After the allocation of 1,000 new medical school places, Professor Jane Dacre considers workforce planning challenges facing the profession and the potential solutions available to create a sustainable workforce.
As you told us, and we reported in NHS reality check: Update 2018, the pressure we are under has increased over the past 12 months. NHS staff, as always, go above and beyond to keep services running and patients safe and well, but this cannot continue.
Today’s allocation of 1,000 new medical school places follows the government's 2017 announcement of 1,500 new medical school places, which responded to the RCP report Underfunded, underdoctored, overstreched. The opening of new medical schools is also to be welcomed.
Facing the facts
Facing the Facts, Shaping the Future: A draft health and care workforce strategy for England to 2027 is an opportunity to make sure we learn from the mistakes of the past. We need to work together to deliver a workforce that allows doctors to deliver the standard of care they were trained to deliver.
But the scale of the challenge to deliver a workforce that meets the needs of tomorrow shouldn’t be underestimated. The impact of the consultant workforce expansion in the late 1990s means the number of consultant physicians retiring each year will increase significantly over the next decade. It will rise from approximately 220 a year in 2017 to up to 680 a year by 2030.
We also need to take into account attrition rates among trainees and consultants, and the fact more people want to work less than full time. New models of care – some that we know about now and some that will be developed over the next decade – will also have an impact. Finally there’s growing patient need, between 3-4% a year, and complexity, which will only increase the strain on the workforce.
The total number of medical school places available should be doubled to 15,000 per year, with the aim of moving towards a small surplus of doctors.
New places
One thousand five hundred new medical school places is a step in the right direction, but we need a step change. The total number of medical school places available should be doubled to 15,000 per year, with the aim of moving towards a small surplus of doctors.
Without these new places and a corresponding rise in the number of foundation year places, the workforce will continue to be overstretched and patients placed at risk. This ambition will require significant investment by government, coordination by Health Education England, and the full support of NHS England, NHS Improvement, the royal colleges and universities.
Whatever happens, the challenges facing the workforce aren’t going away quickly. The journey from medical student to consultant takes at least 13 years, so we need to do something in the short term. We need to increase overseas recruitment and support doctors in the later stages of their careers to continue working.
We also need to improve everyone's morale. Key to that is making sure a physician's career remains attractive. The RCP's recent wellbeing survey found that, to improve job satisfaction, consultants want more protected time for activities such as leadership, education, training and research. They also want to work more flexibly, in terms of working from home where possible and annualised contracts.
Unfortunately, without enough people, it will be difficult to make these things a reality. Which is why making the UK an attractive, accessible place for doctors from other countries is a must.
Professor Jane Dacre is president of the Royal College of Physicians. You can follow her on Twitter at @DacreJane.
