Junior doctors" sleep deprivation poses threat to patients, says GMC

Trainee doctors in the NHS are often so sleep-deprived that they are in danger of harming patients, the medical profession’s regulator has said.

Increasingly heavy workloads and widespread staff shortages mean the UK’s 54,000 junior doctors are being left to look after wards of patients without proper experience, according to the General Medical Council’s biggest annual survey of trainee medics’ experiences

One in four doctors below the level of consultant say their schedule leaves them sleep-deprived and 43% describe their workloads as heavy or very heavy. Those with the most intense schedules are much more likely to encounter patient safety being put at risk, the survey found.

In one unnamed hospital, a junior doctor was the sole medic left in charge of 300 patients overnight – a case the GMC’s chief executive, Charlie Massey, said was extremely concerning. The risk of the doctor being unable to deal with two medical emergencies happening simultaneously meant such lack of cover should never happen, he said.

“Patients who are in hospital overnight are in a hospital for a good reason and if something should happen to one or more patients during that nightshift, and that trainee has been left alone, that creates real potential risk to patients,” Massey said.

He said he was “astonished” to have learned that a single doctor had been left unsupervised and having to handle the care of so many patients.

The proportion of trainees describing themselves as sleep-deprived rose from 21% in 2012 to 24.4% this year. “This is an increasing and worrying trend and it’s very concerning when doctors say that it’s jeopardising their ability to make good judgments and to provide safe care,” Massey told the Guardian in his first interview since taking up his role last month.

“Sleep deprivation matters because [tired] doctors may not remember all of the things that they should remember – for example, all the things to do to safely intubate an individual – because they are so knackered or may not remember all the patient’s history and may therefore make the wrong clinical judgment about them.”

Massey is so worried by the potential for patients being harmed by rising fatigue and workload pressure among hospital doctors that he has written to every NHS provider of care across the UK warning them to take steps to ensure the safety and quality of care are protected.

“Those responsible and accountable for the delivery of medical education locally must take the appropriate steps to ensure the training of doctors remains protected, particularly as medical training is so often a bellwether for the quality and safety of patient care, and because patients are directly at risk if the support and supervision of doctors in training is inadequate,” he wrote in the letter.

A separate survey of junior doctors, undertaken by the Royal College of Physicians and published on Wednesday, found that 80% of trainee medics say their job sometimes or often causes them excessive stress.

One in four of the 498 junior doctors surveyed by the RCP said their job seriously affected their mental health and 54% said it affected their physical health. Pressure on trainees had reached a “harmful and unsustainable level”, the college said.

Massey said the demands being placed on trainees were now so great that there was a risk of some being “used and exploited” by their hospitals because there were too few staff to cope with the work that needed to be done.

“We have seen some signs that that is beginning to happen,” he said. The GMC, which supervises all doctors’ training, fears that some are not getting the training they need and the next generation of consultants may not be as highly skilled as they need to be.

Massey also voiced unease that the quality of handovers from one set of doctors to another – which are integral to patients receiving good care – had emerged as a growing concern. Young doctors’ clinical education is also being interrupted by them being called out of training sessions to attend to problems involving patients, the GMC found.

Key medical specialties that have seen some of the sharpest rises in demand from patients – such as A&E, acute internal and general medicine, respiratory medicine and gastroenterology – are those where trainee doctors’ workloads have increased significantly in recent years, the GMC found. A total of 53,835 junior doctors – just under 99% of the 54,563 across the UK who were eligible to complete the GMC survey – took part.

Dr Pete Campbell, of the British Medical Association’s junior doctors committee, said: “Patients and the public may be shocked by these findings, but no junior doctor will be surprised. It is still far too common that junior doctors are left sleep-deprived after regularly working beyond their rostered hours, on rotas that are desperately short of doctors.”

NHS Employers said the new contract being imposed on junior doctors in England, which prompted the recent year-long industrial dispute between the BMA and the government, would remove or mitigate many of the concerns behind their rising dissatisfaction.

“We want to support our junior doctors,” a Department of Health spokesman said. “That’s why the NHS has employed 11,900 more doctors since 2010. Yesterday, the health secretary announced plans to improve junior doctors’ training, including more support from consultants, more notice of future placements including where couples are placed, reviewing the appraisals process and investing £10m to bring doctors back up to speed when they take time out to have a family or other caring responsibilities.”

Junior doctors" sleep deprivation poses threat to patients, says GMC