Title: Care Under Pressure 3: Optimising the delivery and impacts of interventions to reduce hospital doctors’ mental ill-health in the NHS
Funder: Department of Health and Social Care

Abstract: The NHS needs motivated doctors to provide the best care for patients. However, doctors experience high levels of stress, anxiety, and other mental illnesses due to very challenging demands and pressurised work environments. They worry about patient safety, the consequences of letting patients and colleagues down, and their professional reputation. Many work while unwell or choose to leave the profession. This has contributed to shortages of doctors._x000D_ _x000D_ Existing workplace support for doctors seems to be having limited effect. In the 2020 NHS staff survey, around 40% of doctors reported to have felt unwell because of work-related pressure. Around a third of staff said that they were considering quitting their job. With COVID-19, the need to address mental ill-health in doctors is even more important to the future of the NHS._x000D_ _x000D_ Existing approaches to workplace support do not take into account the different factors contributing to mental ill-health in doctors (e.g. individual, organisational, social); nor how existing approaches to preventing/supporting mental ill-health might interact within the workplace._x000D_ _x000D_ Our previous NIHR project, Care Under Pressure 1 (CUP1), brought together evidence, and produced guidance and recommendations to reduce doctors’ mental ill-health in the workplace. One conclusion from CUP1 was that we do not need MORE initiatives, but we need to IMPROVE the ones that we already have._x000D_ _x000D_ The proposed project, CUP3, transforms the principles and recommendations established by CUP1 into practice in eight carefully-selected NHS Trusts. It addresses the lack of practical guidance on how to apply existing recommendations for preventing or reducing doctors’ mental ill-health in the workplace so that they work as intended. Our aim is to work with and learn from eight NHS Trusts to minimise doctors’ mental ill-health and its impacts on the workforce and patient care, providing guidance for all NHS Trusts. _x000D_ _x000D_ Our objectives are to:_x000D_ 1. Map existing interventions to reduce doctors’ mental ill-health in the NHS; and use this to select eight different NHS Trusts _x000D_ 2. Work with these Trusts to understand their existing strategies to reduce doctors’ mental ill-health _x000D_ 3. Develop guidance for all NHS Trusts to help them evaluate and implement strategies to reduce doctors’ mental ill-health _x000D_ _x000D_ Patients have contributed to the design of CUP3 and reviewed this plain English summary. We have brought together a team of expert researchers and clinicians who have already collaborated successfully on CUP1and other projects. We have an existing project advisory group from CUP1 which includes patients, policy makers, and doctors. We will also create local stakeholder groups, including doctors, managers, and patients, at each of the eight NHS Trusts recruited. These groups will help us to design feasible solutions to the problems identified._x000D_ _x000D_ We will communicate our results via reports and publications, but we will also build on our success in CUP1 of using more innovative approaches, such as cartoons, to make our work more user-friendly and accessible.

Lay abstract: Background: _x000D_ The NHS needs motivated, compassionate, well-supported doctors to provide the best care for patients. However, doctors experience high levels of stress, anxiety, and other mental illnesses due to challenging demands and pressurised work environments. Many doctors work while unwell or choose to leave the profession, or the NHS, leading to shortages of doctors. Existing workplace support for doctors seems to be having limited effect and often does not take into account the multiple factors contributing to mental ill-health in doctors (e.g. individual, organisational, social), nor whether interventions have been implemented effectively. Our previous NIHR16/53/12 review, Care Under Pressure 1 (CUP1), synthesised evidence to produce key principles and recommendations to reduce doctors’ mental ill-health in the workplace._x000D_ _x000D_ Aim: _x000D_ The empirical project proposed here, Care Under Pressure 3 (CUP3), aims to work with and learn from eight purposively selected NHS Trusts, building on the principles and recommendations from CUP1, to develop an implementation toolkit for all NHS Trusts to help them minimise doctors’ mental ill-health and its impacts on the workforce and patient care._x000D_ _x000D_ Objectives: _x000D_ 1. Develop a typology of interventions to reduce doctors’ mental ill-health and use this to inform sampling of eight NHS Trusts_x000D_ 2. Work with recruited Trusts to develop an explanatory account of whether and how their interventions are working, for whom, under what circumstances and why (not)_x000D_ 3. Develop an evidence-based implementation toolkit for all NHS Trusts to optimise their strategies to reduce doctors’ mental ill-health_x000D_ _x000D_ Methods and Timeline: _x000D_ Three sequential phases of research over 24 months, with each phase informing the subsequent ones. _x000D_ - Phase 1 [months 1-4] develops a typology of interventions to reduce doctors’ mental ill-health (based on categorisation of the sources included in CUP1 review, and input from the project advisory group), which will inform the sampling for Phase 2._x000D_ - Phase 2 [months 5-19] involves a realist evaluation of the existing combinations of strategies being used by NHS Trusts to minimise doctors’ mental ill-health (based on n=160 interviews of NHS Trust doctors, mangers, occupational health etc.). We will purposively select eight Trusts to maximise variation (e.g. size, geographical location, staff wellbeing). _x000D_ - Phase 3 [months 20-24] brings together the insights gained through Phases 1 and 2, to create an implementation toolkit that all NHS Trusts nationally can use to optimise their strategies to reduce doctors’ mental ill-health and its impacts on the workforce and patient care. This will be based on engagement with project advisory group and stakeholders from Phase 2._x000D_ _x000D_ Anticipated impact and dissemination: _x000D_ CUP3 will (a) provide tailored and actionable guidance to improve the delivery of interventions to reduce doctors’ mental ill-health in the eight recruited NHS Trusts, and; (b) co-develop an implementation toolkit for use by other NHS Trusts nationally. Dissemination will involve standard and innovative forms, including cartoons and short videos, tailored to different audiences (e.g. doctors, NHS managers, policy makers).

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;6.6 PSYCHOLOGICAL AND BEHAVIOURAL;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH