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Select Committee on Health Appendices to the Minutes of Evidence


APPENDIX 28

Memorandum by the Joint Consultants Committee (SR 58)

  The following is a submission of evidence from the Joint Consultants Committee. The Committee was set up in 1948, by the Royal Medical Colleges and the BMA, as a committee able to speak for the consultant body with one voice. The JCC represents the medical profession in discussions with the Department of Health on matters relating to the maintenance of standards of professional knowledge and skill in the hospital service and the encouragement of education and research. Members include the presidents of the medical royal colleges and their faculties and representatives from the BMA's consultants and junior doctors committees.

MEDICAL WORKFORCE STRATEGY

  The Joint Consultants Committee believes that the principle staffing problem facing the National Health Service is the general shortage of doctors throughout the United Kingdom. This is reflected in figures for 1996 where Germany had 3.4 doctors per 1,000 head of population, France 2.9 and the United Kingdom only 1.8[12].

  This shortage is partially compensated for by the institutionalised dependence on overseas doctors. Successive Governments have claimed that their policy was one of self-sufficiency with regard to the supply of doctors. However, no attempt has been made to implement such a policy and the General Medical Council reports that the majority of new registrations last year were from overseas.

  Countries within the European Union are currently taking steps to reduce their overproduction of doctors. It is expected that by the early years of the next millennium, the only external sources of doctors available to the NHS will be from the developing world. While it will always be right to assist with the postgraduate training of doctors from other countries, their numbers might be expected to balance doctors leaving the United Kingdom to train or work abroad. The UK must aim towards self-sufficiency in medical staffing; reliance on doctors from overseas, particularly from developing countries which need their expertise, is not an acceptable strategy.

Reccommendation 1

  That the Government take immediate steps to balance medical school output with the need for new doctors within the United Kingdom, with a view to producing the appropriate number of doctors to staff the NHS.


 INCREASE IN THE NUMBER OF DOCTORS

  The Medical Workforce Standing Advisory Committee (MWSAC) has made what are probably conservative recommendations for an increase in the intake to medical schools. The Government has accepted these recommendations but has indicated that it intends to implement them over a number of years. New medical entrants undertake five years training at medical school followed by a further 10 years, and in some cases an even longer period of postgraduate training. If implementation is to take place over five years, it would be 20 years before the full effects of MWSAC's recommendation are translated into, for instance, additional consultants. Clearly the NHS needs to have a plan to staff the NHS with the appropriate number of doctors during the next 20 years.

Recommendation 2

  That the NHSE formulate proposals for the supply of doctors for the NHS in both the short and medium terms.

SHORTAGES IN THE MEDICAL WORKFORCE

  Within medicine the problem of medical manpower is not uniform either geographically or across specialties. General practice is currently experiencing a recruitment crisis with too few young doctors being attracted to general practice as a career. In addition there is a general shortage of consultants, which is worse in some specialties, for example psychiatry and radiology and with an impending shortage in histopathology. Shortages in some specialties have repercussions for many other specialties and for the implementation of aspects of Government policy. For instance, a shortage of anaesthetists will reduce the ability of hospitals to provide all surgical specialties as well as intensive care. This will lead to increases in waiting lists.

  In 1994, the Department of Health calculated that, in addition to a steady rise in consultant numbers (historically 2-3 per cent), there was a clear and compelling need for a one-off increase in consultant numbers of about 4,000 in order to implement certain aspects of Government policy, in particular, policies relating to the training of junior doctors, and the reduction in junior doctors' hours of work. The Specialty Workforce Advisory Group (SWAG) has attempted to implement this increase by expanding the numbers of specialist registrars and, although hampered by financial constraints from making the full increase, to date approximately 2,000 additional Specialist Registrars have been injected into the training pool. Regrettably the necessary measures to increase the number of consultant posts to accommodate these extra Specialist Registrars were not undertaken. As a consequence, we now face the situation where, in some specialities, fully trained junior doctors are coming to the end of their training with no consultant posts for them to fill. The specialty of obstetrics and gynaecology is most severely affected, although other specialities will be in a similar situation in the near future.

  Furthermore, the most recent medical workforce figures published by the Department of Health (August 1998) have highlighted once again that the central plank of hospital medical workforce planning strategy, the need for substantial expansion of the consultant grade, is failing. Between 1992 and 1997 the annual increase has averaged only 4.3 per cent (compared with the 7 per cent per annum necessary for implementation of the Calman training changes) while the increases in non-consultant career grade doctors have been 7.3 per cent, 26.6 per cent and 14.2 per cent for associate specialists, staff grade and "other ungraded staff" respectively.

Recommendation 3

  That the Government review its national strategic planning mechanisms to ensure that:

    (i)  consultant numbers are planned to correspond with other aspects of policy (such as those affecting junior doctors training);

    (ii)  planning for training numbers is accompanied by appropriate and consequential planning for career posts.

OTHER GOVERNMENT POLICIES WHICH AFFECT MEDICAL WORKFORCE ISSUES

  The development of medical manpower policies needs to take into account other aspects of Government policy which could have a huge impact on the medical workforce. Issues surrounding clinical governance are a good example. The Royal College of Physicians has calculated that the implementation of the white paper "A First Class Service—Quality in the New NHS" will require an additional 94 consultant year equivalents per annum in medical specialities alone. In other words an extra 94 consultants will be required to satisfy the quality requirements of the white paper without a single extra patient being treated. MWSAC will need to keep manpower requirements under constant review to match changes in Government policy.

Recommendation 4

  That MWSAC comment as a matter urgency on the manpower consequences of health policy changes which have a bearing on medical manpower and make appropriate recommendations.

SKILL MIX

  Clinical tasks should be performed by the health care professional most appropriately trained for the particular task. Although there could be considerable scope for changes in the skill mix if competency-based training were introduced, other health professions, for instance nursing, are experiencing a similar shortage in supply. This reduces the capacity for changes in skill mix.

Recommendation 5

  That an investigation is undertaken into how changes in skill mix might relieve staff shortages both in the medical and other health care professions.

RECRUITMENT AND RETENTION

  Given the acute shortages of doctors described above, the JCC would draw attention to the pressing need to address the problem of retention of doctors. An increasing proportion of medical school entrants are women. The proportion of women students admitted this year at the University of Newcastle upon Tyne Medical School is 67 per cent. This makes it likely that more doctors will wish to take career breaks and/or work part time. There is an urgent need to attract back doctors who have taken time out for family reasons. They will only return to a job which is compatible with their family commitments. Consultant posts at present have very long hours, an average of 51 hours per week, excluding time spent "on call", and provide inadequate scope for part-time or flexible working. The NHS Executive should examine ways of making hospital jobs more amenable to flexible and part-time working. Such policies might well coincide with more flexible ways to provide patient care. For example, an evening clinic could be attractive to patients, and at the same time, be convenient for a doctor to attend at a time when his or her partner was available for child care.

Recommendation 6

  That the NHSE move towards providing more flexible and part-time medical posts.


12   OECD in Figures: 1998 Edition. Back


 
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