:23

are the examples that you're seeing? What

16:25

can we learn from other industries? As

16:28

well and bring back to healthcare to

16:31

try to enable flexible

16:34

working.

16:35

Yeah. So absolutely, we heard,

16:37

as I mentioned earlier, of some really positive

16:39

examples from the people we spoke

16:42

to. So exactly things like

16:44

that where they'd had a conversation with their

16:46

employer and they were able to work something

16:48

out that worked for them. We heard of

16:50

a few examples of job set shares

16:52

in surgery, but a recognition

16:55

that that can be challenging because

16:57

of kind of needing to match, particularly in

16:59

training, the training needs.

17:02

Not impossible at all, but people feeling

17:04

like they almost had to sort it out themselves

17:06

and kind of navigate that

17:08

process. I think more proactive support

17:11

from employers sort of think through

17:13

what those options would would be really valuable?

17:16

Absolutely. I would echo the point about role

17:18

models. We also heard about programs

17:21

that sort of support people returning

17:23

to work after time away. So I'm

17:25

returning from maternity

17:27

leave, for example. There's there's program

17:30

run by Health Education England, which

17:32

does provide some of those

17:35

kind of supported return to

17:37

work things which I think

17:39

are really valuable and were echoed

17:41

in research that we did because

17:43

we heard a lot about that kind

17:45

of confidence fade, not just skills fade

17:47

from being from having time away, but actually

17:49

really needing to support people confident

17:51

coming back to work and how to kind of

17:53

do that most effectively. I think it's

17:56

really important that those support offers are

17:58

really tailored to individuals and really

18:00

tailored to a specialty. So, you

18:02

know, making sure that actually it's reflective of

18:05

what that individual person needs and how their

18:07

experience might be affected by having

18:09

that time away. I

18:12

mean, overall, in terms of the things

18:14

or the top three things that people in our survey,

18:17

mentioned, they wanted or that they

18:19

thought would improve experience of people with

18:21

parental caring responsibilities as

18:23

more flexible working patterns more

18:27

flexible training pathways and a better culture.

18:29

And I think those are all three very,

18:32

very broad things, but think actually they

18:34

also feed into each other so I think

18:36

having a greater acceptability encouragement

18:39

of some of those flexible working options

18:42

would be really helpful to improve that culture.

18:44

I mentioned there are a lot of initiatives, things

18:46

like less than full time training. People

18:48

need to know what their options are. They need to know

18:51

they can ask for who to go to

18:53

for support if they don't get it or they don't

18:55

feel like they're being supported. And

18:58

I think, a culture like Thea

19:00

described that actually sees this as

19:03

really beneficial for the workforce rather

19:05

than something that's challenging. I think at the moment,

19:07

people who and we definitely

19:09

heard this in our work, people feel

19:12

that if they ask for something

19:15

like an amended working pattern during

19:17

pregnancy, for example, there's a worry that

19:19

they're being perceived as weak, unable

19:21

to do their job. And I think that's

19:23

just really shocking. We shouldn't have a situation

19:26

where people aren't asking for things that actually

19:28

they are entitled to ask

19:30

for. So I think that,

19:32

yeah, all of those things are really really cute.

19:34

Okay. Great. So, Regina, other

19:36

examples where that

19:38

could be brought back to the health service Or

19:41

do you see good examples within that

19:43

self-service? I think for me, it's I

19:46

think looking at the big picture, I'm just

19:48

the role of NHS as an anchor institution?

19:50

And just one of the biggest employers in the UK,

19:53

there's something about, if we can't get flexible

19:55

working right there, then work on, we get and there's

19:57

plenty of examples, I think, from the private sector, from

19:59

the voluntary sector as well. They

20:02

can pick them from there. think for me as well, there's something

20:04

around where I've

20:06

seen conversations where the workforce

20:08

voice and patient voice are heard really well about

20:11

really quickly translating what's needed

20:13

from patients until it's needed from the workforce

20:15

where that comes together really

20:17

closely. And I think from me,

20:19

it's also about the support and enablers

20:22

in place around individuals, look

20:24

at the bigger workforce issues and

20:26

challenges beyond the things flexible work in as

20:28

well, then some of things that we hear is

20:30

that where there's

20:32

really good support for healthcare professionals

20:35

to understand, like, the assets available in local communities,

20:37

and that makes a really big difference in how prevention,

20:39

which decreases demands on workforce as

20:41

well. So on the flexible working front,

20:43

I'm not the expert on that. But, yeah, look

20:45

at the bigger picture, it seems to make a lot of

20:47

sense.

20:48

Good. For example, tell us about primary care.

20:50

I mean, are there other examples

20:52

you know from primary

20:53

care? I think primary care, I'd

20:55

like to think has been quite

20:58

head in this. But I

21:00

think it's really important and it's great

21:02

that we're acknowledging this because I'm

21:04

sure Sarah will agree that The reason this is

21:07

important is not just for the the

21:09

the person working, but actually, if

21:11

people are even afraid to say I need an

21:13

amendment or a change in my of

21:15

work pattern because I'm pregnant, and

21:17

they don't feel safe to ask that. That's going to

21:19

have a direct negative impact on patient

21:21

care. So it's great that we're thinking about

21:23

these because I think in the past sometimes it's been

21:26

thought of is a nice to and

21:28

and and have on. I mean, primary care

21:30

is ahead, but if you look again Come on.

21:32

If you look at GP partners, very

21:34

few of them are female compared to

21:36

the Salar Reid workforce. If you look at GP

21:38

leaders, There aren't that many women

21:40

that you see in leadership positions. And

21:44

my experience as a mom has been

21:46

it doesn't matter if you do it a bit later

21:48

than your male counterparts because actually

21:50

you probably spent two decades raising your

21:52

children. So those are the conversations that

21:54

I think we need to have it's more than just the

21:56

hours and more than and, you know, having

21:59

been married to a surgeon. The third the

22:01

surgical mantra from what I understand is,

22:03

oh, if we do less than full time training.

22:05

They won't get their training done. But

22:08

it's not a race. They won't get their training

22:10

done compared to who he became consultant

22:12

before forty. It doesn't matter

22:14

if a female counterpart becomes a consultant

22:17

a little bit later. So I

22:19

think role modeling and culture and

22:22

thinking about what is good

22:24

for you. You do you. I'll do me.

22:26

And and I think that's just something that

22:29

we really need to embrace. Primary care, I think

22:31

it's doing really well, actually, particularly

22:33

with the different of the variety

22:36

of roles that we have from weekend

22:38

working to urgent care, working to, you

22:41

know, GP specialists

22:43

to so there's a lot of variety, and

22:45

I think that helps women and

22:48

men who want to, you know, look

22:50

after children have that

22:51

flexibility. But there's a point about doing

22:53

doing it later. Mean, in your your positive

22:55

about it, that's that's really excellent. In

22:58

your report, right, so the the sense I got

23:00

though that it was a problem. For

23:02

some of the people that you spoke with that they

23:04

were having to postpone either

23:07

child bringing up children or or

23:10

or their career. Because of

23:12

the it was difficult to do both

23:14

at the same

23:15

time. So I think this was an issue where actually

23:17

we heard both sides, and think that's really

23:19

reflective of of the point around, actually,

23:21

it's about what works for individuals. So we

23:23

heard from some people who work

23:27

were were training less than full time and it

23:29

was really working for them. They didn't mind

23:32

that their training pathway was gonna be a bit

23:34

longer the balance worked really

23:36

well, and they were really positive

23:38

about it. We also heard from

23:40

people who were very frustrated that

23:42

they felt

23:44

like they couldn't do that within

23:46

surgery. They felt pressure to

23:49

get those opportunities to

23:51

keep up with other people. We heard

23:53

people who were actually almost working describing

23:55

it as kind of overcompensating because they

23:58

felt like I'm not gonna get that

24:00

pace of sort of training

24:02

that other that peers are going to have.

24:05

So I think that it's actually quite diverse

24:07

in terms of people's preferences. We also

24:09

heard people in our survey

24:11

talking about their experiences around

24:13

parenting, influencing their

24:15

ability to take up additional things

24:18

such as leadership per rolls or additional

24:20

research, things that are sort of perceived

24:22

as being really key to actually people being able

24:24

to develop their career. Actually those opportunities

24:27

aren't necessarily being made

24:29

available to people in a flexible, accessible

24:31

way. So I think it's it's not just

24:34

talking about trainings actually about those other opportunities

24:36

as well and what the impact

24:38

of that has on people's ability to progress

24:40

their career as well.

24:41

Okay.

24:42

Great. Thank you. Thea, finally,

24:44

other examples of good practice

24:47

solutions that you've seen work or

24:49

possibly seen work in other industries

24:51

that we might bring back the

24:52

NHS. Yeah. I think one of the things I wanted

24:54

to talk about was disability and long term conditions

24:57

because we've talked lot about the issues

24:59

of parenting and caring

25:02

But the NHS is a poor employer

25:04

of people with disabilities,

25:07

both mental health and physical disability.

25:09

We're a poor employer of people

25:11

with long term conditions, which is appalling.

25:14

Absolutely appalling. And so one of

25:16

the areas as well, which we can use lies

25:18

flexibility in the way in which we employ people

25:21

is in that area. And it's great, picks up

25:23

your point about lived experience. So if

25:25

you're reaching out very proactively and

25:27

saying, we're welcome for the disability to

25:29

come and work with us in

25:32

all of our roles. That's good

25:34

for your service it's good for the

25:36

diversity that you've got and it's also - it

25:38

is going to be about flexible working and

25:40

suitable adjustments there.

25:43

Those things are really important.

25:45

Ultimately, it's about being open

25:47

and not making it a matter of confidence of

25:49

the individual to come forward. But to

25:51

be you asking, you seek out? What can

25:53

I do to help you? What can I do to support you

25:55

in this role? Because we we welcome

25:58

what you what you can do for us. And

26:00

I think you see that across all industries. It's

26:02

the culture you create that make

26:04

it a positive and welcome

26:06

choice.

26:13

And I'm hearing a lot of positivity about,

26:15

you know, wanting to do this

26:17

and and it's that it's not

26:18

impossible, but there are cultural

26:20

and structural barriers.

26:23

So let's open conversation and

26:25

Martin Marshall, chair of the Trust. I I just

26:27

want to puncture that positivity

26:29

a little bit because it is a really progressive conversation

26:32

and that and exciting and important conversation.

26:34

But there are unintended consequences to working

26:36

less than full time. And I'm particularly interested

26:39

from patient perspective, the impact

26:41

of that on the trust patients have in their

26:43

clinicians. So we know trust is fundamentally

26:46

important and we know from the evidence

26:48

that some of the elements of that trust are

26:50

the perception that the doctor is there for

26:52

you, that they're willing to go the extra

26:54

mile, that they're selfless. And

26:56

I'm just wondering how one manages

26:58

the pieces of patients that doctors

27:01

no longer are willing to do that. And did

27:03

we hear that lot in in general practice? My doctor

27:05

isn't there anymore. They're only there three days a week

27:07

even though three days a week. Forty two hours.

27:11

But I think it has an impact,

27:13

not only in our ability to provide care,

27:16

but also on the influence doctors have

27:18

within society and on the wider system as well.

27:20

And I just wonder what thought

27:22

there's been to the unintended consequences of

27:24

this. Yes,

27:25

good. Would

27:27

you like to just respond

27:29

to that?

27:29

Yes, happy to,

27:30

happy to. And then

27:31

we'll get what questions. You're not

27:33

wrong, Barton. There's, I think, continuity

27:36

of care, trust are really important

27:38

to patients. I

27:41

find every interest in the different perspectives

27:43

we heard there around choice and

27:45

for example people to lie in training and these different things.

27:47

And I think there's something about just recognizing

27:50

and and putting choices in front of people and

27:52

individuals and patients. Like for example,

27:55

I'd hard to buy a GP practice

27:57

where people were being offered either the opportunity

28:00

to see a clinician,

28:02

any clinician on day or told

28:04

you can wait to see the person that you'd like to see,

28:06

and they'll be available at this time. So think

28:09

treating people as adults being clear about what

28:11

is possible, what's not possible, people. There's

28:14

something about, I think, the general

28:16

public, I'm more than aware, I don't think

28:18

anyone is in about the pressures on

28:20

the NHSN think general public

28:22

are aware of these societal shifts where we

28:24

have to have, I think, more inclusive employment

28:27

practices that work for people with prior responsibilities,

28:29

care and responsibility, disability. So it's about how we

28:31

have that conversation, societally, about

28:34

that. I don't think anyone individual

28:36

should have to pay the price for that a year some really

28:38

shocking things from and I've heard lot

28:40

particularly from general practice of

28:43

of people going through burn night, and there's something about

28:45

how we model what good health looks like in the workplace.

28:47

And I mean, the number one modeler of

28:49

that should be in the NHS and within social care and

28:51

trust in the voluntary secretary. So There's

28:54

tensions

28:54

there. It's not straightforward, but I think that's

28:56

a conversation we need to have more openly with

28:59

people in society. Okay. Could you just stick to this

29:01

less than full time working point for a minute?

29:04

Would you like to comment on that?

29:07

Thank you. It's a great conversation and really good report.

29:09

I'm Simon Gregory. I am a GP. I'm

29:11

Health Education England's Medical director

29:13

for primary care soon to be the

29:15

NHS England workforce training education

29:17

director. The the less than full time care

29:19

responsibility isn't only about children. We

29:22

have squeezed generations now. We have

29:25

often trainees, and it still falls

29:27

on on on the women. It's

29:29

not any childcare responsibility that falls

29:32

predominantly on women. So we've got to look

29:34

at all care responsibilities. We've

29:36

increased GP training numbers in England to

29:38

four thousand a year. Largely,

29:40

we've done that by increasing flexibility whilst

29:43

maintaining standards, but also

29:45

by listening. Because

29:47

what we heard is We want

29:49

flexibility. We had a backlash

29:51

from older members of the fish and saying, you're

29:53

failing because you're not producing enough full time

29:56

GPs. That's what we need. But what we

29:58

hear from the youngers is, well, if you

30:00

don't offer that, we'll walk.

30:02

So what's better? A valued

30:05

colleague that's working the

30:07

time they want to work and can work or

30:09

nobody. And I think that's where we

30:11

we struggle. But we do offer

30:14

less than full time training to all GP trainees.

30:18

The problem is often they don't believe

30:20

it because their near peers are telling them

30:22

it's not available. So maybe the information still

30:24

got to get out there. And think professions

30:26

like surgery are still the way behind. But

30:28

find it, you said stick to less and full time training. General

30:31

practice great for less and full time. It's

30:33

not great for those with health condition or long term

30:35

disabilities. There are GPs with long

30:37

COVID who are now out of work

30:39

because the model that works well for less

30:41

than full time work less than well for other things.

30:44

So we've got to improve how we value

30:46

and support diversity across all

30:48

characteristics.

30:49

Okay. I mean, just as well you're there. I mean, what what

30:51

are you hearing from patients? Though, about

30:54

the shift in working

30:54

practice. Well, it's an interesting one because my my practice

30:59

is almost entirely less than full time

31:01

because actually, less than full time in general

31:03

half time partner in my practice works forty eight hours a

31:05

week. There's no such thing as less than full time really,

31:07

and that's part of the problem is that we think

31:09

a working week is, say, seven and a half hours. But

31:11

if you work around it, if you look at in the work

31:14

of people like Dennis Perry Gray with, they've looked at continuity

31:16

of care. But that doesn't mean somebody

31:18

working a hundred and sixty eight hours a week.

31:21

It's actually about how you factor it in.

31:24

And where you factor it in. What

31:26

I what we hear from our patients is If

31:28

they need somebody in an emergency, they're happy

31:30

for anyone in the practice they trust because

31:33

they know they trust the practice. It's when

31:35

they've got a long term condition or something going

31:37

on in their life that they want, the

31:39

person that knows them and they

31:41

know. And it is possible still

31:43

to juggle that. It's harder with the

31:45

workforce on its knees. It is harder,

31:48

but I think also we can try and use some of the

31:50

technology to do that. You know,

31:52

I had a recent experience of contacting a practice

31:55

for review and being offered a

31:57

face to face appointment saying, I don't want it.

31:59

I haven't got the time for that, and I don't need it.

32:01

Oh, but we've got targets now on this. Yeah. You might

32:03

have. But I want to have

32:05

a telephone consultation, please. So I

32:07

think you actually need to we need to understand

32:09

what our patients want

32:12

and need and what our colleagues want and

32:14

need, but they're not mutually incompatible.

32:16

Yeah. So what you're

32:17

saying, it it is possible to we

32:19

know the evidence behind of care

32:21

to deliver that, but at the same

32:23

time, offer flexible working. Victoria

32:25

Gio Brown, I see the resectioned

32:28

innovation lead in Northeast London and

32:30

Vice Chair for the RS2P. So

32:33

on this point regarding continuity of

32:35

care and how can we deliver

32:37

it when actually a lot of our GPs

32:40

are working part time. There are actually examples

32:43

across the country. Of different

32:45

ways of doing these and Chinese micro teams,

32:48

which we have implemented in

32:50

Northeast London, but So as I said, in different

32:52

other parts of the

32:53

country. So it can be done.

32:55

What that is? So it's

32:57

groups two or three GPs working

32:59

together sharing the same kind of population

33:02

list. And therefore, it allows

33:04

you to get to know the patients, the patients

33:07

trust, developed trusting relationships with

33:09

you, and it can work. Claire, final word

33:11

from you on this, and then then perhaps you're gonna move

33:14

it on anyway. Claire Dr. President of the World

33:16

College of GPs. We have

33:18

to be flexible. When my senior partner retired

33:20

twelve years ago, I predicted for his replacement,

33:22

we needed two point two replacements

33:25

for him. He was male, worked

33:27

nine sessions a week before general

33:29

practice become unworkable, and we could

33:31

see the writing in the world. And of course, we haven't had two

33:33

point two replacement. We've had flat

33:36

line replacement in general so you've got

33:38

to have the workforce to be flexible. That's

33:40

the first thing. The second thing is

33:42

sacrifice. I

33:45

have only just dropped down

33:47

to having half a day off a week, which

33:49

I'm now on a Monday morning. And

33:52

I never picked up my children from nursery.

33:55

I never went to the nativity plays. I

33:57

never I did put patience

34:00

in my practice first. And and

34:02

I was consumed with guilt

34:04

the whole time. And I say to the young ones

34:06

now, guilt is something you feel when

34:08

you love somebody. So but

34:12

I don't want that to happen to the next generation.

34:15

I think that you know,

34:17

I've made it to the top. I've done this. I've done

34:19

that, but and then you can't have regret.

34:22

But I do I can't

34:24

wait for my children to have have grandchildren. And so

34:26

that I can repay and re and

34:28

start those things that that I never went. And the

34:30

whole system wasn't designed for

34:32

working mothers. So the nativity play

34:35

was at nine thirty in the morning. Had it been

34:37

all that the assembly, you know, those two little assemblies

34:39

you go to. Had it been at eight AM

34:41

in the morning? I could have gone. The

34:43

the the bits were in the afternoon, even the meeting

34:45

the teachers you had to do at three thirty in

34:47

the afternoon. So the whole system now I

34:49

think the system needs to change in

34:52

order to accommodate us. And finally, Sigman

34:54

Baumann, who was a great sociologist

34:57

in the nineteen seventies, talked about liquid modernity

34:59

that people want much more liquid lives

35:02

and yet we continue to think that

35:04

they want solid lives and and

35:06

concretize lives. And and general practices

35:09

blamed even yesterday, you know, why

35:11

are we not available because we have bloody

35:13

women and whatever you we

35:15

do. Who wipes the bottom of the child?

35:17

Who takes a day off when the washing machine's broken

35:20

down? We do, even though we've got

35:22

enlightened men. Sorry. Okay.

35:27

And we've got liquid modernity.

35:33

Alright. Okay. We're getting

35:35

into culture. Let's who would

35:37

like to raise another theme or

35:39

issue, Kieran. Hi, Cameron. I'm

35:41

Kieran Patel, so I'm Chief Medical Officer and

35:43

Deputy CEO at University Hospital's commentary

35:46

in Warkshire. I think I

35:48

just wanna push the concept of embracing the

35:50

diversity of what people need

35:52

because it is very varied and we mustn't

35:54

put everybody into the same box. And

35:57

I'm just gonna go head into some solution focused

36:00

settings. So one of the advantages of the NHS

36:02

is the scale it offers. So we

36:05

can embrace the complexity of operational

36:07

planning if we embrace the fact

36:09

that we need to plan better. And

36:11

too often, we get into impulsive planning rather

36:13

than saying, actually, I've got twelve and a half thousand

36:16

stuff. I've got to deliver, you know, a

36:18

million out cushioned points here, but I can plan

36:20

that in advance. And then you can stop

36:22

people into what they want to do. So

36:24

it it is possible to do that.

36:26

And the second concept is innovation when

36:29

we talk about agility and flexibility. So

36:31

too often we talk about agility and a

36:33

time. Frame. Actually for

36:35

me, Agility is about looking at the potential

36:37

for agile portfolios. So

36:40

we've integrated cash systems. We have the

36:42

ability for people to work across sectors,

36:44

you know. And we've got GPs who

36:46

do general practice and onology. And

36:48

vice versa consultants who will go out into primary

36:51

care. So there is the art of the possible now

36:53

if we're willing to embrace it. And

36:55

the other concept in terms of agility,

36:58

embracing the need to be

37:00

really compassionate. And when I've

37:02

talked to our international medical graduates,

37:04

they want blocks of time off

37:06

to go back home, to get the pastoral support

37:09

that we just cannot offer here. So

37:11

I've started saying to our international graduates,

37:13

actually, if you want to six block of leave off,

37:15

let's talk about how we can make that happen

37:18

because we cannot substitute for that.

37:20

So we've got to be much more fleet of foot

37:22

in terms of how we think about agility.

37:25

And generate the ability for concepts such

37:27

as sabbatical for people to go off to recharge

37:29

and avoid burner. We just had somebody

37:31

go off and do a three months expedition

37:34

into the North Pole. Mhmm. Actually, we've done

37:36

that because it's worked bloody hard for ten

37:38

years, but we've made it happen.

37:40

So I think we must embrace the ability of

37:42

scale and cross sector

37:44

working if we're going to solve

37:46

this.

37:46

Would there be like to pick up on that? You think

37:48

it's Sorry. Because I shouldn't really

37:50

it's now other people's coming in and I just really wanted

37:53

to follow-up on that point

37:55

because I think that passionate and that

37:57

individualistic approach. What I found in

37:59

the organization is that people will sometimes

38:01

come back and vote. But if you've done that fair, then

38:04

you're going to need to let everybody go to

38:06

the North Pole for three months. And

38:09

of course, that's not the case.

38:12

But there is a tremendous fear that if you

38:14

set the president and I say if we set

38:16

the president of compassion, of kindness,

38:18

of individualistic care, that

38:20

will be okay. We will be fine.

38:23

Everybody won't want to go to the North Pole

38:25

for three months. But there is a

38:27

tremendous fear, and I sure

38:29

most of us have heard, but if you set that

38:31

precedent, what will happen?

38:34

And my experience is

38:37

it doesn't happen. It's okay.

38:42

Okay. Back to the panel bridge.

38:46

Yeah. I I mean You got thirty seconds?

38:49

Yeah. It's been a fantastic conversation. I

38:51

think that the point just made

38:53

or it's been made throughout around actually having inclusive,

38:56

compassionate employment practices,

38:58

and policies is really key this is not

39:00

just about parenting or caring. We

39:02

had one in seven people who responded

39:05

to our survey also said that they provided

39:07

support someone because of old age or disability.

39:10

We heard from people who were caring for children with

39:12

disabilities. This is a huge, huge

39:14

issue, which has implications for

39:17

lots of people. I think that this

39:19

idea of shifting the conversation to

39:23

actually what what's beneficial

39:25

for people. And this

39:27

this fear that was mentioned about

39:30

setting precedent was something we heard

39:32

also from a generational point of view. So people

39:34

saying that, you know, my senior colleagues

39:36

are sort of very anti enabling

39:39

this because it wasn't available for them. So

39:41

actually, why should it be available for you? I think we

39:43

really need to shift that conversation to actually

39:45

say it's not just about what

39:47

people want now, it's actually about what

39:50

does a workforce of the future as well? And

39:52

how do we kind of enable thinking

39:54

about that in our long term sort

39:56

of plans for the workforce? And I think also

39:58

this point about compassion is really key.

40:01

I think continuity is also

40:03

obviously important, but I think at the

40:05

same time, I think patience I'm

40:08

seeing patients having compassion for the workforce

40:10

and actually the workforce being able to

40:12

operate in a way where they are valued,

40:14

they are supported, and I think that's also

40:16

really for patient care. I don't think

40:18

continuity is necessary, the

40:21

opposite of flexible working. Actually, I think they

40:23

can exist in harmony and we need to kind of enable

40:25

that.

40:25

Okay. Thanks. So

40:29

I

40:29

think this conversation comes at a time when

40:31

the workforce is facing particular crisis.

40:33

I think there was a argument made yesterday

40:35

that we should be in a situation where there's an oversupply

40:38

and therefore things like Flex seemed a lot easier.

40:40

And it doesn't feel so drawn to the

40:42

nitty gritty of how do we get this person for

40:44

this r. So there's something about that. think

40:47

there's something, and I think Sylvia,

40:49

I learned it really well around Where

40:51

are we going to be in the future? We're gonna have a

40:53

much greater kind of demographic of older people,

40:55

which means that collectively as a society,

40:57

we're gonna to make sure that we're supportive

41:00

and caring for people and to think we need to

41:02

recognize that, we need to respond to that.

41:04

And ultimately, I think that

41:06

what the workforce doesn't pick up either

41:10

gets worse or gets picked up

41:12

by people, communities, carriers, the voluntary

41:14

sector. So just really keen for that to

41:16

be really sustainable solutions for

41:18

this, and just really glad that the conversation's happening.

41:20

Thank

41:21

you, Verzana. So I think my

41:23

final thoughts are this is an essential

41:25

thing do, it's not nice to have because

41:29

flexible workforce or no workforce is where

41:31

we are at the moment. So and

41:35

as you've already said, this

41:37

is absolutely linked to

41:39

patient safety. So this is really important.

41:42

Again, it's not nice to have. I

41:44

think like Nigel was saying

41:46

yesterday small step. So it's

41:49

great that obviously, you know, HE XHE,

41:52

whatever they're called now. You know, how

41:54

how can't keep up. But but, you know,

41:57

how how how all that. It it has

41:59

to be embedded in in everyday practice

42:01

that that culture as well. So small things

42:03

and one thing we didn't talk about is that

42:05

actually children under five get sick

42:07

quite a bit. That's what they do. They're all bringing

42:09

virus home. What do we do for that?

42:12

You know, is it or so? I was fortunate

42:14

as a as a an employer in a small

42:16

practice. You know, I have the ability to

42:18

let my fellow doctors bring their little ones in when

42:20

that happens. Obviously, I'm not suggesting that

42:22

people go into the operating theater. With their

42:24

two year old. But but, you know, what happened?

42:26

Because these are not things that we can't

42:29

predict. If you've got an under five year old, you're

42:31

gonna have to take care of his leave or do

42:33

something. So So these are these

42:35

are things we can mitigate against, and

42:38

we need to do it, and we need to do

42:40

it quickly. Thank you. We can't

42:42

afford not to do this. For very

42:44

clear reasons that we won't have a workforce

42:46

if we don't do it. But I think also we

42:48

should look at this as a really exciting opportunity

42:51

People are offering us a new way

42:53

of inventing work. We've done

42:55

that during COVID with Microsoft Teams

42:57

and with different ways we work. We're doing

43:00

it now with a generation in

43:02

two places who are demanding of us

43:04

a better work life balance. I think we should

43:06

see this as an exciting time and

43:08

embrace

43:09

all that complexity and try and

43:11

work it out. Well, great. Great.

43:14

Well, we had a lot of can

43:16

do attitudes. We may be an unrepresentative sample.

43:19

Gathered in this room. I mean, it's

43:21

clearly something an ambition, something

43:23

we should all aim for hard to achieve,

43:26

but I think because that requires

43:28

deep cultural change, but then

43:30

that means there's a whole leadership

43:33

approach. To achieving that culture

43:35

change to deliver the

43:37

kind of workforce and the working conditions that

43:40

will deliver the best patient

43:42

care. So thank you very much