Now here’s a potentially controversial idea. In return for doing nightshifts, should NHS staff be entitled to an earlier retirement?
This idea came to me during a 4am callout. A recent general recommendation from our accountants to check for any gaps in national insurance contributions, took me to the HMRC website. It informed me – cheerfully, I felt – that I had contributed 14 full years of national insurance, and I had another 32 to go until retirement. The 10-minute car journey to the hospital presented an opportune moment to reflect on whether this makes me feel young, or depressed.
I enjoy my job and consider much of it to be a privilege, despite the dysfunctions that exist aplenty in NHS decision-making. But the realisation that I’m not even a third of the way through my working life made me slightly queasy, exacerbated by the feeling of small-hours nightshift dyspepsia.
Our knowledge of the importance of sleep, and adhering to circadian rhythm, is still to reach realistic consideration amongst public services. As a society we seem to be hell-bent on (or addicted to?) the idea of 24-hour working. However, there are two inescapable facts: 1) Night shift working is an inevitable requirement of any health system providing acute care (and we all knew this when signing up for medical school); and 2) Night shift working reduces life expectancy, and increases the chances of developing metabolic syndrome, some cancers and mental health problems.
At this point I also need to mention some blatant caveats. The majority of us GPs seem to be feeling harder worked, more pressured and less valued. The last thing we need is unhelpful divisions between ‘them who do nightshifts’ and ‘them who do not’. Pressured and fragile as our own working days can be in rural pracice, we are well aware that our less rural colleagues often start earlier, finish later, see more and have very different stressors on a daily basis.
But I write these blogs to highlight some of the pertinent issues in rural practice, so notwithstanding the above recognition, it seems an undeniably strong argument that if you are signing up for work that will reduce your life expectancy, it would make logical sense to shave off some time at the ‘other end’ to account for it. Crumbs, there is even a decent evidence base to support the maths. The practicalities are beyond this piece, but capped allowances and proportional reductions (as in, work 12 night hours, get a few back) are all options.
Maybe this could be the start of something to bolster under-populated out-of-hours rotas, and mean night shift working is properly acknowledged for NHS staff across the board.
David Hogg is a GP on the Isle of Arran and Chair of the Rural GP Association of Scotland. He writes in a personal capacity. You can follow him on Twitter @davidrhogg