Written evidence submitted by the Royal College of Physicians and Surgeons of Glasgow (RTR0026)
1.1 The Royal College of Physicians and Surgeons of Glasgow although based in Glasgow has a membership of 15,000 and represents Fellows and Members throughout the UK.
1.2 The College was founded by Royal Charter in 1599 to improve the practice of Medicine and Surgery. Through a forward looking, progressive approach to training, assessment, career support and professional development, we continue to inspire and nurture our 15,000 members throughout all parts the UK and abroad to deliver the highest possible standards of care for their patients.
2.1 Domestically the fundamental obstacle to recruitment of skilled healthcare professionals is a lack of supply. In the UK there simply are not enough trained healthcare professionals to meet patient demand. Investment is therefore needed in education and training. However, there is always a time lag between when individuals start training and when they finish and they are able to enter the fully trained workforce.
2.2 Offering more flexibility between and within training programmes, and improving access to less than full time (LTFT) working is essential both for recruitment and retention. Making LTFT working and flexible training more accessible will make the workplace more attractive and accessible to ensure equality, diversity and inclusion of the workforce. This may require a change in culture in the NHS where the emphasis has always been on full time working (and in fact more than full time working) with no or little chance to change throughout one’s career.
2.3 International recruitment
- Ethical international recruitment must be accompanied by staff being supported appropriately when in post
- The Medical Training Initiative should be expanded with an improved matching process developed and implemented. Many countries ask their own trainees to spend time abroad to enhance their training before returning home. A more formal arrangement with these countries could be made
- There is possibility in attracting additional staff from trained outside the UK by reinstating permit free training
3.1 The current shortage of staff in NHS England is the consequence of years of an inadequate increase in the workforce and the associated training. There is not currently an adequate system in place for determining current and future workforce needs to meet patient demand in health and social care. Each country of the UK considers the workforce question independently and does not consider workforce movement across borders. There is need for a consolidated and agreed plan.
3.2 We strongly support the Academy of Medical Royal Colleges’ call for a paradigm shift in workforce planning. We are calling for the establishing of a single planning group to advise on and oversee workforce planning and a commitment by the UK Government to resource this workforce. 3.3 Ensuring that we have a sustainable workforce that is able to meet current and future patient demand is fundamental to protect our NHS, our staff, and our patients.
3.4 The needs of the workforce are changing. Modelling for workforce planning must be improved to take into account
- Vacancies, including ‘hidden vacancies’ (those which are not advertised)
- Growing preference for part time working
- Sufficient time for training, supervision and non-clinical work
- Flexible training options
- Junior doctors who do not progress directly to specialty training
- The immediate need to increase manpower while those who are in training take time to train
- Support and nurture those in the SAS grade
- Alternative strategies such as developing Physicians Associates, Surgical Associates, Anaesthetic Associates and Extended Scope Practitioners (nurses podiatrists and physiotherapists) will use virtually the same training resource as medical staff
3.5 We do not have enough doctors to meet patient demand as seen by the number of vacancies and excessive workloads faced by staff. To ensure a sustainable medical workforce it is necessary to increase the number of medical school places at universities across the UK
- This should include increases to the numbers of from ‘widening access’ backgrounds, UK domiciled students, and students on graduate entry programmes
- The expansion of medical school places must be matched by a commitment to provide consultants with sufficient time for the additional teaching pressures that this change will entail. Employers and government must recognise the importance of ensuring that medical students and trainees are properly supported throughout their training
- An increase in students studying medicine must also be matched by additional funding for corresponding increases in Foundation Programme places and subsequently in Specialty Training posts
3.6 There is opportunity to develop the roles of and training capacity for Physician Assistant, Surgical Care Practitioners, Anaesthetic Associates, Optometrists, Pharmacists, Nurses, Physiotherapists Podiatrists and other enhanced roles to maximise the workforce.
4.1 We believe there are a number of realistic meaningful, realistic and solutions that will have a positive impact on workforce retention. A focus on improving and protecting workforce wellbeing by providing suitable working conditions, contracts, flexibility and support will have an impact on both retention and re-joining.
- Work plans and contracts must provide sufficient time to allow for teaching/training and supervision, CPD and other professional duties
- Efforts to address wellbeing must be ongoing and sustainable and cannot be a replacement for addressing the drivers of poor wellbeing in staff
- Reform pensions tax regime: punitive pensions tax charges are a key factor for many senior consultants choosing early retirement. This involves exceeding lifetime allowance and annual contributions, which means tax thresholds are exceeded
- Giving employees a right to change their contract and job plan throughout their working career to mirror capabilities at each stage
- A more efficient and straightforward process for GMC registration, appraisal and revalidation to match appropriate jobs should be developed to facilitate staff who have retired to return to work
- Flexibility in training and improved access to LTFT working
5 Integrated Care Systems
5.1 Health and social care in the UK are inherently linked services. Integrated Care Systems in England as planned leave them both separate. To be truly integrated they need to have the same management and resource structure. There is an immediate need for care staff to support both hospital and social care so that there is a smooth transition between the two. While technically termed “untrained” care staff should be considered as trained carers with enhanced skills and priority for immigration and work visas. A standardised system of training should be adopted for care staff so that quality assurance is maintained.
Dr Richard Hull