0:00:06 > 0:00:09Now on BBC News it's time for Inside Out.
0:00:09 > 0:00:11Hi, I'm Elaine Dunkley, and welcome to Inside Out.
0:00:11 > 0:00:14This week we've got a series of special reports from the front
0:00:14 > 0:00:18line of the NHS across England coming up: there's a shortage
0:00:18 > 0:00:22of medics in the UK, but as we lure in doctors
0:00:22 > 0:00:26from overseas, what's the impact on those left behind?
0:00:26 > 0:00:32We meet the 82-year-old Romanian brain surgeon.
0:00:32 > 0:00:36And with a shortage of GPs as well, how can we persuade more trainee
0:00:36 > 0:00:40doctors to go into general practice?
0:00:40 > 0:00:43If you could take a breath in and out for me.
0:00:43 > 0:00:47We reveal how stressed junior doctors are facing a growing
0:00:47 > 0:00:50mental health crisis.
0:00:59 > 0:01:03A survey by the BBC suggests more than two-thirds of hospital trusts
0:01:03 > 0:01:06across England are trying to fix a serious shortage of medical staff
0:01:06 > 0:01:08by looking abroad.
0:01:08 > 0:01:11But by luring doctors here, is the NHS simply causing a crisis
0:01:11 > 0:01:15elsewhere, and should we care?
0:01:15 > 0:01:18Chris Jackson has been to one Eastern European country to ask,
0:01:18 > 0:01:20are we getting their doctors on the cheap without any regard
0:01:20 > 0:01:25to the consequences?
0:01:27 > 0:01:32Two doctors, one young, one old, both Romanian.
0:01:32 > 0:01:35Luisa Baca is inserting an abdominal drain.
0:01:35 > 0:01:38She works in Romford.
0:01:38 > 0:01:39I love my job.
0:01:39 > 0:01:42I love working with patients.
0:01:42 > 0:01:45Did your tummy get bigger, basically?
0:01:45 > 0:01:48The NHS is a world-class health system.
0:01:48 > 0:01:52I get here the opportunity to learn something new and not worry
0:01:52 > 0:01:58about your rent.
0:01:58 > 0:02:02Leon Danailla practices brain surgery back in Romania.
0:02:02 > 0:02:04TRANSLATION: I don't have a large fortune.
0:02:04 > 0:02:08I think I'm the poorest doctor in the world.
0:02:08 > 0:02:10Two systems, one rich, one poor.
0:02:10 > 0:02:13The rich, the NHS, sucks in talent from around the world,
0:02:13 > 0:02:16at the expense of the poor.
0:02:16 > 0:02:20So what is that doing to Romania?
0:02:20 > 0:02:23Bucharest.
0:02:28 > 0:02:31Leon is removing a brain tumour.
0:02:31 > 0:02:36He'll be 83 in July.
0:02:36 > 0:02:39TRANSLATION: If the doctor is in good health, it's good to work
0:02:39 > 0:02:44into old age.
0:02:44 > 0:02:48I don't use glasses.
0:02:48 > 0:02:49My hands don't tremble.
0:02:49 > 0:02:52Leon earns less than ?500 a month.
0:02:52 > 0:02:56He is one of thousands who couldn't retire even if they wanted to.
0:02:56 > 0:02:58They are desperately needed.
0:02:58 > 0:03:06There are so few young doctors here.
0:03:06 > 0:03:08It means medicine in Romania is increasingly becoming
0:03:08 > 0:03:09a pensioner's profession.
0:03:09 > 0:03:12Last year there were more than 8,500 doctors over the age of 60.
0:03:12 > 0:03:19Compare that with 1,300 under the age of 30.
0:03:21 > 0:03:25Across Bucharest, students from the Carol Davila medical school.
0:03:25 > 0:03:30In Britain it costs just under ?200,000 to train a medic.
0:03:30 > 0:03:35But it costs next to nothing to take one ready trained from here.
0:03:35 > 0:03:37There's just the wages to pay.
0:03:37 > 0:03:40So in effect Romania is subsidising our health service.
0:03:40 > 0:03:43We seem to like it that way.
0:03:43 > 0:03:48So do the students here in Romania.
0:03:48 > 0:03:52The United Kingdom is on top of my list.
0:03:52 > 0:03:57My first and technically only choice is the UK.
0:03:57 > 0:04:00They will join around 2,000 Romanians practising in Britain.
0:04:00 > 0:04:06They can earn ten times what they get here.
0:04:06 > 0:04:11The higher wage is really the main reason I would go abroad.
0:04:11 > 0:04:15And there's another way that Romania subsidises the NHS.
0:04:15 > 0:04:19Believe it or not there are British students training here in Bucharest.
0:04:19 > 0:04:22Britain limits its medical school places, it even cut them three years
0:04:22 > 0:04:25ago because the government thought there'd be too many hospital
0:04:26 > 0:04:28doctors in future.
0:04:28 > 0:04:30So British students rejected by our medical schools come
0:04:30 > 0:04:33to countries like Romania instead.
0:04:33 > 0:04:34Guess what?
0:04:34 > 0:04:36Once they are qualified we snap them up, despite saying no
0:04:36 > 0:04:39a few years earlier.
0:04:39 > 0:04:42Like Arran Williamson who has been studying in Romania for two years.
0:04:42 > 0:04:49And Anil Velivela, who's been here for three.
0:04:49 > 0:04:52I didn't get a place in a UK university and I read
0:04:52 > 0:04:55about the opportunities to study abroad.
0:04:56 > 0:04:58Classes themselves are in English.
0:04:58 > 0:05:00I'll be fully qualified to do the job.
0:05:00 > 0:05:02It's a little loophole and I was very surprised
0:05:02 > 0:05:04when I read about it.
0:05:04 > 0:05:10But it benefits me so I'm happy about it.
0:05:10 > 0:05:17Like the Romanians, their training also costs the NHS nothing.
0:05:17 > 0:05:20Back with our doctors Leon and Luisa.
0:05:21 > 0:05:24A success, you hope?
0:05:24 > 0:05:30I want tomorrow to see.
0:05:30 > 0:05:35Both are concerned about the exodus of medics to countries like Britain.
0:05:35 > 0:05:38TRANSLATION: Yes, they are a loss to the Romanian health system.
0:05:38 > 0:05:42We need a lot of doctors.
0:05:42 > 0:05:44We are not encouraging enough junior doctors to stay,
0:05:44 > 0:05:47and it's not only about the pay, it's about investing
0:05:47 > 0:05:50in the hospitals.
0:05:50 > 0:05:54Proper services to support the patients.
0:05:54 > 0:05:58Our hospitals scour the world with shopping lists of doctors.
0:05:58 > 0:06:02Mark's made his business to supply them with talent.
0:06:02 > 0:06:04It's a very busy business.
0:06:04 > 0:06:08Hundreds of thousands of agencies are competing for these doctors.
0:06:08 > 0:06:12The most sought-after specialties are acute medicine,
0:06:12 > 0:06:14accident and emergency, intensive care, paediatrics,
0:06:15 > 0:06:17psychiatry and radiology.
0:06:17 > 0:06:22Across Bucharest, 87-year-old cardiologist Leonida Gherasim.
0:06:22 > 0:06:24It's claimed here that poaching the young is making
0:06:24 > 0:06:27health care dangerous.
0:06:27 > 0:06:31TRANSLATION: This is my concern.
0:06:31 > 0:06:33You not only lose individuals, you lose their capacity
0:06:33 > 0:06:38to train others.
0:06:40 > 0:06:42It's a disaster.
0:06:42 > 0:06:46In great towns maybe there are enough doctors.
0:06:46 > 0:06:50But in important towns with more than 100,000 inhabitants,
0:06:50 > 0:06:54the medicine in these places is done with danger.
0:06:54 > 0:06:57That's because specialists have to work in areas
0:06:57 > 0:06:58they know little about.
0:06:58 > 0:07:00For example, cardiologists could be required to help out
0:07:00 > 0:07:04in intensive care.
0:07:04 > 0:07:06Back with Luisa in Romford.
0:07:06 > 0:07:08Her day is coming to an end.
0:07:08 > 0:07:10Her time in Britain isn't.
0:07:10 > 0:07:13Short and medium-term I want to train and to specialise
0:07:13 > 0:07:18here in the UK.
0:07:18 > 0:07:20I will give a phone call to your wife to tell her
0:07:21 > 0:07:22about the medicines as well.
0:07:22 > 0:07:24It's a privilege to help my patients, and to be trained
0:07:24 > 0:07:30at my best, it's both a duty and a pleasure, yes.
0:07:32 > 0:07:38In Bucharest Leon's patient has regained consciousness.
0:07:38 > 0:07:39TRANSLATION: Does anything hurt?
0:07:39 > 0:07:42My head.
0:07:42 > 0:07:43Your head?
0:07:43 > 0:07:44Well, what can we do?
0:07:44 > 0:07:51That's where the problem is.
0:07:51 > 0:07:54I don't know when I'll stop.
0:07:54 > 0:07:58Yes, certain illnesses or situations could make me step aside.
0:07:58 > 0:07:59Surgery isn't a joke.
0:07:59 > 0:08:04People's lives depend on it.
0:08:06 > 0:08:09With the present trend many of the doctors we'll need over
0:08:09 > 0:08:12the next decade will no doubt come from places like Romania.
0:08:12 > 0:08:15The question is, should Britain expand its medical schools or is it
0:08:15 > 0:08:17just cheaper and easier to rely on poorer countries like Romania
0:08:17 > 0:08:25to fill the gap and pay the price?
0:08:25 > 0:08:28Doctors have always supported free movement of labour.
0:08:28 > 0:08:30The British Medical Association is concerned about the effect
0:08:30 > 0:08:32of excessive foreign recruitment.
0:08:32 > 0:08:33There's always a balance, here.
0:08:33 > 0:08:36Overseas doctors have always been the backbone of the National Health
0:08:36 > 0:08:37Service.
0:08:37 > 0:08:41But I do get worried when I hear about the way we can go abroad
0:08:41 > 0:08:43and deliberately recruit too many people, to the extent
0:08:43 > 0:08:46that there are some countries where a substantial proportion
0:08:46 > 0:08:49of their doctors are coming to work in the United Kingdom.
0:08:49 > 0:08:51And that could be worrying for those countries.
0:08:51 > 0:08:54Because we are not doing them a service.
0:08:54 > 0:08:56Early last December we asked the Health Secretary Jeremy Hunt
0:08:56 > 0:08:59for an interview to discuss the issues raised here.
0:08:59 > 0:09:03A month and a half later he declined.
0:09:03 > 0:09:05So we asked the health minister Ben Gummer.
0:09:05 > 0:09:10And last week, almost a month later, he declined.
0:09:10 > 0:09:13We wanted to ask them on your behalf why we can't train enough
0:09:13 > 0:09:15of our own doctors.
0:09:15 > 0:09:17Would the system collapse without the foreign staff?
0:09:17 > 0:09:19And isn't it wrong to exploit the health systems
0:09:20 > 0:09:23of poorer countries?
0:09:23 > 0:09:25The Department of Health did issue a statement.
0:09:25 > 0:09:28It said staffing was a priority, and there are now more than 10,700
0:09:29 > 0:09:32additional doctors since 2010.
0:09:32 > 0:09:36And more than 55,000 doctors in training.
0:09:36 > 0:09:39Overseas staff are crucial to the NHS, but we must also train
0:09:39 > 0:09:42the right number of staff here.
0:09:42 > 0:09:47Experts were reviewing the number of medical degree places.
0:09:47 > 0:09:49It's pretty clear that in places like Romania,
0:09:49 > 0:09:54that review is going to be watched very closely.
0:10:02 > 0:10:05Have you found it difficult to get a GP appointment?
0:10:05 > 0:10:08Well, statistics show there simply aren't enough doctors to go around.
0:10:08 > 0:10:11In fact the Royal College of GPs claims that in parts of the country
0:10:11 > 0:10:14at least 50% more doctors will be needed by 2020.
0:10:14 > 0:10:18So why the shortage?
0:10:18 > 0:10:21Well, some GPs are simply leaving the profession and it's becoming
0:10:21 > 0:10:23increasingly difficult to recruit new ones.
0:10:24 > 0:10:28Mary Rose has the story.
0:10:28 > 0:10:31Doctor Andrew Green runs a GP practice in Biddulph in
0:10:31 > 0:10:32Staffordshire.
0:10:32 > 0:10:38When he needed to recruit a new GP, he was shocked by the response.
0:10:38 > 0:10:43We advertised in the British Medical Journal, advert ran for two weeks,
0:10:43 > 0:10:46and nobody applied.
0:10:46 > 0:10:51Nobody applied.
0:10:52 > 0:10:54It's hard.
0:10:54 > 0:10:56It gets very hard.
0:10:56 > 0:10:59The British Medical Association claims part of the problem is that
0:10:59 > 0:11:01many GPs are retiring early or moving abroad
0:11:01 > 0:11:05because they are unhappy with workload pressures.
0:11:05 > 0:11:08But in this part of the country the lack of trainees is also
0:11:08 > 0:11:12a major factor.
0:11:12 > 0:11:15Nationally one in five vacancies for trainee GPs go unfilled.
0:11:15 > 0:11:18But in the West Midlands it's one in three, and it's having
0:11:18 > 0:11:22a big impact.
0:11:22 > 0:11:24Lovely, that's it, just short and sharp.
0:11:24 > 0:11:27Here in Biddulph they are having to use senior nurses instead
0:11:28 > 0:11:30of doctors to treat some patients.
0:11:30 > 0:11:34So why are so few trainee doctors choosing to become GPs?
0:11:35 > 0:11:36Well, let's ask one.
0:11:36 > 0:11:40In just five months trainee Sasha must choose which profession
0:11:40 > 0:11:42to go into.
0:11:42 > 0:11:44That's good, blood pressure stable.
0:11:44 > 0:11:47Like all trainees she does work placements which allow her
0:11:47 > 0:11:50to sample different roles.
0:11:50 > 0:11:52They last two to three months and at least one must be
0:11:52 > 0:11:55with a GP practice.
0:11:55 > 0:11:57But like many trainees she doesn't find general
0:11:57 > 0:11:59practice that appealing.
0:11:59 > 0:12:02Some people might think it's a little less exciting than hospital
0:12:02 > 0:12:07medicine, not as busy, a bit more like office type work.
0:12:07 > 0:12:11Currently I see myself becoming an acute medical physician
0:12:11 > 0:12:14but there is always room to change my mind.
0:12:14 > 0:12:16Which leads us to a crucial question.
0:12:16 > 0:12:19Would more trainees be won over by general practice if they spent
0:12:19 > 0:12:22more time seeing GPs in action?
0:12:22 > 0:12:24Let's find out.
0:12:24 > 0:12:27Today Doctor Andrew Green is going to try to persuade trainee
0:12:27 > 0:12:30Sasha to become a GP.
0:12:30 > 0:12:33I'd like to think that I can make her think about it
0:12:33 > 0:12:36as a positive career move.
0:12:36 > 0:12:39It will be nice to see what his practice is like and what he can say
0:12:39 > 0:12:41to persuade me, really.
0:12:41 > 0:12:44Nice to meet you.
0:12:44 > 0:12:48As you can see down here, quite a large practice.
0:12:48 > 0:12:51Clear day like today you can see right up to Manchester.
0:12:51 > 0:12:54This is what you could have being a GP in Biddulph.
0:12:54 > 0:12:57It is a very nice view.
0:12:57 > 0:12:59Andrew suspects Sasha finds the idea of working
0:12:59 > 0:13:02in a hospital more exciting.
0:13:02 > 0:13:06But he has his own take on life as a hospital doctor.
0:13:06 > 0:13:09What could be worse than doing an afternoon clinic where you know
0:13:09 > 0:13:13everybody has already got glaucoma?
0:13:13 > 0:13:16Everybody has got the same condition.
0:13:16 > 0:13:20Doing the back pain clinic or the varicose vein clinic.
0:13:20 > 0:13:25According to Andrew general practice is far more interesting.
0:13:25 > 0:13:28One of the great joys and excitements is you do not know
0:13:28 > 0:13:30what is going to walk through the door next.
0:13:30 > 0:13:33You have no idea why Mary Smith has booked that appointment at 10:30am,
0:13:33 > 0:13:35it could be anything.
0:13:35 > 0:13:37Absolutely anything.
0:13:37 > 0:13:38So it's a lot of variety.
0:13:38 > 0:13:41Of course it's variety.
0:13:41 > 0:13:44Next Andrew takes us for a stroll in the community he serves.
0:13:44 > 0:13:47He seems to know everybody in town and for him it's another
0:13:48 > 0:13:53unique selling point.
0:13:53 > 0:13:57You build close relationships with people, and you don't get that
0:13:57 > 0:14:01in other branches of medicine.
0:14:01 > 0:14:02Are you really at the forefront of medicine?
0:14:02 > 0:14:09Are you really where it sat at the cutting edge?
0:14:09 > 0:14:09More and more.
0:14:09 > 0:14:11Things that were treated in hospital five, ten,
0:14:11 > 0:14:1620 years ago, we now deal with those.
0:14:16 > 0:14:17Diabetes, heart failure.
0:14:17 > 0:14:21Severe asthma.
0:14:21 > 0:14:23Finally we join Andrew on his rounds.
0:14:23 > 0:14:27He is visiting patient Leonora to examine a wound on her leg.
0:14:27 > 0:14:32Over the years he's treated four generations of her family.
0:14:32 > 0:14:33Is that sore at all?
0:14:33 > 0:14:38After a new prescription Leonora gets chatting to Sasha.
0:14:38 > 0:14:41I need to decide whether to become a GP or a hospital doctor.
0:14:41 > 0:14:43You should be a GP.
0:14:43 > 0:14:44Why do you say that?
0:14:44 > 0:14:47Well, we need GPs, don't we?
0:14:47 > 0:14:51So, after the charm offensive, the verdict.
0:14:51 > 0:14:54Having done one house-call and spent some time with Andrew
0:14:54 > 0:14:57and seen his practice, any closer to persuading you to go
0:14:57 > 0:15:00down the GP route?
0:15:00 > 0:15:03A little bit closer I think but not quite there yet.
0:15:03 > 0:15:06Just seeing how you interacted with her, how she trusted you,
0:15:06 > 0:15:09and the rapport you had with her, and the long line of family that
0:15:09 > 0:15:12you've been seeing and visiting, it made me want that as well.
0:15:12 > 0:15:15I am a little bit closer but not quite there yet,
0:15:15 > 0:15:16I think.
0:15:16 > 0:15:17All the best.
0:15:17 > 0:15:20So Sasha still isn't persuaded, but it's vital other trainees
0:15:20 > 0:15:24are won over, otherwise we will all struggle to get
0:15:24 > 0:15:29an appointment with a GP.
0:15:33 > 0:15:37Over the past few months, junior doctors and the government
0:15:37 > 0:15:39have been at loggerheads over changes to new working contracts,
0:15:39 > 0:15:43many have been out on strike twice already this year.
0:15:43 > 0:15:46The dispute has shone a spotlight on their often challenging working
0:15:46 > 0:15:50conditions, and Inside Out in London has now uncovered evidence
0:15:50 > 0:15:54of a growing mental health crisis among junior doctors.
0:15:54 > 0:15:58Record numbers are now being signed off with depression and burn-out.
0:15:58 > 0:16:01Senior health officials are warning that the system is close
0:16:01 > 0:16:08to breaking point.
0:16:08 > 0:16:08Emilia Papadopoulos has the story.
0:16:08 > 0:16:09And if you could take a breath in and out for me.
0:16:09 > 0:16:12Junior doctors have been called the workhorses of the NHS,
0:16:12 > 0:16:15and are responsible for much of the diagnosing, patching
0:16:15 > 0:16:19and mending that takes place in our hospitals.
0:16:19 > 0:16:22Registrar here, I just wanted to check when my patient
0:16:22 > 0:16:24was going to have a CT head.
0:16:24 > 0:16:2631-year-old junior doctor Salwa Malik is completing her
0:16:26 > 0:16:30training in emergency medicine at a London hospital.
0:16:30 > 0:16:34Basically you've got to see first of all who is the next patient to be
0:16:34 > 0:16:36seen, but also the order of priority.
0:16:36 > 0:16:39Are you able to sit forward for me?
0:16:39 > 0:16:41It hasn't stopped, it's got busier and busier.
0:16:41 > 0:16:45I haven't had a cup of water yet today so I'm quite thirsty.
0:16:45 > 0:16:49You seem a bit wheezy and you've been coughing up some green phlegm.
0:16:49 > 0:16:51I feel exhausted.
0:16:51 > 0:16:54It's very easy to make mistakes.
0:16:54 > 0:16:57You have to be on the ball all the time.
0:16:57 > 0:17:00Gone is the day when you can say Monday and Friday are the busy days.
0:17:00 > 0:17:02I think Thursdays are particularly bad.
0:17:02 > 0:17:03Tuesdays are particularly bad.
0:17:03 > 0:17:07Actually Wednesdays are pretty bad as well.
0:17:07 > 0:17:10For Salwa and the 50,000 other junior doctors in England it's often
0:17:10 > 0:17:13a constant battle to keep their heads above water and deal
0:17:14 > 0:17:15with the demands of the job.
0:17:15 > 0:17:18For some, the pressures can be overwhelming.
0:17:18 > 0:17:20I trained at Imperial College in London and qualified
0:17:20 > 0:17:24as a doctor in 2010.
0:17:24 > 0:17:28I was on a cardiology rotation.
0:17:28 > 0:17:34And for about two months, staying on until about 8pm,
0:17:34 > 0:17:368:30pm most nights when I was meant to finish at 5pm.
0:17:36 > 0:17:42And what I found out was I was actually doing the job
0:17:42 > 0:17:43of two doctors.
0:17:43 > 0:17:47And the other post was even not advertised or just left unfilled.
0:17:47 > 0:17:49Reena started to struggle with the extra workload
0:17:49 > 0:17:51she was having to take on.
0:17:51 > 0:17:53I was honestly just exhausted.
0:17:53 > 0:17:56But more so than that, my mental health suffered.
0:17:56 > 0:17:59I started becoming quite anxious.
0:17:59 > 0:18:02Worried constantly.
0:18:02 > 0:18:07And feeling dread to go into work the following morning.
0:18:07 > 0:18:11Reena's bad experiences with work rotas seem to be increasingly common
0:18:12 > 0:18:13in the NHS.
0:18:13 > 0:18:15According to a study by the British Medical Association,
0:18:15 > 0:18:18the numbers of junior doctors reporting long-term rota gaps jumped
0:18:18 > 0:18:24from 46% in 2014 to 60% last year.
0:18:24 > 0:18:27We are seeing a situation now that is not simply junior
0:18:27 > 0:18:30doctors not being able to cope with the stresses of medicine,
0:18:30 > 0:18:35this is about a government and a system effectively putting
0:18:35 > 0:18:38untold amounts of pressure that don't need to be put on these
0:18:38 > 0:18:45doctors, because the system is being mismanaged so horribly.
0:18:45 > 0:18:48As an obstetric registrar responsible for delivering babies,
0:18:48 > 0:18:53Doctor Malawana has plenty of experience of rota gaps himself.
0:18:53 > 0:18:57I myself worked on a rota just recently where you needed 30 doctors
0:18:57 > 0:19:01in order to deliver a safe service, and we were 11 doctors short.
0:19:01 > 0:19:04You can't just leave when your shift is over because there's no one
0:19:04 > 0:19:08to take over from you, what do you do?
0:19:08 > 0:19:12The pressures of Reena's job finally caught up her during a stint in A
0:19:12 > 0:19:15It was about 5am and I was having a full-blown panic attack.
0:19:15 > 0:19:18Palpitations, chest tightness, difficulty breathing.
0:19:18 > 0:19:22Mind all over the place.
0:19:22 > 0:19:29And my family encouraged me to call in and say I'm sick.
0:19:29 > 0:19:33And I got a call from one of my seniors basically telling me
0:19:33 > 0:19:36that I was irresponsible and I was selfish for not coming in.
0:19:36 > 0:19:46This just added to that sense of shame and guilt and failure.
0:19:47 > 0:19:50Feeling that she was burning out, Reena decided to put her medical
0:19:50 > 0:19:52career on hold.
0:19:52 > 0:19:56Leaving the NHS a doctor down.
0:19:56 > 0:19:59So what's been the cost of poor mental health on the capital's
0:19:59 > 0:20:01junior doctor workforce?
0:20:01 > 0:20:04Inside Out submitted a Freedom of Information request
0:20:04 > 0:20:07to all of London's NHS trusts to measure the impact over the last
0:20:07 > 0:20:12five years of junior doctors being signed off work.
0:20:12 > 0:20:14The results are striking.
0:20:14 > 0:20:19In 2011 over 1,200 days were lost through doctors in London
0:20:19 > 0:20:23being signed off with stress, anxiety and depression.
0:20:23 > 0:20:26Last year, though, this figure had jumped to nearly 3,200.
0:20:27 > 0:20:31An increase of 159%.
0:20:31 > 0:20:33But when junior doctors reach their breaking point,
0:20:33 > 0:20:35where can they turn?
0:20:35 > 0:20:39The Practitioner Health Programme was set up here in London in 2008
0:20:39 > 0:20:41as a confidential treatment service for medical professionals who have
0:20:41 > 0:20:47developed mental health problems.
0:20:47 > 0:20:49The peak age we are seeing is 28 to 29, mainly suffering
0:20:50 > 0:20:52from depression, anxiety, burn-out.
0:20:52 > 0:20:54When we opened our doors we were seeing three
0:20:54 > 0:20:56new patients a week.
0:20:56 > 0:20:59We are now seeing up to 15.
0:20:59 > 0:21:02We were so inundated with referrals that unfortunately we had to turn
0:21:02 > 0:21:06the tap off and close the service down for about six weeks.
0:21:06 > 0:21:09Doctor Gerada believes that front-line doctors need more
0:21:09 > 0:21:11psychological support to help them deal with the heavy emotional
0:21:11 > 0:21:13demands of their work.
0:21:13 > 0:21:16There are doctors sitting in car parks at work just weeping,
0:21:16 > 0:21:19unable to get out of the car.
0:21:19 > 0:21:22These are human beings that started off, usually as 8-year-olds,
0:21:22 > 0:21:24wanting to serve others.
0:21:24 > 0:21:27We've taken their emotional resilience and we've crushed it
0:21:27 > 0:21:32with the work that we are expecting them to do.
0:21:35 > 0:21:38Some doctors are all too aware of the emotional turmoil
0:21:38 > 0:21:40that the job can generate.
0:21:40 > 0:21:42Doctor Zeshan Qureshi is a junior paediatrician.
0:21:42 > 0:21:46Some of his work can be extremely harrowing.
0:21:46 > 0:21:49I remember the first cardiac arrest I went
0:21:49 > 0:21:51to, an 18-month-old.
0:21:51 > 0:21:54We turned to the parents and we said, we need you to be
0:21:54 > 0:22:01prepared that your child might die tonight.
0:22:01 > 0:22:04And you know, that moment, the tears, the screams,
0:22:04 > 0:22:09the pure and intense outpouring of sadness,
0:22:09 > 0:22:12of grief, of fear, of loss.
0:22:12 > 0:22:16Every time that happens it sticks with me.
0:22:16 > 0:22:19You are having to deal with really intense emotions.
0:22:19 > 0:22:23All of those directly contribute to increasing your personal risk
0:22:23 > 0:22:26of mental health problems.
0:22:26 > 0:22:30The end result of it is severe depression and post-traumatic stress
0:22:30 > 0:22:33disorder.
0:22:33 > 0:22:35In the worst-case scenarios people taking their own lives,
0:22:35 > 0:22:38which has happened, and I've experienced with a few of my friends
0:22:38 > 0:22:44having taken their lives already.
0:22:44 > 0:22:46Following her breakdown, Reena experienced suicidal impulses
0:22:46 > 0:22:49herself.
0:22:49 > 0:22:52Eventually I got to the point where I was so low that I had
0:22:52 > 0:22:57the paramedics round at my house.
0:22:57 > 0:23:01Having been through that I decided that it was time to take out,
0:23:02 > 0:23:04and try and look after myself first.
0:23:04 > 0:23:08We are basically asking for peace on three levels.
0:23:08 > 0:23:10I run something called Mindful Medics, not just for doctors
0:23:10 > 0:23:13but all health care professionals.
0:23:13 > 0:23:16It is a programme which encompasses these yogic breathing techniques,
0:23:17 > 0:23:20and also mindfulness meditation.
0:23:20 > 0:23:24We are trying to get the flow of energy within the body.
0:23:24 > 0:23:28Really I don't want anyone to get to the point where I got to,
0:23:28 > 0:23:32and feel suicidal.
0:23:32 > 0:23:36Can you put up a multiple trauma call to A resus now, please.
0:23:36 > 0:23:40Back in Salwa's A unit, things are as hectic as ever.
0:23:40 > 0:23:43Does she feel warm to touch?
0:23:43 > 0:23:45For Salwa and other junior doctors, their breaking point can sometimes
0:23:45 > 0:23:49feel distressingly close.
0:23:49 > 0:23:52I was supposed to finish at 8pm, I didn't finish until 1:30am,
0:23:52 > 0:23:56I didn't get home until 2am.
0:23:56 > 0:24:00It was only at 2am I realised my own father was waiting for me to talk
0:24:00 > 0:24:03to me about the operation he was due to have that day,
0:24:03 > 0:24:08and he wanted to talk to me about the anaesthetic as well.
0:24:08 > 0:24:11And I just felt really bad because his daughter is a doctor,
0:24:11 > 0:24:20and I felt like I couldn't look after my own father.
0:24:20 > 0:24:22But I was trying to help someone else.
0:24:22 > 0:24:25That's really difficult.
0:24:25 > 0:24:33It's really difficult because I feel like I totally failed as a daughter.
0:24:33 > 0:24:37Two weeks after we filmed with her, she collapsed while working,
0:24:37 > 0:24:40suffering dehydration, low blood sugar and a racing heart
0:24:40 > 0:24:43rate of 150.
0:24:43 > 0:24:47In a statement NHS employers told Inside Out: If the NHS was a coal
0:25:05 > 0:25:08If the NHS was a coal mine or a factory it would be closed
0:25:08 > 0:25:10down now as not fit to provide
0:25:10 > 0:25:14a safe working environment.
0:25:14 > 0:25:15I have worked in the NHS for 35 years.
0:25:15 > 0:25:21I have never seen so many demoralised individuals.
0:25:21 > 0:25:24And unless we deal with this urgently, and I would say
0:25:24 > 0:25:27by an urgent enquiry, I'm afraid we are not
0:25:27 > 0:25:32going to have the staff to deliver the care our patients need.
0:25:37 > 0:25:39That's it from us this week.
0:25:39 > 0:25:42If you'd like to see more stories from your area join our Inside Out
0:25:42 > 0:25:44teams on Monday evening at 7:30pm on BBC One,
0:25:44 > 0:25:52or on the BBC iPlayer.
0:25:52 > 0:25:54or on the BBC iPlayer.