15 September 2017
Any healthcare system relies on having enough well-trained, skilled and motivated staff and NHS Wales is no exception. Doctors are a key part of our local health services, but concerns about the recruitment, retention and sustainability of the medical workforce are well publicised. In the first half of 2017, the Assembly’s Health, Social Care and Sport Committee undertook an inquiry into the recruitment and retention of medical staff in Wales. The Committee’s report following the inquiry will be discussed in Plenary on 20 September.
Terms of reference for the inquiry
The inquiry on medical recruitment was part of the Committee’s broader programme of work on the sustainability of the health and social care workforce. The inquiry looked at:
- The capacity of the medical workforce to meet future population needs, in the context of changes to the delivery of services and the development of new models of care;
- The implications of Brexit for the medical workforce;
- The factors that influence the recruitment and retention of doctors, including any particular issues in certain specialties or geographic areas;
- The development and delivery of medical recruitment campaigns, including the extent to which relevant stakeholders are involved, and learning from previous campaigns and good practice elsewhere;
- The extent to which recruitment processes/practices are joined-up, deliver value for money and ensure a sustainable medical workforce.
This follows on from the Fourth Assembly Health and Social Care Committee’s inquiry on the GP workforce, and an initial, broad piece of evidence-gathering undertaken by the current Committee to help understand the key workforce issues across the health and care sector.
The Committee wished to ensure the inquiry heard from a wide range of organisations and individuals; during autumn 2016 it ran a consultation and the responses have been published. The Committee also held a number of sessions where it heard evidence from local health boards, the Wales Deanery, professional bodies, the medical schools, individual clinical staff and the Cabinet Secretary for Health, Well-being and Sport, who also provided written evidence to the Committee.
The Committee was also keen to hear the views of trainee doctors themselves, and one of the evidence sessions included a specially convened panel of trainee doctors from across Wales from both General Practice and a number of different hospital specialties. In addition, the written evidence received by the Committee included a report outlining the views of current trainee doctors in Emergency Medicine across Wales on their medical training, and another containing a survey of current and previous students from the Swansea Graduate Entry Medicine Programme (GEMP).
The Committee also visited Cardiff University, where they saw some of the facilities used in training future clinical staff, heard about the University’s work on inter-professional education and had the opportunity to talk to students about their experience of training and what had influenced their decision to train in Wales.
Some common themes were identified in the evidence the Committee saw and heard, including:
- The need for greater engagement with schools and pupils in Wales, to encourage interest in medicine as a career and increased applications to medical schools – especially those in Wales;
- Despite some improvements, the number of Welsh students studying medicine still lags behind other UK nations, and the number applying to study within Wales remains low, and there is a need to increase recruitment of Welsh pupils to Welsh medical schools;
- The need to increase undergraduate and postgraduate training places in Wales;
- Ensure the accessibility and quality of training, especially for staff in more rural areas;
- The growing importance of the wider multi-disciplinary team in training and services;
- The importance of a good work/life balance for all medical staff and their families, including good access to schools, communities, social life and stability of trainee placements. The recent recruitment campaigns for Wales were seen as positive;
- The difficulties in recruiting in a number of specific areas such as general practice and specific geographical areas, particularly rural settings;
- The potential impact of Brexit on recruitment and retention of medical staff;
- The need for a clear strategic vision for future healthcare in Wales, including an increased focus on service centralisation and the role of the wider healthcare team;
- The impact of service pressures and demands on training as well as the image of the medical profession as a career which can be extremely pressured.
The support for additional undergraduate medical places within Wales was especially strong. The UK Government has recently announced plans for 1,500 more student places at medical schools in England, and in their evidence to the inquiry, the Higher Education Funding Council for Wales stated that “Without an equivalent increase in Wales, we are likely to see undergraduates recruited over the border who may not return to Wales to practice”.
The Cabinet Secretary acknowledged the calls for increased medical school places in Wales, but in his evidence to the Committee stated that he believed the medical schools could deliver more within existing resources and any additional investment into the expansion of medical school places “would have to be on the basis that there would be more Welsh-domiciled students taking up those places”.
The Committee’s recommendations
The report sets out sixteen conclusions and recommendations, covering a number of key areas:
- Planning the future workforce: By September 2017 there should be an action plan and timeline published for establishing the new single body which will be responsible for workforce planning, training and education for NHS Wales;
- Developing undergraduate medical education: Welsh Government to work with the medical schools in Wales and the Wales Deanery to increase:
- The number of undergraduate places in Welsh medical schools;
- The number of Welsh-domiciled students both applying to and securing places at medical schools in Wales, accompanied by increased support and advice to pupils in Wales on medical schools admissions and interviews;
- The availability of undergraduate medical education in North Wales, supported by the publication of a clear plan by summer 2017.
- Increased focus on community and rural care: Welsh Government, the medical schools, Deanery and NHS Wales should work to both increase time in general practice for the undergraduate curriculum and trainee doctor foundation training and develop an action plan for rural medical training and education.
- Increasing training capacity: Develop and agree proposals for increased training places for trainee doctors; this should include powers for greater flexibility in local deployment of training capacity, especially GP training;
- Amending regulations: Welsh Government to seek to amend existing regulations, so that doctors who have completed the second year of Foundation Training (F2) may work as GP locums. Discussions with NHS England are also needed to enable doctors to be on the medical performers list for both England and Wales;
- Developing recruitment strategies: Welsh Government should:
- Ensure a comprehensive evidence base on recruitment and retention is developed to inform future recruitment campaigns;
- Evaluate the current Train, Work, Live recruitment campaign, focusing on outcomes achieved and lessons learned, to inform ongoing medical recruitment campaigns;
- Report by the end of 2017 on the impact of the GP Incentive Scheme and identify options for other incentive schemes to attract and retain potential and practising doctors.
- Vacancies: Develop options for a single, national point of access for detailing current medical vacancies within Wales. In addition, medical vacancy numbers within Wales should be collected and published, to better inform workforce planning;
- Brexit: Welsh Government to continue dialogue with the UK Government, aimed at clarifying the ability of EU nationals to continue and commence working in the UK, and seek assurance about the ability of EU nationals to work as doctors in Wales in the future.
The response from Welsh Government
The Welsh Government has responded to the Report, accepting eleven and partially accepting five of the Committee’s recommendations, and setting out:
- The intention, following on from a recent Ministerial Statement, to publish in September 2017 a timeline for establishing the new Health Education and Improvement Wales;
- The intention to work with Welsh medical schools to increase applications from Welsh-domiciled pupils to study medicine in Wales and to support programmes for pupils interested in medicine as a career;
- Whilst not supporting the case for a North Wales medical school, the Cabinet Secretary issued a written statement in July recognising the need for increased levels of medical education in North Wales, to be delivered collaboratively by Cardiff, Swansea and Bangor Universities;
- Support for a greater focus in training on community-based medicine and rural health;
- Acceptance of the case for targeting increased trainee doctor places in priority areas, although noting that this would need additional funding;
- Discussions would continue with the UK Government on a joint England and Wales performers list and with the Deanery to explore post F2 ability to undertake GP locum work;
- An evaluation of the medical/GP phase of Train, Work, Live would be undertaken in April 2018, with the GP Incentive Scheme being evaluated separately;
- Work is underway aiming for NHS Jobs as a single point for advertising all Welsh GP vacancies;
- Support for developing a mechanism to collect and publish medical vacancy information;
- The Welsh Government’s strong belief that it wants to continue enabling people from the EU and beyond to work within NHS Wales and live in our communities, including after Brexit.
Article by Dr Paul Worthington, National Assembly for Wales Research Service
Image from Flickr by Chris Sampson. Licensed under the Creative Commons