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Health policy review

Summer 2006

Issue 2: Different approaches to reforming health services

Current projects at the health policy and economic research unit - Tania Fisher
BMA cohort study of 2006 medial graduates
For the past 10 years, the health policy and economic research unit (HPERU) has undertaken the longitudinal cohort study of the 1995 graduates of UK medical schools. This study has now reached its conclusion. In order to continue to provide valuable information on the careers of doctors, we are planning a further 10-year cohort study of 2006 graduates of UK medical schools. Like the previous 10-year study, the 2006 cohort study will focus on the career choices and aspirations of a cohort of 500 doctors and provide important insights for medical workforce planning. The 2006 cohort study will also provide an important source of information about doctors embarking on the new medical training structure, while also providing a comparator group with the 1995 cohort. Recruitment of participants for the BMA cohort study of 2006 graduates has begun. Final year medical students have been contacted from most medical schools in the UK and expressions of interest are currently being collected. These will form the basis upon which the final sample of cohort members will be selected. The study is due to begin in the summer.
For further information read more here.

Medical workforce policy
The Medical Workforce Standing Advisory Committee in 1997 recommended an increase of about 1,000 in the annual intake of medical students and advocated keeping constant the number of undergraduate medical students from overseas. The aim was to move towards self-reliance in the medical workforce [go to note 43]. Subsequently, the Wanless Review’s workforce model looked at the government’s proposed increases in the NHS workforce. It concluded that looking 20 years ahead, the planned increase in the supply of doctors would fall short of demand by a total of around 25,000. In April 2006 Reform published a report which argued that the logical conclusion of the government’s health reform agenda is a significantly smaller and higher quality NHS workforce [go to note 44].

HPERU is working with a cross-craft group looking at models of the future medical workforce. The aim of the group is to produce a workforce policy in the face of competing views on future demand and uncertainty about supply. The perceived market for doctors is a tight one, 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 a plentiful labour supply. On the other hand, financial and competitive pressures seem likely to force employers to look for low cost solutions and substitution rather than employ those doctors who are or will become available. Hanging over all this is uncertainty about the future length of medical training and the role that will be played in future by international medical graduates (IMG) particularly those from the enlarged EU. With this in mind, HPERU will be looking at different scenarios for workforce supply in the light of realistic assumptions about future demand.

Workplace bullying and harassment of doctors in the workplace
Bullying and harassment is on the increase in the health service and occurs across the medical workforce from medical students, to junior doctors to consultants and GPs. A report written by HPERU provides an overview of the research undertaken addressing this issue. The report, Bullying and harassment of doctors in the workplace formed the basis for a conference held at BMA House on 19 May 2006. Key topics debated included bullying in medicine and the psychology of bullying. Based on the findings of the report and the subsequent debate, the BMA is calling for a culture of zero tolerance to be implemented from the top down throughout the health service.
Read more here.

Medical academics
HPERU is continuing its research programme focusing on issues of recruitment and retention of clinical academic staff in the UK. A report, Research assessment exercise 2008, survey of clinical academic and research staff, reports the views of clinical academics and research staff across the United Kingdom on reasonable assessments within the context of their work. While a fifth of respondents regarded the RAE as having had a positive impact on their career, 40 per cent regarded the RAE as having a negative impact on their career. Further work has been undertaken by HPERU on medical academic role models in response to suggestions that there is a recruitment and retention crisis in academic medicine. The report was published to highlight examples of ‘role models’. The academic staff in the report were nominated by their peers and colleagues for being inspirational, having a positive impact on others and being passionate about what they do by highlighting staff from a range of backgrounds who were at different stages in their careers. This report shows the wide range of career options available in academic medicine and underlines the satisfaction that can be gained from pursuing research and teaching the next generation of doctors.
Read more here.

Plurality
HPERU has been heavily involved in research on the operation and impact of independent sector treatment centres (ISTCs) on local health economies in England. An ongoing research programme, including a survey and focus groups, involving clinical directors in those specialties most likely to be affected by the ongoing treatment centre programme has enabled the BMA to develop an informed critique of many elements of the ISTC regime and publicise the BMA’s concerns. Furthermore, HPERU has been central in producing the BMA’s written submissions to the Health Select Committee’s inquiry on ISTCs (March 2006) and the Parliamentary Labour Party Health Committee’s review of health reform (December 2005). These submissions have, in particular, pointed to the need for a robust independent monitoring system, transparent clinical governance arrangements, safeguards for the training and experience of junior doctors, and much better planning for, and integration of, ISTCs alongside conventional NHS organisations. HPERU’s work in this area has led to invitations being extended to the BMA to join a number of Department of Health advisory groups with the aim of ensuring that continuation of the ISTC initiative proceeds subject to proper scrutiny and with input from the profession.

For more information about any of these projects please contact
Tania Fisher on 020 7383 6248 or tfisher@bma.org.uk