Royal College of Surgeons – Regional Representatives Event

Future medical workforce: Employer views

5 November 2009

David Grantham Head of Programmes, NHS Employers

The role of NHS Employers

Represents NHS organisations in England on workforce issues:

• employer representation

• negotiation on behalf of the NHS

• good practice and knowledge sharing

• promotion of careers in the NHS

Why do employers’ views matter?

• Roles and the training for them must reflect future service (i.e. patient) need

• Service determines available career opportunities

• Need to set out for all aspirant doctors future requirements and expectations – aligned with service and professional requirements

• Employer views should influence regulators, educators and service commissioners

Why should employer views matter?

Not just negative – real issues to address

What influences employer views?

• Pursuit of quality, responsiveness and value for taxpayer

• Population and workforce demographics

• Healthcare need

• Workforce supply

• Technology and innovation

• Policy and priorities set

• Finance

• Legislation, standards and regulation

• Timeframes

What happened in the last 10 years?

Medical Workforce 2007 - 2008

0

10,000

20,000

30,000

40,000

50,000

60,000

Consultant(including

Directors ofPublicHealth)

AssociateSpecialist

Staff grade Doctors intraining (andservice postequivalents)

Otherhospitalgrades

GPProviders

Other GPs GPRegistrars

GPRetainers

Head

co

un

t

1997

2008

Factors influencing the next 10 years?

• Commitment to expand care outside hospital

• New roles and care pathways – need for flexibility

• Increased GP training opportunities

• ‘Oversupply’ in some specialties – eg surgery

• Globalisation – healthworker mobility

• Impact of demographics – eg feminisation, generation Y etc

• Revalidation and regulation

Employer views – training in general

• Responded favourably to ‘Tomorrow’s Doctors’

• Support for Foundation Programme

• Mixed views on run-through – majority favoured a split

• ‘Big bang’ recruitment remains a concern – but recognise the economies and benefits of a national process

• Anxiety that CCT holder is no longer the same as before

– capable, but lack experience

• Challenge balancing training and service

Surgical training

• Want to stick to principle of ‘broad based general specialist training’

•2 or 3 years, as evidenced – but not both

•A ‘mixed economy’ runs the risk of inequity and inflexibility, for trainees and the service

•Needs time to plan (at least a year?)

•Talk now about what to do in 2011

Specialist supply issue - surgery

1000

1500

2000

2500

3000

3500

FT

E

HistoricalGrowth

WRT SupplyForecast

RCSEngDemandEstimateEffect ofreduction

Employer views - Consultants and Specialists

• Service wants an alternative specialist grade:

• Role between CCT and consultant appointment to gain experience, broaden leadership skills and maintain progression

• Hierarchy within the consultant grade:

• New consultant (focussed on service delivery)

• More established (training and service leadership / management roles)

• Senior consultant (Clinical Director, Medical Director etc)

Why a new specialist role?

•Different work (more of what junior doctors did)

•Different CCT product – capable of consultant appointment but not the same as before

•Affordability - a key issue

•Maintenance of career progression incentive

•Dissatisfaction with elements of current consultant contract

Employer views - General issues

• Increasing flexibility – allowing doctors to adapt to service change

• Standards of accreditation/credentialing – points between license to practice and CCT

• Employers to determine their own structures

• Improving workforce planning

• Creating a modest oversupply in the workforce against anticipated demand

Revalidation

•Support for principle

•Engaged about design and process

•Concerned about complexity

•Want to ‘build up’ from current practices and systems

•Need to develop ‘remediation’ models

Concluding remarks

•Real challenges lie ahead

•Productivity is a key issue

•Employers concerns are real and should be debated

•Are there alternatives? – if so are these affordable?