Evidence submitted by the Council of Heads
of Medical Schools (WP 45)
INTRODUCTION
1. The Council of Heads of Medical Schools
is the authoritative voice of all the UK's Medical Schools. Its
main purposes are to:
— be a principal source for informed
opinion and advice on all matters concerning basic medical education
and medical school research in the UK and on the relationship
between medical schools and the NHS;
— improve and maintain quality in basic
medical education and general clinical training and to facilitate
sharing of experience;
— promote medical education and research
through collaboration with the NHS, Government Departments, the
General Medical Council, the Royal Colleges, the Research Councils
and the Medical Research Charities;
— promote and develop relationships
with medical schools and universities in other countries concerning
medical education and research; and
— serve as a point of reference for
the media.
2. The Council works closely with the Council
of Head and Deans of Dentals Schools, and the Association of UK
University Hospitals, which represents all the major university
teaching hospitals. CHMS is the principal source of informed opinion
and advice on all matters concerning medical education and research
in medical schools in the United Kingdom, on relations between
medical schools, the National Health Service and other treatment
providers, and on relations with university medical schools and
faculties in other countries. As such it is well placed to respond
to this inquiry.
FACTUAL INFORMATION
AVAILABLE TO
THE HEALTH
COMMITTEE
3. CHMS strongly recommends that the Health
Committee refers to its Clinical Academic Staffing Levels Survey,
collated and published annually. This gives the precise number
of doctors and dentists employed by the UK's Universities with
details of their medical and dental specialties. An in-depth report
is published approximately every three years and the last of these
was in May 2004. This report and further data including the 2004-05
update and Annual Report can be downloaded from the CHMS website
at www.chms.ac.uk. It is intended that data for the year to 31
July 2005 will be published in May 2006.
4. In addition further surveys are carried
out as required and these provide invaluable data, for example
in relation to the availability of placements for clinical experience,
the number of graduate entry students, the number of women in
senior positions etc The Health Committee is advised to contact
Dr Katie Petty-Saphon, Executive Director of CHMS should it require
further statistics.
EVIDENCE
In considering future demand, how should the effects
of the following be taken into account?
General Comments
5. The education and training of the future
health service workforce is both central and essential. Workforce
planning needs to consider not only NHS staff but also those doctors,
dentists and nurses employed by universities who teach the next
generation and whose research leads to innovations in the delivery
of care. It needs to protect the investment in education and training.
Before deciding on numbers required, a careful evaluation of the
roles which make up the clinical workforce should be undertaken.
6. Successive Governments have recognised
the importance of education and research in delivering ever improved
patient care. Given universities are the country's key foci of
innovation, leadership and acute analytical skills the Government
should consider making more use of this resource to scrutinize
policies before implementation to guard against unforeseen consequences.
CHMS would welcome greater collaboration between Higher Education
and health services in this way.
7. In the 2000 CHMS and CHDDS (Council of
Heads of Dental Schools) survey there were 28,275 NHS consultants
and 2,243 clinical academics (7.9%). By 2004 NHS consultants had
grown to 35,152 whereas total clinical academics numbered 2,351—down
to 6.7% of the total. More worryingly hidden behind the small
increase in overall clinical academic numbers is a dramatic 17%
decrease in the number of junior staff in the 12 months from the
2003 survey to 2004. This is more pronounced in some disciplines
than others: the number of clinical lecturers in pathology now
stands at a mere 19% of the numbers in 2000. The situation for
dentistry is even more serious as there are now only 444 dental
academics in the whole country.
8. It is encouraging that the Government
recognised the gravity of this position and responded by setting
up the Academic Careers Sub-Committee of Modernising Medical Careers
chaired by Mark Walport to suggest ways of ameliorating the situation.
It will be imperative to ensure that the funding for the new positions
being put in place on the recommendation of that group is protected
despite current NHS budget difficulties. Indeed it is vital that
a long-term view be taken and that the Education and Training
budget is protected—and not eaten into to provide a simple
cure for Trust deficits.
9. In terms of workforce planning outside
the universities, a picture needs to be developed of how care
will be delivered in 20-40 years' time—the problem is, the
pace of technological development and of organisational change
tends to outstrip the planning horizon. The NHS is not alone in
finding over and over again that its planning assumptions have
proved wrong. However the almost continuous turbulence in the
NHS—the changes in structure, finance, performance management—and
increased patient expectations—has heightened the problems.
A lengthy period of stability is a prime requirement.
Gender and an ageing population
10. Planners will also need to take into
account the age and gender profiles of clinical academics—which
are again provided in the CHMS report. More than 50% of all clinical
academics are over 45 and fewer than 10% are under 35—young
doctors do not perceive clinical academia as an attractive career
path—partly because of the increased time required to complete
training. Medical School intake is now 58% female—yet only
20% of clinical academics are women—and at the professorial
level this drops to 12% for medicine and 11% for dentistry. CHMS
and CHDDS have set up a group to look into Women in Clinical Academia
in the hope of identifying barriers to participation and encouraging
more women to consider such careers.
The increasing use of private providers of services
11. The Committee has asked specifically
about the impact of the increased use of private sector providers.
One of the many strengths of UK Medical Education is the early
experience of clinical situations given to students (as well as
emphasis on Fitness to Practise—instilling the correct behaviours
and attitudes as well as acquiring knowledge and competencies).
Allowing students to see patients slows down treatment and it
is already very difficult to find sufficient "placements"
for students in hospitals and GP practices. There is at present
no requirement for private hospitals or Independent Sector Treatment
Centres (nor indeed Foundation Trusts) to accept students—this
should be made obligatory.
To what extent can and should the demand be met,
for both clinical and managerial staff, by?
The recruitment of new staff in England
12. The UK has one of the lowest ratios
of doctors per head of population in the EU. This needs to be
remedied. If it is intended that the UK becomes self-sufficient
so that the number of doctors trained matches those required by
Trusts and Universities then, as mentioned above, a mechanism
will have to be found to ensure Trusts have sufficient training
posts available to match the output from the Medical Schools.
There has been an issue this year because there were more UK and
rest of EU applicants for Foundation Year 1 posts (the year immediately
after Medical School when doctors are only provisionally registered
with the GMC) than there were posts. Six years ago, when the decision
was taken to increase medical student numbers by 40%, it was agreed
that the number of F1 posts would also be increased—this
now needs to happen as a matter of urgency.
13. A Joint Implementation Group (JIG) with
members from DH, DfES and HEFCE is currently trying to determine
whether the number of medical and dental students should be increased
again—its deliberations should be considered carefully.
If young doctors are not to become disillusioned it will be important
to ensure that sufficient specialist training posts are available
for those with the capacity to develop their skills to the highest
levels. It would be surprising if the JIG did not stress the importance
of future flexibility, of continuous professional developments
and the need to re-skill and update. It is however essential to
recognise and respect profession-specific competencies—patients
will confirm that their over-riding desire is that the correct
diagnosis is made first time and that they are then managed effectively
and with dignity and respect. The doctor has a key role here,
as part of the health care team, in making critical and analytical
medical decisions.
Changing the roles and improving the skills of
existing staff
14. Consequently CHMS would argue that any
long-term commitment to a health service workforce must have a
core of medically educated professionals. CHMS does accept the
role of a wide range of health professionals and recognises that
delegating some jobs currently carried out by doctors to allied
health professionals may free doctors to perform essential tasks.
However, it is vital that all allied health professionals receive
adequate training with a medical perspective.
15. It is essential that the roles that
currently make up the clinical workforce be evaluated before considering
how they might be changed or augmented. Any change must be evidence
based.
International recruitment
16. International recruitment has long been
necessary to deliver the required volume of service within the
health service—and the variety of background and experience
has enriched the care delivered and often enhanced the quality
of research undertaken. However it is vital that systems for effective
quality assurance are in place that recognise the differences
in the training received by medical professionals.
17. Further Comments
CHMS would also highlight that the professional
life of healthcare workers involves lengthy training to consultant
level and a commitment to continuous professional development.
The infrastructure and funds to provide this must be made available—it
would be foolish to expand medical student numbers without an
equivalent commitment to increase training posts in the NHS.
How should planning be undertaken?
To what extent should it centralised or decentralised?
How is flexibility to be ensured?
18. Central planning has not worked well
in the past—and given the freedoms allowed to Foundation
Trusts, CHMS would argue that local solutions are likely to be
more successful, flexible and innovative and would encourage moves
in this direction. Nevertheless it is vital to ensure the central
collection and use of workforce planning data to avoid imbalances
within the UK as a whole.
19. CHMS would welcome the opportunity to
give verbal evidence to the Health Committee if required.
Council of Heads of Medical Schools
March 2006
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