Medical workforce - public health doctors
Maintaining the specialist public health workforce
December 2006
“We want to improve the health and well-being of every local community ….. Despite major successes in tackling some of the biggest killers, progress on preventative measures, such as improving diet, has been slower, and in some cases is heading in the wrong direction.” Extract from the recently published Local Government White Paper, Strong and Prosperous Communities, Volume II, Section B - Health and Well-being.
The BMA is concerned about the significant threat to England’s public health specialist workforce as a direct result of the recent reconfiguration of Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). The reduction in the number of SHAs and PCTs has resulted in a commensurate reduction in the number of Directors of Public Health (DsPH).
In partnership with local authorities and voluntary organisations Directors of Public Health and public health consultants ensure that the local population’s needs are assessed and addressed through public health programmes. They provide leadership across the three domains of public health: health protection, health improvement and tackling health inequalities.
As the timing coincided with NHS deficit recovery plans, fears have grown that the new PCTs will seek to reduce rather than increase the number of consultant public health posts, putting existing consultants as well as former DsPH at risk. This would undermine the ability of PCTs to deliver one of their key objectives. The BMA has urged SHA and PCT HR Directors to maintain specialist public health capacity and to avoid redundancies.
- It is vitally important for SHAs and PCTs to take steps to retain the public health specialist workforce to ensure the availability of sufficient capacity to provide public health leadership.
- It is too early to predict fully the number of displaced public health clinicians as Directors of Public Health appointments by PCTs, and the consequential appointments of consultants in public health, will continue into early 2007.
- The Government and primary care trusts must give assurances that the public health specialist workforce displaced by the reorganisation are offered suitable public health posts, that capacity is not reduced and that a coherent, nationally co-ordinated approach to recruitment and retention is taken.
- Reducing public health capacity would be a short-term measure with significant redundancy costs. It would not be compatible with the government’s conviction that investment in public health can lead to net savings.
Adequate public health capacity is necessary to implement the policies outlined in the Government’s Choosing Health document, just as any other policy objective.
A letter from Mr Kevin Orford, former NHS Deputy Finance Director, to SHA Finance Directors on 3 October 2005 confirmed this. In a letter that sets out guidance on delivering the Commissioning a Patient-Led NHS, including the objective of achieving £250 million in management cost savings, the letter stated:
“….. it is important to highlight expectations early to ensure that the NHS maintains capacity to deliver. For this reason, SHAs and PCTs should not identify for savings those posts working on Choosing Health. This would exclude from the target all consultant and specialist public health posts and posts working on frontline services, for example health protection, smoking cessation services and other health improvement services outlined in Choosing Health”.
This guidance is in danger of being ignored by some PCTs more concerned with cost savings than implementation of key government strategy.
Public Health specialists, including high proportion of doctors trained in effective public health practice, have a major role to plan in implementation of Government policies to empower people to lead healthy lives. It is vital for multidisciplinary training programmes to continue, and to include training of doctors in public health, as future leaders within the profession.
At a time when the country is faced with significant public health challenges such as increasing levels of childhood obesity, smoking rates and health inequalities, any reductions in senior public health workforce undermines the potential for progress.
Background notes:
The Commissioning a Patient Led NHS document was published in July 2005 with the aim to improve commissioning arrangements for health services. Within the strategy was a commitment to reduce NHS management costs by £250 million through the merging of Strategic Health Authorities and Primary Care trusts.
When Special Health Authorities were reconfigured on 1 July 2006, their number was reduced from 28 to 10. This resulted in the Regional Directors of Public Health and SHA Directors of Public Health having to compete for the ten Regional Directors of Public Health posts. Some RDsPH opted out on terms unknown which left about 30 competing for the posts.
The reconfigured PCTs were established on 1 October 2006 with the number reduced from 303 to 152. Each PCT previously had a Director of Public Health (DPH), but with the merging of PCTs, around 150 DsPH were displaced by this process. Most, though not all, of these posts were staffed by doctors. Each DPH displaced by the reorganisation should be offered consultant level posts by the new PCTs in order to maintain public health capacity in each area.
The BMA, Department of Health and the Faculty of Public Health are collecting information on consultant and DPH appointments in the English regions.
For further information, please contact BMA Parliamentary Unit:
Email: parliamentaryunit@bma.org.uk