BMA Survey Reveals Care Concerns and Blame Culture

Nicky Broyd

September 20, 2018

The BMA has published results of a survey of members designed to help identify today's challenges in the NHS around culture, workforce, and structure.

A total of 7,887 UK doctors (GPs and hospital doctors) took part in the survey by ICM in May and June this year. The results are published today as part of a project called Caring Supportive, Collaborative . Many of the findings cover UK-wide issues while others are limited to just England. A specific report covering Scotland is due to be published later in the year.

Survey Findings

Survey findings highlighted in the report include:

  • 45% of doctors are often fearful of making a medical error and 55% are more fearful of this than they were 5 years ago

  • 78% of doctors said NHS resources are inadequate, significantly affecting the quality and safety of patient services

  • 76% said waiting times have worsened

  • 74% said staffing levels have worsened

  • 77% said national targets and directives are prioritised over patient care

  • 74% said financial targets get priority over care quality

  • 89% cite pressure or lack of capacity as major reasons for errors

  • 55% are concerned about being unfairly blamed for errors due to system failings and pressures

  • Due to these concerns 49% of doctors said they practise defensively

  • 93% said system pressures affect delivery of safe patient care

  • GPs were most likely to report the ability to provide safe care being affected by pressure to carry out multiple tasks, lack of time with patients, and fatigue from working long hours

  • Hospital doctors were more likely to highlight a lack of doctors, support staff, and beds

  • 43% of doctors reported feeling cautious about recording reflections due to fear of them being used against them, while 49% said they do not have the time to learn and develop professionally

  • 39% of doctors report problems with bullying, undermining, or harassment in their workplace often or sometimes

  • 75% of white doctors believed there was a culture of inclusion and respect for diversity at work but the number fell to 55% among BAME doctors

  • 71% of doctors in England said CQC inspections add to fear and worry amongst staff and only 9% said the inspections take system pressures into account

Next Steps

The report calls for increased funding of at least 4% a year for the NHS across the UK to bring it into line with other major European countries, as "current NHS funding does not match the job it is expected to do."

Extra money is needed, it says, to cope with changing demographics and patient expectations, capacity, and sustainable investment in services.

"A fundamental shift in culture in the NHS" is needed it says to tackle a persistent culture of fear and blame. This should also include creating a supportive learning environment for staff that's essential for patient safety.

Regulators, it says, need to "drastically change their approach, starting with a clear acknowledgement that errors may result from the environment in which a doctor works rather than being the fault of an individual." Reforms are also needed to England's inspection regime.

The report wants steps taken to make doctors of all grades confident about raising safety concerns. It also wants legal protection afforded to doctors' written reflections.

Doctors should be able to contribute to maintaining and improving care through "a strong culture of medical leadership and engagement."

Schedules and rotas need to be adjusted to remove excessive workloads and allow time for continuing professional development, the report says.

It also calls for an end to tolerance of bullying, harassment, and undermining, with earlier and more effective interventions.

Care at the Coalface

The report says the findings and recommendations "are a starting point for a
much wider conversation – about how we can change the NHS for the better and empower those who work in it to do what they do best: provide outstanding care for patients."

The project was the idea of BMA chairman, Dr Chaand Nagpaul. "It is vital that the Government and policy makers heed the views of all doctors who provide care at the coalface; they are in the best place to know the problems the NHS faces on a daily, hourly basis," he said in a statement. 

"They know the scale of impoverishment in the NHS is staggering. They are working in a culture which has improved little since the publication of the Francis and Berwick reports following the tragedies in Mid-Staffordshire 5 years ago.

“Doctors experience challenges of trying to provide safe patient care when there is poor staffing, gaps in rotas, lack of adequate facilities and where a persistent culture of blame stifles learning and improvement."


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