Health Secretary Jeremy Hunt has announced that the number of medical school places available to attract young doctors will increase by 25% from 2018.
The intention is to ensure that England can be completely self-sufficient in training doctors following the recent decision to Brexit from the EU.
In alignment with this goal, trading places will be increased from 6,000 to 7,500 on an annual basis.
It is hoped that the number of homegrown doctors will also play a role in addressing the inevitably greying population.
But Prime Minister Theresa May has already commented that the Conservative party wishes to see the NHS recruit doctors from within the UK as much as possible.
Considering the difficult relationship that the government currently has with junior doctors, it may also be thought that extra recruitment is required to deal with professionals moving overseas.
It is also becoming increasingly difficult to attract talented young people to the medical profession.
Indeed, the latest figures from Health Education England show one in 10 education places remain unfilled.
The biggest gaps are seen in psychiatry (19%), GPs (17%) and paediatrics (7%).
But Hunt told the Conservative Party conference in Birmingham on Tuesday that putting provisions in place for the NHS of the future is essential.
“We need to prepare the NHS for the future, which means doing something we have never done properly before – training enough doctors. Currently a quarter of our doctors come from overseas. They do a fantastic job and we have been clear that we want EU nationals who are already here to stay post-Brexit. But is it right to import doctors from poorer countries that need them while turning away bright home graduates desperate to study medicine?”
Despite the £100 million of investment in training places announced by the government, many healthcare leaders and experts are unconvinced that this is satisfactory.
British Medical Association leader Dr Mark Porter suggested that the announcement “falls far short of what is needed”.
Porter went on to criticise the role of the government in what he sees as a declining NHS system.
“The government’s poor workforce planning has meant that the health service is currently facing huge and predictable staff shortages. We desperately need more doctors, particularly with the government plans for further seven-day services, but it will take a decade for extra places at medical school to produce more doctors. This initiative will not stop the NHS from needing to recruit overseas staff.”
Nigel Edwards, chief executive of the Nuffield Trust, largely concurred with this verdict.
“For decades, the NHS has failed to train enough of its own staff, so increasing the number of UK-trained medical staff is long overdue. However, if this new announcement involves simply replacing overseas doctors with UK-trained ones, that won’t increase the total number working in the NHS, and certainly won’t solve the agency staff crisis that is affecting the NHS right now.”
Currently approximately one-quarter of the NHS medical workforce is trained outside the UK.
New information released by Health Education England (HEE) indicates that a significant number of younger professionals training to be clinicians have applied for specialist training positions in the NHS.
Data from HEE indicates that over 120 additional additional junior doctors have applied for specialty training, with 170 trainees applying to become GPs.
This represents a small increase in the number of doctors applying for training post following foundation training, with the year-on-year expansion around 2%.
It is also notable that the total occupancy rate for specialty training positions has remained pretty much stable from last year at 90%.
It was in general practice where the largest increase was experienced, with 178 additional additional doctors applying to become GPs; an overall fill rate equivalent to 83%, or 2,691 trainees.
However, despite the apparently positive news, this was still significantly below the target of 3,250 which HEE has set in order to fulfil its overarching aim of attracting 5,000 extra GPs to the profession by 2020.
With this target in mind, a new round of recruitment for doctors will begin later this month.
Meanwhile, emergency medicine recruitment remained stable at a fill rate of 99%, or 317 trainees.
This has been aided by a £50 million program launched by HEE intended to improve the levels of emergency medicine staffing by creating 75 new training posts on an annual basis.
However, nearly one-fifth of psychiatry training places are unfilled based on data released by Health Education England.
This information can be considered important, as it had been feared following the dispute over junior doctors’ contracts that trainees would leave for foreign climes in order to work in overseas healthcare systems.
Indeed, hundreds had applied for certificates from the General Medical Council in order to work abroad.
Leading healthcare professionals were happy to welcome the news, suggesting that it reflected positively on the recruitment policies of the NHS authorities.
Danny Mortimer, chief executive of NHS Employers, was optimistic about the data released by Health Education England.
“Employers are reassured to see that the fill rates for medical training programmes have matched previous years. A number of organisations and geographies continue however to face real challenges with vacant medical posts, and they look forward to STP discussions which both alleviate pressure on their services as well as provide support for innovation in their workforce.”
However, although the data can be received positively, it is important to understand that the information does not give any indication requiring the number of doctors who leave training later in their career.
Many royal colleges have already warned of rota gaps at both senior registrar and consultant levels within the healthcare system.
And not all healthcare experts were in accordance with the view that this is a positive indication of the future direction of NHS staffing and training.
Interviewed for comment about the apparent recruitment successes in general practice and emergency medicine, despite the ongoing junior doctor disputes and pressures within the specialties, Andrew Vincent, Partner at Academyst LLP, had an alternative explanation.
“I agree that the behaviour seems contrary to what conditions might suggest. It’s easy when that happens to think you were wrong about the effects of conditions but a more plausible explanation is that a sudden desire to enter a distressed specialty is being driven by motives that aren’t immediately apparent in the figures themselves.”
Vincent continued by giving his personal take on the figures, indicating his view that the data could give a false impression of the actual situation.
“My personal view is that the most likely explanation is that individuals who are thoroughly disgruntled may well see general practice and emergency care as specialties that enable them to move to another health system e.g. Australia, with the greatest ease due to global shortages in these specialties. I would advise HEE and Deaneries to be very cautious about the numbers and perhaps commission some subtle research to better understand just why they have experienced recruitment ease when conditions suggest they should have difficulty. I think it would be dangerous to pat yourself on the back just yet.”
As the junior doctors dispute rumbled on, it was recently announced that there will be a judicial review on the legality of imposing the contractual conditions on healthcare professionals.
Media reports today indicate that the system of checks related to nurses and midwives is about to be significantly changed.
The new plans have been instigated in the context of the so-called mid-Staffordshire scandal.
An estimated 400-1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital.
As a result of the fallout from this case, nurses and midwives will now undergo checks every three years.
NHS watchdogs indicated that the reforms, which will be officially announced on Thursday 8th October, will constitute the biggest change in the history of the regulation of nurses.
The new regulations were considered essential in order to ensure that poor standards were not replicated on a wider scale in the NHS.
As a result of the new system of checks, nurses will be required to provide evidence demonstrating that they are both skilled and compassionate.
This can include feedback from patients, managers and fellow members of staff.
The new regulations are a first for the nursing profession, as it had previously been standard practice for workers in this sector to declare themselves fit for work without third-party evidence as support.
But recommendations from the public enquiry into the Staffordshire scandal have led to this new system of checks and balances.
The new system will be implemented by the Nursing and Midwifery Council, and will further require nurses to prove to regulators is that their professional skills are adequate, and that regular training has been undertaken in order to ensure complicity with contemporary practices.
Nearly 700,000 registered nurses and midwives in the UK will be subjected to the checks.
It has been pointed out with regard to the decision that it would generally not be expected for an individual to be present on a professional register for several decades without significant checks on their ability to conduct their duties.
Yet this was precisely the situation for nurses ahead of this new regulation and legislative measure.
In particular, nurses will be tested against the code of conduct of the Nursing and Midwifery Council.
And the hierarchy of the council has already placed a particular emphasis on the importance of patient feedback.
It is clear that this measure is intended to restore public confidence in the health service, and also to ensure that nurses and midwives engage more readily with the general public.
Sir Robert Francis QC called for the system of “revalidation” two and a half years ago, in his public inquiry into the scandal at Mid Staffordshire NHS Foundation trust.
And it seems that the radical overhaul recommended by Francis is now ready to be implemented.
Student nurses and midwives could be forced to fund their own education under a scheme currently being considered by the government.
The new Treasury plans would see these critical NHS workers being forced to pay their tuition fees and living costs, if proposals currently being assessed by the government come to fruition.
This will be a particularly worrying precedent for many concerned about the state of the health service, considering the fact that there is already a shortage of nurses in the NHS.
Indeed, it is often argued that the health service is one of the biggest beneficiaries of migrant labour of any organisation in the United Kingdom.
This certainly applies to doctors, physicians and surgeons, but also to nursing staff as well.
Due to the relatively small numbers of qualified nurses among the UK population, hospitals have frequently resorted to paying up to £2,200 per shift for locum staff, with thousands more being recruited from abroad.
And many people applying to train as nurses in the UK are currently turned away, with three times as many applicants as funded places, figures indicate.
Nonetheless, the government is apparently pressing on with the assessment of plans to compel student nurses and midwives to pay tuition fees and living costs.
The Councils of Deans of Health and Universities UK have already submitted plans to the government’s spending review.
This critical document is due to be published next month, and seemingly seeks to axe the existing system of free education completely.
All bursaries will be scrapped completely, replaced by a loan system. Tuition fees would also be introduced, and these would have to be funded by student applicants.
Many people will be extremely critical of the government scheme, viewing it as merely another opportunity for the financial sector and private equity to gain a valuable source of revenue.
Considering the importance of nurses within the NHS, and the obvious gulf between the required number and existing qualified individuals, putting such a significant barrier in the way of qualification will surely exacerbate the problem.
Critics will suggest that this scheme rather grates with the rhetoric that has issued forth from the government in recent weeks and months about the importance of the NHS in general.
Already nursing and midwifery unions have spoken out about the proposed changes.
The complaints of the largest nursing unions in the country indeed seem rather plausible, and are focused on the suggestion that many potential entrants will be deterred, particularly those from financially disadvantaged backgrounds.
With nursing already attracting a relatively meagre starting salary, the prospect of large debts will doubtless be viewed as a millstone by many potential applicants.
Tom Sandford, director of nursing at the Royal College of Nursing raised concerns that such changes could put potential nurses off entering training completely.
“Financial hardship is the top reason nursing students drop out, and the full time demands of the course make it very difficult for nursing students to earn extra money while they are training,” Sandford said.
Meanwhile, the Royal College of Midwives claimed that the plans risked worsening a shortage of 2,600 midwives.
A raft of important British healthcare institutions have submitted letters to GP practices all over the country regarding the Workforce Minimum Data Set (WMDS).
Health Education England, the Department of Health, NHS England and the Health and Social Care Information Centre (HSCIC) are all involved in this important initiative.
The letter provides important background on the role of WMDS in securing a well-trained workforce for the future.
It also includes details on the upcoming collection of data by the HSCIC, and the steps that GP practices need to take now to prepare.
The results of this process are due to be published before the end of this month.
Meanwhile, data collections will also take place at the beginning of October, with the latest submissions in the process required by the middle of November.
The organisations involved in the process were keen to emphasise that those who didn’t participate at an early stage can still get on board now.
WMDS is intended to help plan a future workforce for the healthcare service that meets the needs of all patients.
As primary care within the NHS comes under increasing workforce pressure, the data gathered as part of the WMDS process is intended to address this highly pressurised situation.
Central to the initiative is also improving staff training within the health service.
The first part of this process is to assemble an accurate picture of the existing workforce in order to fully understand the current skill set within the NHS.
This will make it possible to understand accurately the existing capacity within primary care.
Data will underpin the delivery of the joint 10-point plan agreed by the participating organisations, intended to catalyse the delivery of initiatives to ease workforce pressures in general practice.
This is merely the first year of a continuing process, in which data will be directly diverted into the Workforce Plan for England.
The Health and Social Care Information Centre is the organisation tasked with collecting the workforce Minimum Data Set.
HSCIC will contact healthcare professionals beginning from 1st October, with entries for this stage of the process closing on 14th November.
Healthcare professionals can visit the HSCIC website here.
Guidance documents and further information on accessing the Primary Care Web Tool for submitting data can be accessed here.
More information about the process can be acquired here.
Finally, HSCIC will answer questions directly on the process at firstname.lastname@example.org. Be sure to type ‘Workforce Collection’ in your subject heading when submitting an email.
New animation which helps healthcare professionals develop their clinical academic careers has been unveiled by Health Education England (HEE) and the National Institute for Health Research (NIHR).
The animation sets out the opportunities on offer to all professions through HEE’s Clinical Academic Careers Framework and the NIHR’s research programmes (funded by HEE).
There are two distinct programmes: (i) the NIHR Integrated Academic Training (IAT) Programme for doctors and dentists, and (ii) the HEE/NIHR Integrated Clinical Academic (ICA) Programme for non-medical healthcare professions. Both programmes allow the opportunity for clinicians to combine their clinical and academic development, and each programme contains awards at different levels, to allow all professions to consider developing a clinical academic career.
The IAT programme is for doctors and dentists and includes academic clinical fellowships, which allow medical and dental trainees in the early stages of training to get involved in research alongside clinical training over three years. For those more advanced in specialty training, who already have a research doctorate and who show potential for a career in academic medicine or dentistry, clinical lectureships are available for up to four years.
Alongside this, the ICA programme offers opportunities to non-medical healthcare professionals via a short introductory internship or a Masters in Clinical Research Studentship. Whilst applications for the annual round of doctoral and post-doctoral awards may have passed for this year, potential applicants are being encouraged to start thinking about their applications in plenty of time.
“We are delighted to have received the number of applications we’ve had to the ICA Programme doctoral and post-doctoral award schemes”, said Professor Nicki Latham, HEE Executive Director of Performance and Development. “We took the decision to widen the range of professions eligible to apply and we are really pleased that everyone has risen to the challenge in submitting applications. I hope this new video will get more people thinking about a clinical academic career and remind everyone planning their applications for next year to allow plenty of time to enable them to be the best they can be.”
The HEE/NIHR animation is available to view on HEE’s YouTube channel.
A multi-professional team of experts from around the world will be gathering in Bath from 5 to 6 March 2015 for a symposium to share their experiences of using simulation training to improve maternity care.
Organised by the PROMPT Maternity Foundation (a group of obstetricians, midwives and anaesthetists employed at NHS hospitals in the South West of England) and supported by Limbs & Things, an industry leader in medical simulation products, this inaugural event will feature keynote speakers including Professor Cathy Warwick CBE (Chief Executive of the Royal College of Midwives), Dr Carl Macrae (Organisational Psychologist & Health Foundation Improvement Science Fellow) and Professor Charles Vincent (Chair of Patient Safety, Oxford).
Aimed at obstetricians, midwives, anaesthetists and other professionals and students interested in safety and quality improvements in maternity care, the symposium will feature hands-on workshops focusing on new training models, new PROMPT training packages for undergraduate and pre-hospital settings and different methods for monitoring outcomes.
“We are delighted to be able to include speakers and maternity teams from the UK and right around the world to share their excellent quality improvement projects at the symposium”, said Professor Tim Draycott, trustee and research lead for the PROMPT Maternity Foundation.
Managing director of Limbs & Things, Nic Riley, added: “Limbs and Things is pleased to be supporting PROMPT Maternity Foundation in this first symposium. The aim is to bring multi-disciplinary healthcare teams together from across the world to learn and share ideas, promote collaborative working and ultimately improve patient outcomes.”
As part of its remit to improve safety in the NHS through the delivery of its education and training work, Health Education England (HEE) has produced a film to help staff in raising concerns over patient safety.
The film, produced under the auspices of the Commission on Education and Training for Patient Safety chaired by Professor Sir Norman Williams and Sir Keith Pearson, will provide support for staff at all levels, addressing not only the importance of raising concerns but how to do it whilst providing further information on speaking out when patient safety is at risk.
The film, formally launched today at the Royal College of Nursing, will also be used in response to Robert Francis’s review into whistleblowing in the NHS which recommended that every NHS staff member receives robust training in how to raise concerns about the way patients are being treated.
Professor Ian Cumming, HEE chief executive, said: “High-quality education and training is the basis of high quality, safe and effective patient care. Patient safety should be the number one concern of all who serve patients in the NHS; the first and most important lesson they learn.
“We would hope that employers, universities, trainers and others use this film to raise awareness in staff, stimulate discussion about best practice and to ensure that all students, trainees and staff are aware of the importance of their responsibility to raise concerns when they see patients at risk. Patient safety is everybody’s business.”