Memorandum from the British Medical Association
EXECUTIVE SUMMARY
— The Defence Medical Services (DMS)
show a severe shortfall of 55%[10]
for trained Medical Officers.
— DMS doctors deliver high quality
medical care to British military personnel working in challenging
environments, yet they typically earn less than their NHS colleagues.
— The current constraints on the UK
medical workforce are magnified for the DMS, given certain restrictions
on recruitment within the wider workforce.
— There is a need to retain DMS Medical
and Dental officers to support manning levels and operational
capability.
— It is also important that pay levels
between NHS and DMS doctors are comparable, to avoid an exodus
of DMS doctors to the NHS.
ABOUT THE
BMA AND THE
ARMED FORCES
COMMITTEE
1. The British Medical Association (BMA)
is an independent trade union and voluntary professional association
which represents doctors from all branches of medicine all over
the UK. It has a total membership of over 138,000.
2. The Armed Forces Committee was established
by the BMA "To consider matters relating to the medical branches
of the armed forces and the medical branches of the reserve armed
forces and so far as possible to ensure that medical officers
serving in the medical branches of the armed forces are not disadvantaged
in relation to their civilian counterparts." The main focus
of its work has traditionally been the production of evidence
to the Armed Forces Pay Review Body. The committee also represents
civilian doctors working for the defence medical services
MORALE
3. In its Supplement to the Thirty-Fifth
Report 2006, the Armed Forces Pay Review Body acknowledged that
continuing commitment to operational medical support, compounded
by specialty shortages, resulted in a high rate of deployment
would have a detrimental impact on retention.[11]
The DMS are currently involved in a greater degree of active service
than many would have foreseen a few years ago and two in five
respondents to the BMA Tripartite Cohort study of doctors[12]
reported that this had weakened their desire to serve in the Services.
MANNING LEVELS
4. Current DMS manning levels are significantly
below requirements, with a severe shortfall of 55%[13]
against the total requirement (1080) for trained Medical Officers.[14]
It is acknowledged that shortages are most severe in specialty
areas crucial to operational capability.
5. Table 1 indicates the manning levels
in specialty areas as at April 2006 and shows that these deficits
are greatest in anaesthetics, general medicine, surgery, pathology,
A&E and psychiatry. The deficit of GMPs across the three Services
is 34%.[15]
These shortfalls must be seen in the context of continued shortages
in NHS consultants and GMPs. Continued overstretch and increased
operational tempo mean that DMS medical officers in specialities
experiencing shortages will continue to face a high rate of deployment.
This in turn will impact on the retention of medical officers
in these specialties.
Table 1
TRI-SERVICE REQUIRED MANPOWER AND DEPLOYABLE
DMS DOCTORS ACCORDING TO SPECIALTY SHORTAGES, APRIL 2006[16]
| Total Requirement
| Trained strength* | Deployable trained strength**
| Shortfall (%)*** |
General Medical Practitioner |
410 | 260 | 150
| 36 |
| Dental Officer | 290 | 260
| 150 | 10 |
| Anaesthetists | 90 | 48
| 42 | 47 |
| General Surgeons | 42 |
18 | 12 | 57 |
| General Physicians | 29 |
13 | 6 | 55 |
| Accident & Emergency | 29
| 13 | 10 | 55
|
| Psychiatrists | 27 | 13
| 9 | 52 |
| Orthopaedic Surgeons | 28 |
19 | 16 | 32 |
| Pathologists | 13 | 4
| 3 | 69 |
| Aviation Medicine | 16 |
11 | 6 | 31 |
| Rheumatology and Rehab | 7 |
4 | 2 | 43 |
| Neurosurgery | 3 | 0
| 0 | 100 |
| |
| | |
* The number of qualified officers in a particular specialty.
Not all will be deployable in their specialty as they may be medically
downgraded or working out of specialty.
** The number of officers who, as of 1 April 2006, were
able to deploy in their specialty.
*** Measuring trained strength against requirement.
RETENTION
6. Retention of DMS doctors is critical and must be addressed
as a priority. Evidence from the BMA Tripartite Cohort study of
doctors[17] highlights
this issue, whereby only a quarter of respondents reported that
they would continue on or transfer to a full career commission,
whilst a further quarter reported that they intended to work in
the NHS and/or private practice. Few reported extending their
commission for three years or taking an intermediate service commission.
7. Morale and motivation is a key factor in the retention
of doctors in the DMS. Separation from family and the impact of
a career in the Services on family life were the main factors
cited by respondents to the BMA Tripartite Cohort study as influencing
their morale to the extent that they would or have considered
leaving the Services. Results from the National Audit Office (NAO)
study of recruitment and retention in the Armed Forces shows that
the impact of Service life on family life and the ability to plan
life outside of work are key drivers in the decision to leave
the Services.
8. According to the NAO, whilst a degree of separation
from home and family life is expected in the Services, substantial
numbers of personnel have exceeded "harmony guidelines"
within their respective Services on the maximum time personnel
should spend away from home so as to achieve a sustainable balance
between time away and time at home. Whilst this varies according
to each Service, evidence shows that the extent to which personnel
in Army pinch-point trades have breached individual harmony guidelines
includes general surgeons (21%) and GMPs (6%).[18]
9. Results from the NAO study[19]
also show that the majority of serving personnel in pinch point
trades felt that pressures on their time when not deployed had
increased in the last few years and this may be indicative of
a rising level of dissatisfaction with service life or the worsening
of Service life conditions. This will impact on the longer term
retention of DMS doctors.
FLEXIBLE WORKING
10. Increasingly women make up a greater component of
the medical workforce, and improving opportunities for flexible
working practices and balance between professional and family
lives is required in response. Feminisation of the medical workforce
will increasingly impact on the DMS as women now account for around
a third of DMS medical and dental officers. We await the outcome
of the MoD's work in this area (Project 22).
11. Changing aspirations of doctors, along with a greater
acceptance that part-time working is a reasonable option for a
whole variety of personal reasons, will mean greater numbers of
part-time and flexible posts will be needed if doctors are to
be retained in the DMS. A key factor in the morale and motivation
of doctors is achieving an acceptable work-life balance and consequently
more doctors are choosing career paths which allow greater flexibility
and the ability to combine professional and domestic commitments.[20]
Increasingly, the desire for flexible working arrangements will
impact on the morale and motivation of DMS doctors.
12. Retention of DMS doctors, particularly those with
longer experience approaching mid career is of concern. An important
reason for leaving the Services is reportedly the availability
and increasing attractiveness of civilian employment in the NHS.[21]
RESERVISTS
13. The DMS relies heavily on the contribution made by
Reserves to our Armed Forces. Reservists serve alongside their
Regular colleagues on operations, and they are vital to our ability
to expand our forces in times of crisis. The continued increased
operational tempo in the DMS and a smaller cohort of Regular DMS
personnel who are deployable means a greater reliance upon Reserve
Medical and Dental Officers in maximising operational capability.
However, the Reserves also suffer manpower shortages, which will
in turn contribute to overstretch. Retention and improving morale
of Reserves is therefore crucial.
14. The main burden of support to the Regular forces
has fallen on the Territorial Army (TA) and the ongoing mobilisation
of volunteer reserves of all branches has resulted in a considerable
net loss to the TA, which currently is at its lowest strength
ever. Although this outflow has particularly affected non medical
units, there is some evidence that medical units are increasingly
facing retention problems.
15. The impact of active service upon the morale and
retention of Reservists needs to be carefully evaluated if this
strategy is to be sustained in the longer term. Recruitment may
be adversely affected by not only the unwillingness of individuals
to serve, but also the attitude of their employer. NHS employers
are increasingly commercially oriented and target driven organisations,
and are more likely, given the choice of two equal candidates
for a consultant post, to appoint the candidate with no reserve
liability.
16. Similar remarks can be made for NHS general practitioner
appointments; unless existing partners are sympathetic to the
concept of reserve liability, it will often be considered a handicap
and a disincentive to recruit. NHS GP partnership agreements generally
mention reserve liability and, for the practice, the need to cover
the absence of deployed colleagues can represent a major financial
commitment. These situations are driven again by the medical workforce
shortage coupled with the severe lack of contingency capacity
in most NHS organisations and general practices
SATISFACTION
17. Satisfaction with overall career management is a
further issue impacting on the morale and motivation of DMS doctors.
Although half of respondents to the BMA Tripartite Cohort study[22]
were generally satisfied with working for the DMS, only two in
five respondents were satisfied with their overall career management.
15 May 2007
10
Thirty-sixth Supplement of the AFPRB Report 2007. Back
11
Paragraph 19. Armed Forces Pay Review Body. Supplement to the
Thirty-fifth Report 2006. Back
12
Health Policy and Economic Research Unit. BMA Tripartite Cohort
study of doctors in the DMS, 2006, BMA: London. Back
13
Thirty-sixth Supplement of the AFPRB Report 2007. Back
14
Thirty-sixth Supplement of the AFPRB Report 2007. Back
15
Thirty-sixth Supplement of the AFPRB Report 2007. Back
16
Data supplied by the MoD-Manning figures as at 1 April 2006 from
D Med Op Cap. The table shows total requirement for each specialty
set against the number of officers who as of 1 April 2006 were
able to deploy in specialty Back
17
Health Policy and Economic Research Unit. BMA Tripartite Cohort
study of doctors in the DMS, 2006, BMA: London. Back
18
National Audit Office, 2006, Recruitment and Retention in the
Armed Forces, London: Stationery Office. Back
19
National Audit Office, 2006, Recruitment and Retention in the
Armed Forces, London: Stationery Office. Back
20
Health Policy and Economic Research Unit. BMA Tripartite Cohort
study of doctors in the DMS, 2006, BMA: London. Back
21
National Audit Office, 2006, Recruitment and Retention in the
Armed Forces, London: Stationery Office. Back
22
Health Policy and Economic Research Unit. BMA Tripartite Cohort
study of doctors in the DMS, 2006, BMA: London. Back
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