Choose Psychiatry in Scotland: right here, right now

I was going to begin this blog post by sharing all the good work being done at the College in Scotland, by members and staff, in relation to workforce recruitment, retention and wellbeing - start with something positive. But I feared that for many of our colleagues it does not reflect the reality on the ground and they would be put off from reading any further. I want to acknowledge this reality before going on to share some of the work we are doing via the Choose Psychiatry in Scotland (CPS) committee and more widely at the RCPsychiS.

Workload Pressures

We know the situation with workforce pressures in many parts of Scotland. For several reasons, and over a period of time, numbers of consultant psychiatrists have been reducing with not enough coming through the training route in sufficient numbers and in time to make up the gaps.

Workload pressures, job plans with 9:1 PA:SPA splits, electronic job planning where every minute of every day is scrutinised and the autonomy, integrity and intelligence of consultants to manage their own workloads is challenged, devaluation of the role of senior doctors within organisations to promote a flattened hierarchy often for the sake of it, being penalised for experience and seniority by unfair tax changes forcing many of our colleagues to retire earlier than they would have wished and inviting them back to jobs that are hard to fill for a reason (and with even less time to do so). I could go on. High stress levels, burnout, physical and mental health problems, are all consequences. 

This is also what trainees see and we wonder why they are in no rush to complete their training and take up consultant posts. The time from joining medical school to coming out the other side as a consultant is rarely 13 years anymore and it will only get longer with large numbers of students and trainees expressing an interest for less than full time working. Of course, there are several good reasons for and benefits of flexible working but it needs to be a choice they wish to make and not one influenced by the current state of play.

Choose Psychiatry in Scotland

For various reasons not many medical students are choosing to take up psychiatry as a career option. A survey of student career choices conducted a few years ago clearly showed students were open-minded in year 1 but due to a combination of  the following factors they were considering other medical specialties by year 5:

• poor placement experience (often related to jaded consultants with no time or head space to teach)
• poor teaching that doesn’t do anything to challenge the myth that psychiatry is not a scientific specialty
• specialty bashing by our medical colleagues etc.
  

There are several areas where consultants and SAS doctors remain motivated and enthusiastic, are supported by the organisations they work in to deliver good clinical care, teaching and training, and are given time to get involved in the non-clinical aspects of the job, often what helps maintain wellbeing and promote career longevity. There are several examples of trainees enthused by the specialty and happy to train and live in Scotland. Examples in the Choose Psychiatry in Scotland brochure are testament to this. All is not lost.

As an international medical graduate (IMG) arriving in this country nearly 25 years ago I can vouch for the excellent training opportunities and support available to doctors in Scotland and this is something I often talk about to anyone who will listen. I’m happy to expand on my experience further, perhaps together with other IMGs, in another blog if I’m ever invited back after this one!

In my time as chair of CPS we have built upon and expanded the work of my predecessors Drs Tom Brown and Rhiannon Pugh (as part of the Scottish Training & Recruitment Group which became recognised as the CPS committee in 2020), focussing on recruitment into the specialty from medical students through to consultants, retaining our students, trainees and consultants, and having wellbeing as a strand that runs through all we do.

Once again this year the fill rate for core psychiatry is 100% and whilst the effects of the pandemic restricting movements have had some impact it is nonetheless impressive and clear evidence that we are doing somethings right at the placement level and at College level. Given what I’ve said about the current state of play we clearly cannot drop the ball at this crucial stage. 

Workforce

We are also fortunate to live in a country where we have strong links with Health Boards, NES and the Scottish Government with many fora to meet including the Workforce Steering Group which meets quarterly. An expansion in foundation places in psychiatry from 33% to 36% is very welcome and it was also encouraging to see the Foundation Priority Programme (NES) offering 6 additional FY places in psychiatry (with mentoring and other supports as part of it) and identify places for them in the north of Scotland where recruitment has been a challenge.

A ‘race against the clock’ piece of work requested by government and involving NES and RCPsychiS has resulted in five new core training places with recurrent funding as of this August (and the promise/suggestion of more over the next few years) was a great example of collaborative working towards a common goal and recognition of a shared understanding of many of the workforce issues facing us. However we need to ensure that these placements offer excellent training experiences or risk these doctors moving away from psychiatry and/or Scotland.

CPS Committee

I’d now like to mention a few of the activities of the CPS committee. We were successful in a funding bid to NES but had to change how we delivered our plans due to the pandemic. RCPsychiS staff have done an incredible job of moving to the virtual world, from the Welcome Pack for medical students (very well received to date and others looking to replicate) and several useful webinars to the aforementioned Choose Psychiatry in Scotland brochure.

We are especially proud of our brochure and I’d like to acknowledge all the hard work of staff and volunteers and support from NES to make it a reality. This is now on the RCPsychiS website and hard copies will also be sent out widely and available on demand. The brochure will be launched at the International Congress.

Providing bursaries to students and trainees is something we have continued to do and have expanded further including places at Scottish and some other events, travel (pre-pandemic!) expenses, research bursaries and networking bursaries. There is scope to provide more of this so please contact us.

Exhibition Stand at International Congress

By the time this post comes out I hope many of you will have attended the International Congress and visited our Choose Psychiatry in Scotland exhibition stand. Having seen the preview it looks pretty impressive and we are hopeful that it will attract attention from the UK and abroad. At last count over 3000 delegates had registered to attend and that number is likely to rise by next week. The gains from this event, as with a lot of our work, may not be felt for a few years. 

The wellbeing agenda runs through all the work we do even if it is not always visible or tangible and the benefits may not be immediately evident. The RCPsychiS has for a few years been lobbying for the development of a service to support sick doctors and this was eventually given the go-ahead with the establishment of the Workforce Specialist Service.

A lot of people have worked very hard over the years to help set this up and although not fully up and running it is on the right track and we should see the benefits in years to come. In the meantime, there is agreement (and funding) to refer to the Practitioner Health Programme in England.

Recruitment, Retention and Wellbeing

Other initiatives include promoting StartWell in Scotland with an event planned for early next year. The College are also setting up mentoring for consultants. Of course, as members we all have access to the Psychiatrists Support Service.

RCPsychiS is leading the work on improving consultant and SAS job descriptions in Scotland with a paper submitted to the Scottish Academy with proposed changes to the External Advisor role including greater scrutiny around job descriptions, the use of exemplar job descriptions that has, among other improvements, a clearly defined section on wellbeing and (this is the most challenging bit) moving away from 9:1 contracts. This has been well received by the Academy but the work here has only just begun. It is our hope that such changes will have a direct effect on recruitment and retention and help us compete with services elsewhere in the UK.

I am aware of so much more work being done on recruitment, retention and wellbeing in many parts of the country and hope to be able to acknowledge and showcase a lot of this going forward. 

This may sound like a cliché but it is true that we are at a critical juncture in psychiatry in Scotland. We need to recruit more psychiatrists and ensure we retain those we have. We need to ensure that trainee placements are fit for purpose and consultant jobs are not only do-able but enjoyable. There are no quick solutions even if temporary fixes are welcome.

We need to ensure that the wellbeing of our students and doctors is on top of our thinking. We need to demonstrate that Scotland is the place one has in mind when thinking about training, living and working in psychiatry. In the immortal words of Fatboy Slim this needs to happen ‘Right Here, Right Now’!

Dr Ihsan Kader - Chair, Choose Psychiatry in Scotland