Patients need more doctors - there can be no shortcuts.

Call To Action

Someone told me this morning that they thought some of the non-doctors taking on doctor roles in the NHS were “just as good as doctors”. I have to admit, I found this bizarre. No one would be happy sitting on-board a plane which didn’t have a pilot in the cockpit, would they? No one would be happy driving around a car that hadn’t been designed by an engineer. Yet politicians have persuaded some people that doctors can be done away with and replaced by people who haven’t gone to medical school and undergone the same rigorous training.

As someone who went through this education and training, the idea fills me with horror. Not because I emerged from medical school with a high level of expertise; quite the opposite - I worked my socks off for 5 years, passed dozens of exams, and came out of that with the baseline level of knowledge that anyone needs when they venture onto hospital wards as a new doctor. It is this baseline knowledge that creates an invaluable foundation for what comes next.

When doctors start working, we’re heavily supervised by seniors. As you move through your first few years working clinically, you will gradually be given more responsibility for the patients under your care. At every single step, taking on that additional responsibility feels terrifying. I remember the very first time I had to write my own management plan for a patient. I remember the first time I inserted a IV cannula, unsupervised. I remember the first time I turned up at a cardiac arrest before other staff members arrived, and had to start the resuscitation attempt. Every single one of these experiences was terrifying, and every single one of these experiences was a learning experience.

You learn gradually in medicine, because there is an awful lot to learn. But crucially, there are boundaries to the knowledge you need to know too. Over hundreds of years, the medical school curriculum has been honed so that medical students are taught enough to get started, and then doctors are supervised closely for a very long time to ensure they gain the breadth of expertise needed to back up the science they learned at university. It’s similar for other healthcare professionals too. Nurses have a defined area of expertise, so do physiotherapists, and so do speech and language therapists. The knowledge is gained slowly, and there’s a hierarchy within professional teams to ensure that junior staff receive enough supervision and support.

Medicine is carefully organised into specialities and departments, and so, in your early years as a doctor, you have an acute awareness about the things you don’t know. There are clear training pathways and qualifications. You rotate around various specialities and gain skills. As you are doing this, it is patently obvious to you that the doctor who has 1 or 3 or 5 more years of experience than you is much better at performing tasks and assessing patients. This is humbling, and entirely necessary, because dangerous things happen in healthcare when someone doesn’t understand the limits of their own knowledge, the boundaries of their expertise.

This is why something dangerous is happening in the NHS right now; the boundaries are becoming blurred. If you’d told me 20 years ago when I was at medical school that people who didn’t have a medical qualification were taking on roles traditionally performed by doctors, I wouldn't have believed you, but that’s exactly what is happening right now…