Written evidence submitted by The British Infections Association (RTR0032)
The British Infection Association (BIA) is contributing to this consultation as the primary infection specialist society in the United Kingdom. We represent over 1000 members, mostly doctors but also nurses, pharmacists and healthcare scientists, working in clinical Microbiology laboratories or Infectious Diseases departments across the UK. This consultation response reflects the findings of a comprehensive workforce survey undertaken by the BIA in conjunction with the Royal College of Pathologists in Summer 2021. The survey was sent to all acute trusts/health boards in the UK and had an overall response rate of 72%. The current staffing landscape in Infection Specialties is suboptimal with 20.3% of existing Consultant Medical Microbiology, 14.6% of Consultant Virology and 9.3% of Consultant Infectious Diseases posts unfilled (BIA workforce survey). Furthermore, this shortage is at a time when services continue to respond to COVID-19, have had little opportunity for other strategic and planning activity for 2 years and will now be required to respond to the Infectious Disease and Infection Control consequences of pandemic recovery and pressing long term needs including combatting antimicrobial resistance. Geographical variation in numbers of infection specialists per inpatient bed was marked and this also requires addressing to ensure that a high quality infection service is provided to all UK patients regardless of where they live.
Length of training for consultant medical and clinical scientific staff make it very difficult to adapt to fluctuations in staffing levels in the short or medium term and imply the need for much more reliable, frequent and granular workforce planning than exists currently including fuller understanding of retirement plans of senior staff. Although an ambition to improve workforce data is already embedded in the NHS People Plan, its importance to smaller, highly skilled specialties such as infection is important to emphasise. As detailed above, there are already real challenges due to significant staff shortages across the infection workforce and without better data, there is a very real risk that shortfalls in service provision will continue to worsen without the necessary training occurring to fill the gaps.
Many microbiology departments have 3 or fewer consultants and vacancies within these create a vicious cycle with short staffing making posts unattractive to new applicants and exacerbating the workforce shortage. Such departments are also usually unable to support trainees and therefore lack access or familiarity with doctors approaching completion of training. The workforce challenges of small departments can be mitigated by networking laboratories and by utilising a blend of scientific and medical consultant posts but such strategies need to ensure that the resulting posts are sufficiently attractive to retain staff. Similarly, senior nurses and pharmacists are able to fulfil significant roles more usually undertaken by consultant medical staff. In order to assist this development of roles and to permit more straightforward transfer of skills, better definition of competencies of non-medical consultant staff would be desirable.
The consultation specifically asks about recruitment from overseas and in the short term we are likely to need medical staff from ethically acceptable countries to ensure adequate and safe staffing of the NHS but recruiting from those countries carries its own unpredictability with respect to staff retention as changing economic and geopolitical variables impact upon the attractiveness of UK and NHS as a workplace compared to country of origin. It is therefore difficult to give an ideal medium term proportion. In the long term, the aim must be for training adequate numbers of staff within the UK and thus achieving a balance between staff leaving the NHS to work overseas and staff moving to the UK to work. The importance of not removing talent from poor countries is inherent in the question and is key whilst recognising benefits of a period of training in the UK for doctors and other healthcare professionals to the individual, their healthcare system and to the UK, especially in a global specialty such as infection.
On the other hand, we strongly believe that current medical training periods should not be further reduced in infection. Earlier specialisation has been suggested as a route to reduction in the duration of postgraduate training but this reduces breadth of experience, of particular benefit in specialties such as infection, which overlap widely with other specialties. In addition, we do not feel that the cap on medical students should be removed given the investment both by the country and the individual in medical training in terms of both time and money/loans, it would seem unfair to risk training too many doctors and so a cap is required but obviously needs regular review in the context of high quality workforce planning.
With respect to ongoing training, we feel that the next iteration of the NHS People Plan should prioritise the importance of continuing professional development (CPD) and employers should have a greater responsibility for ensuring that time allocated to CPD is protected as planned. Currently it is all too often the first thing to be sacrificed when other competing pressures are present and both trainee and substantive post-holders across the workforce will have had training and CPD compromised by the COVID-19 pandemic impacting on both quality of care, job satisfaction and staff retention.