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Health policy review - Volume 2, Issue 1

Medical workforce - Winter 2007

This journal is produced by the Health Policy and Economic Research Unit and is designed to stimulate debate. The views expressed do not necessarily represent BMA policy.

Editorial - Eleanor Gray
This winter edition of Health Policy Review introduces papers on the medical workforce within the NHS. The BMA has been looking at the issue of workforce planning during the current year and have undertaken work across the Association on the future of the medical workforce. The papers in this edition are not necessarily representative of BMA policy but are designed to stimulate debate about the future of the medical workforce in the NHS.

Recently there has been a significant shift in the distribution of medical professionals within the medical workforce. Changes in policy since the late 1990’s have led to an increase in the number of medical students and therefore, with the NHS a monopoly employer and educator of junior doctors, the number of medical graduates entering the NHS. The impact of the Modernising Medical Careers agenda has also had a significant impact on the distribution of newly qualified doctors and how they progress through their training. For the first time, some junior doctors have found themselves facing unemployment and UK graduates have resorted to continuing their training overseas. There have also been changes to the immigration laws which have led to fluctuations in the number of medical practitioners who have qualified overseas working within the NHS. Further developments have seen a small but not insignificant growth in the numbers of new non-medically qualified, roles, which are perceived by some, to be in direct competition with medical trainees and therefore the future of the medical workforce. All these factors have a significant impact on the shape and future of the medical workforce in the UK.

The BMA health policy and economic research unit has looked at models of the future medical workforce and, as outlined in the paper by Amanda Downing, what should be a simple science is clearly not. It becomes apparent that the NHS does not appear to know the numbers of health professionals it has; ‘medical workforce planning is simple: count the number of doctors currently working in the NHS, add in those who enter from medical school or through immigration, take out those who leave through retirement or emigration, and you get the future supply of the medical workforce. Match this to the number that you need to deliver the service that you want to provide and you’re finished. Practically, it is highly complex and more of an art than a science’. To make informed decisions about the future of the NHS, not only do we need to know to we are providing care for but we also need to know who will be providing that care. Information needs to be available to workforce planners and medical professionals to support them to make informed career choices. The paper concludes that only with a coordinated and consistent approach to workforce planning across the NHS can things get better.

The perceptions of the medical workforce for their future careers are highlighted in Tania Fishers paper on the morale and motivation of doctors. The paper highlights a significant body of research undertaken by the BMA; the cohort study, a 10-year study of doctors who graduated from UK medical schools in 1995. The research provides insights into patterns of workforce participation and the factors influencing doctors as they progress through their training and provides a useful background to the discussion around workforce planning. It gives an insight into the individuals behind the statistics. The paper concludes that motivation and morale is an important determinant of both recruitment and retention of the medical workforce and good morale and motivation are essential to the retention of doctors in the workforce where by a sense of value and respect are inherent to improved motivation.

The paper on role of the non medically qualified practitioner looks at new roles which have been developed as part of a workforce need to provide a bridge between medical skill shortage, the need to provide high quality patient care and a potential solution to reduce the current skill shortage in the UK. The paper highlights the differences between the extended roles, the role of the doctor and the way in which the medical profession is increasingly being challenged. The paper concludes that the ideal outcome is for enhanced skill mix within the healthcare delivery team and for the specialist skills of those delivering healthcare to be used appropriately.

Jon Fords paper looks at an market based approach to workforce planning. The paper points out that recognition of supply and demand are basic principles which have a bearing on the NHS workforce and are inherently linked to the principles of a needs based approach within the NHS whose business is caring for patients. The economic principles behind workforce planning are explored through the structure of the NHS, the paper points out that as a monopoly employer of doctors in the UK, the NHS has an obvious interest in ensuring that sufficient doctors are available and are trained to the requisite standard. The paper suggests that while it may make economic sense for need to drive the supply of healthcare resources need is a misleading concept involving predictions of future technological and behavioural change, productivity improvements and some consideration of unmet need. It goes on to say: ‘demand, while obviously a more effective indicator of the numbers of doctors required is difficult to predict, will have the potential for short-term instability and is susceptible to Government action’.

This edition of health policy review brings together different perspectives of medical workforce planning. It highlights the differences in how the medical workforce is viewed, from an economic perspective, the perspective of those working in the system and the perspective of the workforce planners. The perceived market for doctors is, in the future, likely to become an increasing cause for concern as evidenced by the desire of employers to secure productivity gains from existing staff and the securing of high rewards by the profession for delivering these in the absence of over supply of labour.

In the future it is likely that the NHS will see financial and competitive pressures forcing employers to look for low cost solutions and substitution rather than employ medical professionals who are or will become available. The papers will hopefully encourage readers to think about what the medical workforce will be like in the NHS in the future and how could it meet the needs of the patients it serves.

Contributors
Amanda Downing, Research Analyst, Health Policy and Economic Research Unit
Tania Fisher, Research Analyst, Health Policy and Economic Research Unit
Jon Ford, Head, Health Policy and Economic Research Unit
Thomas Frusher, Policy Analyst, Health Policy and Economic Research Unit
Eleanor Gray, Research Analyst, Health Policy and Economic Research Unit