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15.08.18

Listening to the frontline

Source: NHE July/August 2018

Professor Wendy Reid, executive director of education & quality and national medical director at Health Education England (HEE), shares insight into the work of her organisation and explores the ways in which we must prepare the NHS for its next 70 years.

Workforce retention and rota gaps are two of the most significant issues impacting upon the delivery of excellent care across the NHS. At HEE, we have heard this loud and clear. We are listening to doctors in training and know that there are a number of things we can do to help improve their working lives. In turn, this will help trusts address their workforce challenges by encouraging more people to become doctors and remain in medicine. 

Our work on Enhancing Junior Doctors’ Working Lives, which is inspired by doctors in training and has their voice as its key driver, is a vital element in ensuring that we have a highly skilled, highly motivated medical workforce, providing high-quality patient care and experience. 

Through this work, we believe we need a new way of doing things to meet these challenges. This is the task not only for HEE, but for the whole NHS. More of the same won’t work. Reform is essential – a shake-up of the old way of doing things. This means introducing more flexibility into training, with the active support of providers essential to make it work. 

Allowing trainees to work less than full time acknowledges that some may find full-time training is not for them. This should not reflect badly on those doctors and, indeed, our successful Emergency Medicine pilot of less than full-time training has demonstrated strong support for this approach, with those taking part telling us that they are more likely to remain in medicine. 

This flexibility can only work if trusts embrace it, recognising that the need to fill rota gaps left by those training less than full time will be more than made up for by a more motivated, committed and engaged workforce that they gain as a result.

Why do we make it so difficult for trainees to step on and off their training programmes, or for those who have left to return? Our recent draft workforce strategy, ‘Facing the Facts, Shaping the Future,’ identified return to practice as one of the levers to solve the workforce challenge, along with more new graduates, better retention, and recruitment from abroad.

We have put in place additional support through our Supported Return to Training package, run locally and supported by a £10m package to aid the return of doctors into training. We are also actively working to enhance step on, step off training opportunities. 

Again, we need providers to support these changes, and their own staff, if we are to make a real and lasting success of flexibility in training.

Enhanced preferencing is now allowing those with special circumstances to have more of a say about where they do their training. This is recognising that doctors in training are also human beings, with families, hobbies and interests other than work. This is about listening to doctors in training for the benefit of them, the system and patients.

We all know that some parts of the country, and some specialties, are facing particular challenges in recruitment and retention. As an example of the sort of joined-up working that I’m talking about, HEE worked hand in hand with the Higher Education Funding Council for England on the recent allocation of 1,500 new medical student places, including at five new medical schools. A key consideration in this was placing students in areas they would both want to study and work in, but also areas that face challenges in attracting them. The new medical schools are in Sunderland, Liverpool, Lincoln, Chelmsford and Canterbury, and the new medical school places are spread from Plymouth to Newcastle.

Similarly, and with a link to this work, we have recently begun a review of the foundation training programme in England. We are bringing together colleagues from across the healthcare system to look at how we deliver this fundamental training, and also involving the devolved nations to see what we can learn from each other.

The review aims to maximise the benefits of this important stage of training. To do this, we want to increase flexibility whilst maintaining standards, with a better transition from undergraduate education to postgraduate ‘doctoring.’ We anticipate that these reforms will  enhance foundation training and help medicine remain an attractive option for young people thinking about their future career choices.

We also need to move healthcare to prevention, population health and community-based care and to reflect the current geographical and specialty workforce challenges, as well as reflect the spread of innovation and technology. A doctor starting their career now in 2018 will still be working in the NHS in 35 years’ time, in 2053. 

But in this 70th anniversary year of the NHS, if we look back in time 35 years, half the life of the NHS – how different things were. No mobile phones or telemedicine. Symptoms, diagnoses and treatments were looked up in textbooks, not online. Patient letters were produced on typewriters by vast banks of secretaries, not on computers where errors can be corrected quickly and easily and the letter sent by email.

If we can address the challenges in training the medical profession, surely there are also lessons for the wider workforce? This was identified in our recent review of the Annual Review of Competence Progression (ARCP) process, where our report, ‘Enhancing Training and the Support for Leaners,’ recommended that the best elements of the ARCP should be considered for other professions. Equally, there will be other elements of our work that will support staff to work together across professional boundaries.

Our ambition is for a truly multiprofessional workforce with highly skilled, highly motivated clinicians working at the top of their capabilities. Workforce is the single biggest challenge facing the NHS and we must all work together to embrace change to address this challenge.

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