NHS staffing and training need to be more ‘fluid’ in response to the health needs of the nation and ‘identifying where the demand will be,’ said a speaker at a meeting of the Health and Social Care Committee on 11 May

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At a meeting convened to examine evidence from leading professionals on how to tackle NHS shortages in the medical workforce, Professor Colin Melville, Medical Director and Director of Education and Standards for the General Medical Council (GMC), said: ‘We need to ensure a workforce prepared to meet the health needs of the nation today.’

The healthcare system is based on a reactive model, Professor Melville said, stressing the need to ‘shift the focus and identify where the upcoming demand will be.’

He cited the example of knowing that the prevalence of diabetes was increasing and that, therefore, ‘we need to train more diabetes doctors rather than say why has that happened and try and reduce it.

‘We need to be more fluid in how we meet demand, and the pandemic has taught us this writ large,’ he said, adding: ‘the question is what is the type of workforce we need? We don’t have the right number of doctors for the model of care that we’ve adopted.’

Questioning whether the NHS was using highly skilled and highly trained people to do the things that they can uniquely do, Professor Melville asked what other components of the workforce could be drawn upon: ‘What is their [associated medical professionals’] role as well as the roles of other parties in this, for example pharmacists and nurses?’

Select committee set up to address lack of doctors

The Health and Social Care Committee—chaired by Jeremy Hunt MP, who was Health Secretary between 2012 and 2018—launched the inquiry, set up to source solutions to staff drain within the NHS and social care last November.

Mr Hunt asked leaders from the GMC, the BMA, the Royal Society for Medicine, and the Medical Schools Counci:

  • whether the country was training enough doctors, and if not, how many more should be trained?
  • whether they had got the training right, broadly
  • whether there was any way of reducing the time it takes to train a doctor or if there was a way to ‘get [recruit] more doctors, more quickly, with the pressures the NHS is under currently?’

Prior evidence has cited poor workforce planning, weak policy, and a lack of a national NHS workforce strategy as responsible for ‘the crisis’, as termed by the Committee. Estimates suggest that by 2030/31, up to half a million extra healthcare staff would be needed to meet the pressures of demand and recover from the pandemic—the equivalent of a 40% increase in the workforce.

Draw on the ‘firm’ system of medical training

Professor Roger Kirby, retired surgeon and President of the Royal Society of Medicine, agreed that there was a shortage of around 10,000 doctors in the NHS right now, and said improving the retention level was central to the solution: ‘Many of the best doctors are qualifying here and leaving—many for New Zealand and Australia.’

He suggested a training system that drew on the ‘firm’ system, where a group of doctors worked together, offering a consistent source of professional and emotional support. The ‘firm’ system was discontinued in 2005, said Professor Kirby, and ‘then they started rotating them from A to B to C to D on a yearly basis. A year isn’t long enough, and there is a disconnect between the trainer and the trainee. This could be changed easily by increasing the length of the rotation and have somebody mentoring that student.’

By potentially giving trainees 2-year rotations, under the mentorship of one or two senior clinicians who took overarching view of their career, he remarked, trainees would find ‘a sort of guardian angel to help them through and it wouldn’t cost much to establish that.’

‘Clinicians would be keen to do it given that they often don’t know who their trainees are and often feel disconnected themselves,’ he added.

Drop in pay and need to reconnect with research

In terms of pay and conditions, Professor Kirby noted: ‘doctors now take home 24% less than 10 years ago, but the work we have to do is at least 24% more difficult—100% more difficult, I would say.’

Focusing on developing a doctor’s broader skillset, Professor Kirby emphasised the need to a more rounded set of skills, such as those of communication and negotiation.

Reconnecting research and clinical medicine would also reap benefits and might curb some of the drain to the US and other countries with a strong research agenda, he pointed out: ‘Back in 2005, doctors would commit to some research and obtain a higher degree. We would produce clinician scientists who would link up with universities and produce innovative ideas that would stimulate the economy in the longer term.

‘We need to re-establish a link between scientific research and clinical medicine. This will help keep the best doctors in the UK and stop them leaving for the US or elsewhere.’

‘Drastic’ shortage of doctors: BMA

One possible longer-term solution for meeting the needs of an NHS, as well as the mounting backlog in care, is to ‘to ensure a workforce prepared to meet the health needs of the nation today,’ Professor Melville remarked.

Dr Latifa Patel, interim Chair of the BMA and paediatric respiratory doctor, reiterated that the UK was not training enough doctors and drew comparison with European Union nations: ‘Our doctor-to-population ratio is 2.9 per 1000 people. In Germany it is 4.3 per 1000, and we’re aiming for 3.7 per 1000. We need 11,000 more medical students per year to get us on par with EU nations, and we are at a shortage of 46,300 at the moment. We are drastically short of doctors,’ she said.

She stressed that the UK medical training system was one of the best in the world, but added: ‘We are at risk. We are working on a shoestring throughout undergraduate and postgraduate [training] within the NHS.’

The evidence session was held on Wednesday 11 May, Macmillan Room, Portcullis House, Westminster, UK.

This article was originally published on Medscape, part of the Medscape Professional Network.

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