Published: 16/12/2004, Volume II4, No. 5936 Page 34

Hospital doctors are quick to tell you what makes them unhappy - but what do different grades say they want that would make them happier?

A survey of more than 1,600 hospital doctors earlier this year shows that nonclinical support would most improve working lives for consultants, while for all other grades it is education and training.

Following the Department of Health's Improving Working Lives policy document in 2001, all NHS organisations have to have policies, practices and people in place to implement IWL initiatives.

To identify exactly what doctors want the DoH-funded intercollegiate IWL committee drew up a survey that was carried out in the spring. The results were restricted to four grades of hospital doctors - consultants, specialist registrars (SPR), senior house officers and pre-registration house officers, and staffgrade and associate specialties (SAS).

Perhaps unsurprising was the emphasis on education and training needs, and mentoring, from doctors in training and the SAS group.

While SAS doctors do not have ringfenced time for education and training, the committee said that better use should be made of annual appraisals to improve personal and professional development.

The message from consultants is that they require additional administrative support. The committee says this is no surprise given the greater administrative load required in a target-driven, consultantled and more open working environment. It is also concerned about the potential of Agenda for Change to downgrade the role of the medical secretary.

'Medical secretaries have an important supportive clinical role liaising with patients, families and other healthcare professionals and a vital administrative role in organising the service, ' it says.

The committee also says consultants need more support from nurses and nonmedical clinical-trained staff.

It notes that in recent years nonmedical clinical personnel roles have expanded to provide high levels of technical support - for example, nurse endoscopists and pharmacy technicians.

But more is still needed.

The other trend from the research was a need for better childcare support - although not, as yet, for all doctors.

The only grade and sex of doctors to identify childcare support in their top five IWL choices were female SPRs, who made it their number one choice. Childcare was top choice for paediatricians, 71 per cent of whom were female. It was ranked third among those in obstetrics and gynaecology and dental specialties.

The committee says that with an increasingly female medical workforce, the NHS will need to expand and adapt its childcare facilities.

'Most hospital creches still do not have opening hours that correspond to junior doctors' shift patterns, especially early morning and evening work, ' it says.

For a copy of the report or more information, contact IWL Intercollegiate committee member Anne Dornhorst at iwl@rcseng. ac. uk