Starting in the NHS
Guest Blog: Catriona Barlow, Scottish Clinical Leadership Fellow of the Royal College of Physicians and Surgeons of Glasgow.
My first day in the NHS
Wednesday 4th August 2010 loomed large on the calendar.
A trawl through my emails has revealed that our rota was sent out on the 2nd, not exactly much notice – we soon learned that the ‘rota 6 weeks before starting a post’ standard was mostly an aspirational one. I was nervous to finally be starting work as an FY1 but the clinical shadowing at the end of July and after finals during our ‘P for P’ block – Preparation for Practice or, as we preferred to call it, Punishment for Passing – had allowed me to become pretty familiar with the hospital, its systems and the staff I would be working with.
A group of us all lived in the same part of Glasgow and decided early on that we would car share, primarily to share the driving but also for the camaraderie. It was like the first day of school except instead of a new pencil case and folder I had a pristine stethoscope, tourniquet and clipboard – we’d learned from the outgoing FY1s that carrying a supply of blood forms, cardiology request cards, discharge scripts and continuation sheets was vital to being efficient and making it through the ward round.
There were usernames and passwords – so many usernames and passwords – for a smorgasbord of online systems: PACS, SCIstore, RISweb, ePortfolio, DOTS… Induction talks stretched far into the afternoon on topics as varied as HR policies, infection control and hospital at night. At least lunch was provided – a bonus when most of us were pretty broke at that point, the first payslip couldn’t arrive soon enough. Pagers were handed out, some in a better state of repair than others; if yours didn’t have a belt clip on it and your skirt or trousers didn’t have pockets then your pager was cumbersome as well as an incessant source of noise and interruption.
During a coffee break, a man from security took our photos for our first NHS ID cards. I was the first of the new FY1s to have my photo taken and I forgot that I had my stethoscope around my neck; it looks a bit ridiculous in the photo in retrospect, a rookie error. The other FY1s all learned from my mistake and removed their stethoscopes. I still have that ID card, it lives in my wallet – useful for both NHS discounts and a small reminder that smiley FY1 Catriona was full of excitement and anticipation for what lay ahead. I didn’t yet know how hard it would be, how stressed I’d feel and what bumps there might be along the road. My FY1 year was tough but we all mucked in together and we got there. You might not think it now but, as time goes on, it will all feel a little easier and you’ll get better and better. By the time that you’re thinking about moving on to FY2 and the prospective FY1s come to shadow you, you won’t believe how far you’ve come.
How has it changed?
In many ways little will have changed in only eight years but there will be some differences for anyone starting on August 1st 2018. First, smart phones have come on in leaps and bounds over that time so it is very much the case that ‘there’s an app for that’. In 2010 I had only just moved to a smart phone, the now parochial seeming iPhone 3. I could access my email in the scattered pockets of 3G around the hospital – hospital wifi was a long way off – and an app showed my rota. Now there is an app for the BNF, local guidelines, NICE guidance and clinical scoring systems – much quicker than thumbing through a battered book. There’s also Whatsapp – other group messaging apps are available – which allows collaboration and conversation amongst a large group of colleagues much more easily than text messages did. We had a bulky handbook, paper copies of the BNF, paper blood forms, paper discharge scripts, paper everything. In 2018 many hospitals have electronic prescribing, electronic discharge letters and electronic request systems. The only common paper commodity remaining might be the good old continuation sheet.
Some things haven’t improved however. I suspect that someone starting now may be more demoralised and even more worried about slipping up than we were. You cannot escape stories of NHS ‘failure’ and ‘missed targets’. Anyone starting FY1 this year will have been a medical student during the junior doctor contract negotiations in England and can’t have failed to see how this impacted upon relations between doctors, the public and the press. Depending on where someone has trained, the level of student debt will be considerably higher. Mine was high enough and was only paid off in March of this year.
This is counterbalanced by a greater understanding and awareness of the importance of junior doctor wellbeing, support and resilience. Rotas have been changed to stop the ’12 on, 2 off, 12 on’ pattern that dominated my FY1 year and this can only be a good thing. Just because we got through it doesn’t mean other people should have to. Professional bodies such as the Royal Colleges and the Faculty of Medical Leadership and Management have produced reports calling for the return of clinical mentoring, protected rest space off the ward and a better balance between training and service provision.
One thing that hasn’t changed is the need for pockets. You’ll always need pockets.
My advice to doctors starting today
As doctors we do like lists so here is my list:
- It does get better
- You will get there in the end
- A shift will always be easier if you have eaten and drunk something
- Support other FY1s and they will support you
- If you can, car share or commute together with other FY1s as it means you have company and you are likely to all help each other get tasks finished at the end of the day so you can all get home
- The nurses, midwives, healthcare support workers and ward clerks have a huge amount of knowledge about their ward so never be afraid to ask them for help if you’re stuck, they may well have the answer
- You are allowed to look things up whether it’s in the BNF or on google
- There are no stupid questions, don’t be afraid to ask
- Get yourself some comfortable shoes and clothes that are easily cleaned
- You can never have too many pens
- Sometimes veins just disappear
- Talk to your patients and learn from them, you’ll hear some great stories you’ll never forget
- Try to see your portfolio as a record of achievement to be proud of rather than a never ending assessment
- Plan nice things to look forward to, especially after a set of nights, whether that’s a trip to the cinema, a brunch or a payday night out
- Sleep is important, try to get as much as you can
- Keep an eye on your payslips, pay is wrong more often than you’d think
- You can claim tax relief for professional costs such as GMC fees and defence union subscriptions
- Have someone you can talk to, whether a friend or family member, sometimes a good rant after a hard shift is all you need to restore yourself
- Look after yourself, you matter
- Did I mention pockets?