Workhorses of private care deserve nurturing
Dr Stephen Drotske
Leading supplier of RMOs in the independent hospital sector, NES Healthcare UK, has welcomed the GMC’s publication of survey results in Understanding the Role of Resident Medical Officers in the independent sector.
But the firm’s medical director Dr Stephen Drotske and operations director Justyn Tollyfield say an opportunity was missed to provide greater insight into this essential group of doctors.
The aim of the GMC-commissioned report was to improve its understanding of the role of Resident Medical Officers (RMOs) in the independent sector.
Justyn Tollyfield
From the survey’s methodology, it is clear that NES, the largest RMO employer in the UK with almost 500 doctors on the designated body, was not invited to participate or to encourage our doctors to engage with the survey.
Both the GMC survey and a Centre for Health and Public Interest (CHPI) 2017 report inferred an inconsistent level of support to the RMOs, yet neither sought clarification on this from RMO employers.
For many years, RMOs have also worked in the NHS, yet this group of clinicians was excluded from the GMC survey and from the CHPI report. It is therefore our view that without the input of a wider range of stakeholders, the results of these exercises are of limited value.
The survey has, however, established some learning opportunities for RMO employers which will help us to enhance the support we already provide for RMOs.
The RMO role is a non-training post and does not have the same supervision or learning opportunities as a training position in the NHS.
Vital role
These limitations ensure that no doctors trained in the UK or established within the NHS are attracted to apply for these positions. It is, however, a vital resource for the independent sector and, increasingly, within NHS trusts looking to address staff shortages.
As with the GMC’s survey sample, the vast majority of NES’s RMOs received their qualifications outside the UK. These international graduates fulfil a vital role across the UK healthcare sector and it is important that employers carefully manage their recruitment and introduction to their roles in the UK and that support thereafter is effective.
This article outlines the support provided by NES to its doctors and offers an opportunity for other stakeholders to support us in looking after our RMOs.
Recruitment support
During the recruitment phase, which can take up to six months, doctors are actively supported to learn about the UK healthcare sector. We also start at a very early stage to consider patient safety through online training in life support, blood transfusions and a whole raft of mandatory training.
The table on the right shows the full list of online training we provide. If this is not completed in full, the doctor will not be cleared to commence their role in the UK.
Training on arrival
Once in the UK, NES doctors complete Intermediate Life Support (ILS), Advanced Life Support (ALS) and European Paediatric Advanced Life Support (EPALS).
The GMC report noted the high level of responsibility an RMO has. To mitigate risk and to enhance care, NES has for many years insisted on training all its doctors in adult and paediatric life support before they commence work.
In addition to this, we provide practical training and support with prescribing and infection prevention.
As part of their introduction to the UK, we support our doctors with opening bank accounts, registering with GPs, resolving occupational health issues and booking their first GMC appraisal. As employees, all NES doctors receive professional indemnity insurance.
Ongoing support
While doctors are working for NES, we regularly offer update training in their role as leader of the resuscitation team. Online workshops also include updates on human factors, new medication and devices. There is also a 24/7 clinical team that is available to offer assurance and or advice to clinicians on duty.
NES obtains regular feedback from those working in conjunction with our RMOs to further support their individual training needs. Such feedback can result in case studies or updates for all doctors as part of our ongoing support and learning programme for RMOs.
The GMC survey referenced RMO workload and, for a number of years, NES has been carrying out regular audits to provide data to facilitate the assessment and management of our doctors’ workloads. Each doctor also has a dedicated medical staffing manager who maintains regular contact with them.
As an example, recently a doctor was struggling during his training courses. We learned that he lost his wallet and his luggage following his flight and had no means of support.
We provided him with accommodation and also with food and money for clothes. This doctor is just one of the many who found relocating to the UK to be challenging and benefited from the personal support NES can offer.
Continuity
Since 1994, when NES employed its first RMOs, we have invested in the continuity of care for patients as we recognise that regularly seeing the same doctor is hugely beneficial for patient safety and welfare during their hospital stay.
By ensuring high continuity of care by NES doctors, the outcome for patients during the post-operative period is much better. We measure continuity of the ‘same face at the same place’ to support patient care.
To allow for continuing professional development and holidays, we have set 80% as the benchmark for continuity and in 2020 achieved 86.7% across the 1.5m hours of doctor cover we provided.
Employing more RMOs
RMOs who answered the GMC survey suggested that more doctors should be on duty at any one time.
In an ideal world, every hospital has ample doctors and nurses, but reality dictates that there is a shortage of these disciplines in the UK and doctors are currently on the shortage occupation list.
NES operates safe working rotations for its doctors, with workloads – including night disturbances – and responsibilities closely scrutinised and controlled. The extraordinarily low number of adverse patient outcomes supports the work that we do.
We employ many standby doctors who we can deploy to hospitals in support of clinicians and hospital clients. This group of doctors allows us to cover those who are unwell or unable to work and safeguards our commitment to provide doctors to hospitals.
As many of the NES doctors were not involved in the survey, it could well be that doctors who responded to the GMC were not aware of this back-up plan available to others.
Conclusion
While welcoming the information gathered by the GMC about RMOs, we are disappointed that no effort was made to engage with RMO employers such as NES. In this way, an opportunity was missed to provide greater insight into this essential group of doctors.
Nevertheless, NES continues to be open to dialogue with the GMC and through this to further improve the support it already offers to its doctors.
Future considerations
The focus of the RMO role is patient care, not on training. Therefore NES, with its robust assessment and selection program, ensures that only well-trained clinicians accept the role.
Throughout the Covid pandemic, it has been evident that RMOs played a major role in the UK’s response and they will play a huge part in the future in supporting the private sector to help the NHS clear the millions on the waiting list.
We all therefore need to carefully consider support for this important group of clinicians.