Case Study

‘Beneath The White Coat’ play is the result of a close collaboration between Pluto Play Productions and Doctors in Distress, both charities.

Pluto Play Productions was founded in 1997 by Brian Daniels and was created to take over the running and management of the New End Theatre in Hampstead, North London. Brian was CEO and Artistic Director of the theatre for 14 years. Since 2011, it has been concerned with the development of theatrical writing that is inspired by real stories with a view to advancing public education through the staging of plays and other expressions of drama. It is a registered charity (number 1062498) based in Leeds with Brian as CEO and Artistic Director. There are three other members of staff working on programming, public relations and administration and three trustees.

There are over 20 plays in the organisation’s portfolio, all written by Brian Daniels, that address contemporary issues around health and social care including life-limiting illness and bereavement, dementia, MND, young male suicide and care homes including during Covid and lockdown. They have been commissioned by a variety of organisations and individuals and performed in theatres, hospitals, hospices, universities and community centres across the UK plus in Portsmouth Cathedral, The Crucible Theatre in Sheffield, The Barbican Theatre in London and at the Houses of Parliament. An ensemble of professional directors and actors are commissioned for each performance and they bring the stories to life in radio-style where the actors sit facing the audience and read script-in-hand. A performance is followed by a discussion involving the audience and an invited expert panel. The atmosphere in the room created by a performance provides a unique forum for promoting critical thinking and the exchange of ideas, for shining a light on difficult issues and encouragement to initiate change, individually and collectively.

The plays in the Pluto Play Productions stable are increasingly being recognised by many NHS, social care, palliative/end of life care organisations and charities as providing an excellent platform for the creative arts to enable education and learning for those working in the health and social care fields.

Website: www.plutoplayproductions.co.uk

Doctors in Distress (number 1184953) was founded in 2018 by Amandip Sidhu following the tragic death of his brother, Dr Jagdip Sidhu, a cardiologist, who worked to the point of burnout and felt he had only one way to escape his suffering. He did not feel able to ask for help.

In the years since its inception, the organisation, whose registered office is in Watford, has grown and now includes five members of staff with Ann Paul as CEO. Ann has worked in the charity sector for nearly 25 years and has a passion for leadership development. It has 12 trustees with Dame Clare Gerada as President. She established the Practitioner Health Programme to support doctors and nurses with mental health and associated issues and is also currently President of the Royal College of Practitioners.

The objectives of Doctors in Distress include promoting and protecting the mental health of health professionals and end suicides; reduce stigma around mental health in the health sector; promote a duty of care by employers for the mental health of their staff and develop and provide initiatives/interventions to promote and protect the mental health of all health workers. These objectives are pursued through facilitated peer support programmes for health care staff and lobbying decision-makers for a culture change within the NHS around mental health. There is no healthcare without self-care.

Website: www.doctors-in-distress.org.uk

One doctor takes their own life every three weeks; one nurse takes their own life every three days. In 2022, 366 nurses made attempts to take their own lives and six million working days were lost to poor mental health in the NHS. There is a stigma in the medical profession about asking for help and many feel they will not progress in their field if they do ask. Healthcare professionals often feel it’s a sign of weakness and demonstrates a lack of resilience. Burnout and suicide rates are much higher among doctors than among the general population.

The play takes place in a fictional GP surgery and involves a range of roles. Performances provide a new and unique forum for health professionals to discuss sensitive issues, such as addiction and suicide and other factors affecting their mental health, due to the demands of their work. Audiences can identify with the struggles that the characters in the play are going through and feel able to speak up in a secure environment. The play shines a light on a hidden tragedy and deserves recognition for the service it is providing, and will continue to provide, for those that need it.

Brian Daniels was listening to a British Medical Association podcast involving Dame Clare Gerada who was talking about the increasing number of medical professionals battling depression and anxiety and the difficulties of balancing their clinical and personal lives that resulted in reduced quality of time with patients. Clare has written a book about it, called ‘Beneath The White Coat’ and Brian approached her after the podcast to suggest that issues raised in her book could be effectively dramatised and shown to a wider body of health and social care workers to provide them with a better understanding of how to combat stress, addiction and depression. Clare is Chair of Trustees with Doctor In Distress whose aim is to enable healthcare professionals to look after their own mental and physical health – no healthcare without self-care – and, in so doing, help patients have a more positive healthcare experience and they came on board with the initiative.

Pluto Play Productions with CEO Brian Daniels and Doctors in Distress with CEO Ann Paul and President Dame Clare Gerada were involved in the planning and delivering of the initiative. When the first draft of the script had been written, a rehearsal using actors was performed via zoom to an audience of health and social care professionals invited by Doctors in Distress, who then provided feedback on the performance and the scenarios presented. The comments enabled further discussion between the two organisations to reflect on what had been said and then alterations made to the script before the launch performance at the Royal College of GPs.

The main impact from this initiative is assessed through feedback provided by those watching performances.

In the words of Dame Clare Gerada, President of Doctors in Distress and President of the Royal College of GPs: “Brian Daniels created a fictional GP practice, inspired by my book “Beneath The White Coat, representing a range of practice workers and the stresses and strains they have felt in recent years. We join them on each of their journeys in lockdown, laugh with them and cry with them. When the play premiered at the Wounded Healer Conference at the Royal College of GPs in London, we, in the audience, recognised characters and colleagues with whom we had all worked. What came across loud and clear are the benefits associated to any stressed professionals provided by reflective space meetings. I wholeheartedly applaud the work of Brian Daniels and his team on delivering the play so skilfully to a large group. The feedback I received was terrific and I hope the play will be seen by many more medical professionals.”

It has been performed in front of an audience of medical students at Derby University, giving them insights into the kinds of challenges they might encounter as they move through their careers. More performances for medical students and other healthcare professionals are planned.

Feedback from audience members so far: “Amazing;” “Glad the cameras were off;” “It normalised difficult conversations and included a bit of humour; “Very emotional.”

Pluto Play Productions and Doctors in Distress will continue working together to promote the play to wider audiences and encourage health and social care organisations to engage with the play and host performances on their own sites.

The play was enthusiastically launched at the Royal College of GPs with further performances at the Royal Society of Medicine that included an after-performance discussion between Brian Daniels and Dame Clare Gerada on the issues highlighted by the play. It has also been performed at Derby University in front of medical students so they can gain an understanding of the personal and professional challenges that may face them in their future careers.

There is interest from the General Medical Council in hosting performances and a number of NHS Trusts are considering the idea of having a performance to coincide with the planting of a tree as symbolic to those that have died through suicide or other causes while giving their professional lives to the health and welfare of others. Together with Bafta award winning writer and former doctor Adam Kay, four trees have so far been planted with interest from other hospitals including in Wales. It is a way of remembering those who have taken their own lives and to remind Trusts to think about how they can actively support the wellbeing of their staff.

Using drama to highlight incredibly sensitive and stigmatised issues of depression, addiction and suicide among health professionals makes this initiative special and stand out. The ability of audience members to identify with the characters in the play and the experiences they go through, based on real stories, is very important in enabling them to consider their own positions and whether they may have issues that they need to consider and get advice on.

The commitment of the two organisations involved, Pluto Play Productions and Doctors in Distress, to work together as partners in order to promote and enable as many professionals as possible, working in health and other care services, to see the play and take part in discussions afterwards and offer help where needed, is second to none.

In the first instance, for those interested to approach Pluto Play Productions and Brian Daniels, an experienced and talented playwright who gets to the heart of issues covering health and social care, and talk with him about a topic they think could be better explored and have more impact if it was presented as a drama. Then, if agreed, work closely with him in the writing of the script and then put on performances.

A drama developed in this way enables audiences to closely identify with the stories of the characters as they are inspired by real life experiences. The issues and scenarios presented can touch them at a deep and emotional level, in a way that a speech or the written word cannot, and spur people into self-realisation about their own circumstances and the need to do something to help themselves. It can also enable NHS and other organisations to better understand the impact of not attending to the wellbeing of their workforces.