You’re fresh out of university and it’s your first day in a new job. You’ve never been to this building before, have never met your colleagues and don’t know your way around. It’s a pretty daunting prospect.
Then your shift starts and all of a sudden you’re responsible for a queue of people waiting for urgent, potentially life-saving medical care.
Since 2009, the first Wednesday in August has been known colloquially in the NHS as “Black Wednesday”. It’s a dark nickname which refers to the fact that all new and early stage doctors start their new jobs on the same day each summer.
Today, almost 10,000 newly qualified doctors will begin their first full-year as an NHS doctor. At the same time, every existing resident (formerly ‘junior’) doctor will switch places, moving to new roles in new hospitals. In total, that means more than 50,000 NHS clinicians will be clocking into a new department at a new hospital in England alone.
The disruption created by this mass migration makes “Black Wednesday” a highly disruptive day in the NHS calendar. Historically, some research even points to an increase in patient mortality rates of up to 6% as a result.
When I first stepped onto a hospital ward back in 2014, I had no idea what I was walking into. I don’t mean delivering care or handling patients with a vast array of needs. That was the stuff we’d trained for. I mean I literally didn’t know where I was going. If it hadn’t been for the endless kindness (and patience) of more experienced colleagues, I might still be locked in a broom cupboard or lost in a maze of corridors. Once I’d got my bearings, I spent hours trying to log into the various computer systems I needed to record crucial patient data, track my work and communicate with colleagues.
These might sound like the kind of minor inconveniences that can blight anyone’s first day on the job, but when there were hundreds of doctors in the same position at my hospital alone - and thousands of others across the country - it’s easy to see how “Black Wednesday” got its name. In a service that is chronically overstretched, where every second of clinicians’ time is under pressure, basic obstacles like this can mean the difference between life and death.
What lies beneath the somewhat-cynical nickname is a perfect encapsulation of innovation inertia. The concept of rotating a huge chunk of your staff all on the same day doesn’t make sense. But the alternatives have, for too long, been perceived as fiddly or complicated. So we’re stuck with a status quo that damages a system that deserves better.
Alternatives to Black Wednesday have, for too long, been perceived as fiddly or complicated
The medical merry-go-round which sees resident doctors placed on constant rotation (they move roles every four months in the first four years after medical school and then every six months for four or more years after that) leaves them unfamiliar with the people, practices and policies of the hospitals they work in. And whilst doctors are equipped to get up to speed with new systems quickly and can rely on more seasoned staff to support them through the onboarding, the practice damages the fabric of our health service. The short-term, transactional relationship it creates between hospitals and staff prevents either party from building any real loyalty to one another, and can undermine a sense of community among colleagues.
What’s so frustrating is that we know it doesn’t have to be like this. Countries like Canada, France, Germany and Australia have all built health systems which allow their young doctors to complete most or all of their training in the same place.
In Canada, where I spent six years as a student, new doctors are typically based at one teaching hospital for the entirety of their postgraduate training (this can be up to seven years). The preference-based “Canadian Residents Matching System” pairs medical school leavers to hospitals based on their specific interests and needs, with added incentives for those who choose to work in rural areas or underserved communities.
While clinicians might rotate between different specialties or care settings within the same local health system, the loyalty and trust staying in one place builds between clinicians, healthcare organisations and communities is something which the NHS would truly benefit from.
Changing the system doesn’t have to be a headache. Just because we’ve become accustomed to ingrained practices doesn’t mean we shouldn’t seek to change them. There’s no reason, for example, that we can’t use algorithms to organise staggered start dates for new medics - spreading those onboardings across a month, instead of a day. Or explore offering longer-term places for medics within specific Trusts; allowing them to put down roots and build lives without the perpetual threat of disruption.
Likewise, new tech can also help make onboarding smoother. Digital resources like VR tours or video briefings would help doctors familiarise themselves with their new environments. Tackling the IT log-on hell before you turn up for the first day would be a godsend. And providing clear organisational charts, contact details and procedural information so you know who to contact for certain queries, and how.
This isn’t just about making doctors’ lives easier. It has major implications for patients and for the long-term health of our NHS. If we’re serious about building a health service that’s fit for the future, we need staff who are given the chance to build deep roots within the organisations they work for. Clinicians who understand the historic challenges and specific goals of their Trusts, who can become embedded in the local community, and develop solutions and strategies which work for them. Ultimately, we need to design a system that makes young doctors want to stick around.
For too long, our early-career doctors have been passed from hospital to hospital, moved from city to city, and asked to continue delivering world-class care under challenging conditions. There’s a chance to make today the last “Black Wednesday”. It’s time to end the medical merry-go-round, embrace a new approach that prioritises roots, not rotation, and give doctors the stability they need to grow in a healthy, sustainable NHS.
Dr Anas Nader worked as a resident doctor across Trusts including Lewisham and Greenwich NHS Trust and East Kent Hospitals University NHS Trust. He is now co-founder and CEO at Patchwork Health, a London-based NHS staffing initiative. He is also a Board Trustee at Macmillan Cancer Support.
