Health, Wellbeing and Local Government Committee
Committee Inquiry into Health and Social Care Workforce Planning - Evidence from the School of Postgraduate Medical & Dental Education, Wales College of Medicine
This report is written from the perspective of the Postgraduate Medical and Dental Education perspective. The Postgraduate Deanery is responsible for the training of all doctors after graduation from medical school until they get a Certificate of Completion of Training to enable them to go on to be either a consultant or a general practitioner.
We have over 2000 doctors in Wales training across all specialties and within every acute Trust in Wales.
General Practice training is undertaken in a 2-year hospital rotation followed by 1 year in General Practice. These are in trainer practices up and down the country. At any one time we have approximately 400 doctors training to become General Practitioners.
Training numbers are decided on a year-to-year basis and do take account of the number of specialists required in the future, both in Wales and across the United Kingdom. Examples where UK-wide workforce planning is required is in subjects like Cardiothoracic Surgery, where there has been a dramatic reduction in the number of Cardiothoracic Surgeons needed and, therefore, a reduction in total number of training numbers that any individual country are recommended to institute.
Training numbers are discussed with workforce planners within the Welsh Assembly and these numbers are then recruited to by the Deanery and funded by the Assembly. There is no real integration of numbers of doctors in any of the specialties with other workforce planning of other health professionals in the system. NLIAH does have the workforce numbers for all other allied health professions apart from links with the doctor training numbers. We are beginning to work more closely together and I believe this is going to be essential for the delivery of healthcare to Wales both with the integration and merger of Trusts, the financial implications of the expanded numbers coming through Medical Schools and the affordability of qualified doctors within the workforce.
Previous separation of medical manpower planning from all other health professions planning was based on the fact that it was felt that medical workforce planning budgets should be ring fenced and separate from other health workforce planning. This may not be a tenable position in the future as an overarching global picture of the healthcare needs for Wales does need to emerge and be properly planned for incorporating all those involved in healthcare delivery.
The Deanery is investing in a workforce planner very specifically to look at the numbers of doctors in training and ultimately the needs of the Trusts and Local Health Boards in Wales to accommodate our training numbers. This person should be in post before Christmas and they will be working in close collaboration with NLIAH’s workforce planning people.
The other issue that we need to look at in workforce planning terms, with regard to postgraduate medical education, is academic training opportunities for doctors in Wales. There is currently no transparent organised academic programme within Wales to deliver at those doctors who will make a major contribution to health research in the future. There is a project planning team incorporating members of the Welsh Assembly, specifically looking at this issue and will make recommendations by May of next year.
One of the major problems with workforce planning with regard to the medical profession is the long lead-in times and hence the difficulty in making changes on the short-term.
Medical School training is between 5 and 6 years. This is followed currently by 2 years in a Foundation Programme and then run-through training leading to a Certificate of Completion of Training which can be anything from a further 3 years to 8 or 9 years depending on the specialty chosen. This does mean that reconfiguring the training numbers and indeed the curriculum content to reflect the changing needs of the NHS in Wales can take years to turn around.
There is currently a lack of flexibility within the curriculum within specialties to allow for a more rapid response to service needs and defining exactly the role of a doctor in the future NHS in Wales. This is beginning to be addressed by the recommendations within the Tooke Report published last week where it looks for a more modular system of educating doctors in the postgraduate arena. These recommendations are unlikely to come into effect before 2010 and again depending on the length of training will take several more years to come to fruition. The major stakeholders, therefore, in the postgraduate training are the Royal Colleges, who are responsible for the curriculum, PMETB (Postgraduate Medical Education Training Board) which are responsible for the overall quality assurance of medical training in the postgraduate arena, the Postgraduate Deanery, the workforce planners within the Welsh Assembly.
Currently, postgraduate medical training has no formal links with social care, voluntary or private sectors.
We do have some cross-rotations with England, principally with Bristol in the South and with Liverpool and Manchester in the North. These are very small training numbers as Wales is otherwise self-sufficient for training its requirements in all specialties.
We do have some problems with Welsh speaking qualified doctors, particularly in General Practice in the rural areas and this does emphasise to us the need to be able to keep and train our own Welsh graduates without losing them to other countries.
The European Working Time Directive will have an effect on the numbers of doctors required for service delivery in the future, particularly as we hit 2009 and the hours come down to a 48 hour week. That fact, coupled with the increasing feminisation of the workforce again makes workforce planning particularly difficult to predict. It may well be that we need to train more doctors in the future because of the workforce responding both to the 48 hour week and to less than full time training and practice by a more female based workforce.
This again emphasises the need for the doctor workforce planning to be integrated into the entire service delivery requirements of any one Trust and cannot be seen now in isolation from that fact in the future.
Wales has always been heavily reliant on International Medical Graduates and would still find it currently quite difficult to maintain the service without those doctors from outside the EEA. We recently had a very small number of doctors in the EEA applying to Wales, but the majority of our applicants did come from non-EEA countries. This will have a significant impact on recruitment in the future as our medical school output is going up. It is, therefore, essential that we plan correctly for the numbers of International Medical Graduates that we need and ensure in the first instance that our own graduates here in Wales are able to access appropriate training to get them to the level of Certificate of Completion of Training in either specialty or general practice. There is a consultation process currently being undertaken by the Welsh Assembly with regards to the impact and role of IMG doctors in the future.
In summary, Postgraduate medical education is a small part of the overall workforce planning structures. It isn’t fully integrated with any other group planning the global workforce strategy for Wales. The lead-in times and length of training make it very difficult to predict or indeed change the curriculum as sufficiently quickly to respond to healthcare needs within Wales.
The impact of the European Working Time Directive and feminisation of the workforce has not been fully factored in to workforce planning with regard to medicine.
Annex 1
Figures for Wales
GPs: 400 in training
2717 qualified GPs
Hospital Doctors: 224 ST1
398 ST2
719 ST3 and above
Dentists: 1248
Dental Graduates: 55 June 07
June 08
June 09
61 June 2010
Medical School 295 June 07
Graduates: 311 June 08
350 June 09
Professor Derek Gallen
15th October 2007
