Posts Tagged ‘Workforce’

Workforce planners warn of funding cuts for specialist training

By Francesca Robinson - 28th August 2010 8:30 am

Financial pressures on the NHS are likely to hit funding for specialist training warns a report from the Centre for Workforce Intelligence (CfWI), the new national authority for workforce planning.

The report, the first from the Centre, makes recommendations on how many specialist trainees will be needed for the 2011 intake.

It identifies which medical specialties are at risk of over or under supply and highlights where trainees are unequally spread around the UK, outlining how training posts should be redistributed.

The CfWI suggests a small reduction of less than 1% of current places is needed. In a few specialties improved recruitment to training posts could result in higher numbers of doctors in specialty training in 2011.

But it warns that trusts needing to cut costs may be tempted to employ trust doctors. This would force trainees to achieve Certificate of Completion of Training (CCT) via the Combined Entry Programme Specialist Register (CESR) route.

It also fears that if the Multi Professional Education and Training (MPET) levy is reduced, strategic health authorities and deans will want to modify the report’s recommendations.

A spokesman for the Royal College of Physicians said they too were concerned that the CfWI’s recommendations will not be matched by sufficient funding, either by hospital trusts in employing newly trained doctors or by deaneries funding the training places. “Without this financial support, the opportunities these recommendations give the NHS will be lost and patient care will suffer as a result.”

But he said the report was a big step in the right direction for medical workforce planning in England. The RCP was pleased that it supported the recommendations of Sir John Temple’s report on the effects of the European Working Time Directive on medical training.

“The CfWI recommendations for maintaining trainee numbers in the medical specialties will help the development of consultant delivered care which can only be a good thing for patient care. Furthermore the CfWI has taken a very considered view of the skewed distribution of trainees in some parts of the country by using ‘weighted capitation’. This imbalance of both trainees and consultants currently has a large adverse affect on patient services. Correction of these imbalances is crucial to providing a fair health service for all,” said the spokesman.

Bill McMillan, head of medical pay and workforce at NHS Employers, also welcomed the report. He said: “It is critical that the correct number of doctors are trained in the specialities and geographical areas where they are most needed to avoid the risk of either a shortage or significant over-supply, both of which can be expensive, demoralising for doctors and affect patient care.”

Tags: , ,
Posted in Hospital Dr News | No Comments »

McKinsey’s vision for raising productivity in the NHS

By Mike Broad - 9th June 2010 9:24 am

The full scale of controversial plans drawn up by management consultants to raise the productivity of consultants across England has been revealed.

A report produced for the previous government by McKinsey has finally been published, revealing plans to slash workforce numbers by 137,000 in order to achieve up to £20bn of savings by 2014.

In February 2009, McKinsey was instructed by the Department of Health to provide advice on how commissioners might achieve greater productivity in the NHS.

The information was presented in March 2009 though not made public. It was partially leaked in September 2009, but released in full last month in response to freedom of information requests.

There are three key themes to the presentation - driving through cost efficiencies in provider organisations; optimising spending and ensuring compliance with standards; and, shifting care into more cost effective settings.

Driving acute provider productivity is a major focus, with a stated aim to provide more care with the same level - or less - of staff and resources.

McKinsey claims that up to £2.4bn could be saved through higher productivity.

It suggests improvements in diagnostic referrals, lowering re-admission rates and improving the cost effectiveness of interventions.

On staffing, the management consultancy urges the NHS to tackle sickness absence and maximise the amount of time clinicians spend with patients.

It calls for a review of patient contact time and processes in ward rounds and clinics, and the recalculation of staffing rotas.

In nursing, it suggests that only 41% of their time is spent with patients and must be increased. And, in primary care, proposes that variations in productivity between GP practices could be reduced drastically by increasing their working hours.

McKinsey criticises most surgical specialties for their lack of progress on day surgery rates. It highlights big gaps in breast surgery, gynaecology, urology, vascular, general surgery, head and neck surgery, ENT and orthopaedics recommended levels of day cases as a proportion of total activity and reality.   

McKinsey also urges the NHS to stop procedures with limited clinical benefit.

Cuts are also important to the McKinsey strategy. And the presentation suggests that they would be felt as much among clinical staff as administrators.

Based on its analysis of different staff group efficiencies, it says the reductions required to full time equivalents for an NHS hospital with a clinical staff of 300 would be: two consultants, one registrar, 10 nurses, 10 healthcare assistants, three allied health professionals and eight non-clinical staff.

In preparation for reducing the head count, the presentation recommends aligning training with reviewed funding. It urges cuts in medical training positions at the next academic year to avoid oversupply. An early retirement programme should be introduced within two years to deal with recessions.

Also, it calls for the introduction of mandatory staffing levels to be limited. “Some royal colleges are recommending introduction of mandatory staffing ratios on safety grounds that will lead to increases in staff required above the activity growth e.g. the ratio of 1:28 per midwife,” it explains. “Review current plans to introduce mandatory staffing costs or investments in quality of care requiring an increase of the staffing levels.”

The presentation also calls for a recruitment freeze, based on stats showing that the average leaving rate is 10.5% for medical staff.

Barriers to progress also need to be removed, it claims, citing the immobility of the workforce, the lack of a failure regime for poor providers and the inability for trusts to embark on mergers and acquisitions.

Other large scale efficiencies that need to be made across the NHS include reducing drug spend, optimising the supply chain and procurement of supplies, and better estate management by trusts.

Shifting care into more cost effective settings is also a major theme, and the presentation calls for greater self-care, significant local health reconfigurations and the shift of acute care to primary, community and home settings.

The leaked presentation was met with great dismay last year and the former government was quick to say it represented advice rather than policy.

Its publication on the Department of Health website follows the release last month of an equally contentious report by McKinsey submitted to NHS London, which formed the basis of proposals to shift work en masse from hospitals to GP polysystems.

And the latest report to emerge makes clear that the London plans, now vetoed by Lansley, were recommended for implementation across the UK.

Read the full presentation into the fiscal future of the NHS.

Tags: , , ,
Posted in Features | No Comments »

Forget A&E, put radiology at the front door

By Bob Bury - 3rd May 2010 11:26 am

So we need double the number of A&E consultants? I don’t think so.

The reason A&E is knee-deep in whinging patients is because most of them don’t have anything wrong with them. They’re only there because they rang NHS Dire, and some nurse or spotty work-experience yoof reading from the wrong list decided that the caller’s unfocused sense of unease and general dissatisfaction with the twenty-first century might actually be an indication of acute meningococcal septicaemia.

What we need in A&E are more scary, middle-aged proper nurses to tell them to f-off and stop bothering doctor. And then, once you’ve kicked out the inadequates and malingerers and sent them back to the GP (or to be more exact, the practice nurse, now it’s impossible to actually get an appointment with the GP), you can employ more proper doctors in A&E. And what I mean by ‘proper doctors’ is radiologists.

Clinicians spend their lives moaning about poor access to imaging facilities, and this will matter even more now that medical students spend all their time in empathy workshops instead of learning anatomy, and qualify with the clinical skills of a golden retriever. None of them will have a clue what’s wrong with their patient until we have worked our radiological magic, so here’s what we need to do.

Having wittered on for most of my career about how radiology needs to be at the centre of the hospital, I have changed my mind. It needs to be at the front door, staffed by radiologists who are now the only generalists in an age of super-specialisation, and equipped with the finest that Siemens, GE et al have to offer. Clincians would only be allowed to see a patient once we have decided that he might actually benefit from the skills of a specialist in non-infective interstitial diseases of the left lung.

This would save enormous amounts of money. No need to equip sections of damp corridor with rusty trolleys and put up signs saying ‘Clinical Decisions Unit’ in order to circumvent the four-hour A&E target. The clinical decisions will all be made by people sufficiently good-looking, clinically gifted and technologically equipped to undertake that role. No more patients hanging around in beds waiting for scans or results of scans, and no more hapless SHOs (or whatever they’re called now) sent into the dragon’s den to ask radiologists to perform unnecessary investigations requested by their bosses for reasons which escape everyone.

There - job done. We’ve saved all the money we need to pay the bankers’ bonuses and clear the national deficit, and saved countless lives in the process.

Oh, wait a minute. Have just realised that this will only work if we use ‘proper’ radiologists (yes, of course like me). I had forgotten that the ABCFY1s or whatever will be coming directly into radiology after 20 minutes experience on a dermatology ward in the West Midlands, and won’t actually be any more clinically savvy than any of the other clincians.

Bugger.

Tags: ,
Posted in Bob Bury | 6 Comments »

Specialist training posts soon to be slashed

By Mike Broad - 11:12 am

Deaneries around the country are drawing up plans to cut specialist trainee posts over the next three years.

Health authorities describe a 15% reduction in the national training budget - a loss of £650 million a year - between now and 2014, the Sunday Telegraph claims.

In some parts of the country, this could translate into the number of training places for surgery, trauma and orthopaedics falling by a third.

The official line is that the cuts are necessary to avoid unemployment in future and to try to ensure deaneries are training doctors in appropriate specialties to meet NHS requirements. But many suspect it is about cost cutting.

While some fear there is oversupply in the surgical specialties, others believe that the demands of the Working Time Directive mean that doctor numbers must be maintained.

Mr David Mahon, a surgeon working in Musgrove Park NHS hospital in Taunton, told BMJ Careers that the South West Deanery was facing a 14% reduction in the budget for trainees. He believes the cuts will fall disproportionately on some of the larger specialties, such as medicine and surgery, where there is greater room for manoeuvre.

“This is unprecedented,” said Mr Mahon. “Trainee numbers have increased year on year for as long as I can remember. My specialty is going to be harder hit than many other specialties.”

He also warned that a loss of trainees would lead to hospital staffing problems and would mean “either spreading the remaining doctors more thinly, which is potentially dangerous; using consultants, possibly unnecessary and definitely expensive; or using non-training grade doctors or non-medical staff”.

Papers drawn up by the strategic health authority NHS East of England describe a net loss of more than 500 clinical training posts, suggesting that nationally the cuts could amount to more than 5,000 jobs.

The SHA which covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk warns that the public sector is moving into a period of sustained economic recession, with “significant implications” for the NHS workforce.

There are 6,800 training posts available for doctors graduating from medical school this year - a significant increase on previous years. In future, GP numbers are set to grow at the expense of hospital doctor roles.

The Department of Health confirmed it has been reviewing specialty training and specialist numbers to ensure they are appropriate for future demand.

It follows Conservative claims that significant numbers of clinical posts are to be cut.

Tags: , ,
Posted in Hospital Dr News | 2 Comments »

Call for doubling of A&E consultant numbers

By Mike Broad - 30th April 2010 1:48 pm

The next government is being called on to more than double the number of consultants working in emergency departments.

The College of Emergency Medicine says every emergency department needs a minimum of ten dedicated consultants to deal with the growing number of patients presenting in A&E.

The current average is 4.2, while the number of patients averages 70,000 to 80,000 per year.

Increasing the number of consultants would guarantee their presence at evenings and weekends, and promote the highest standards of quality and safety.

The college claims that despite the increase in salaries the move would save money in the bigger picture. It would help reduce inappropriate investigations, unnecessary admissions and unsafe discharges.

Dr John Heyworth, president of the College of Emergency Medicine, said: “Emergency care is currently failing to deliver the service which the public expect and deserve. The single most important factor in providing a high quality, timely and clinically effective service to patients is care led by emergency medicine consultants.

“We are concerned that patient outcomes may suffer if this failure to invest in emergency medicine continues.”

The college has also called for a review of emergency care standards in its ‘manifesto’ A matter of emergency. The current target for all emergency care systems to achieve a target of 98% of patients being seen, treated and discharged within four hours is challenging due to understaffing and compromising patient care.

It also wants patients to have one-stop access to effective emergency care. The college supports co-location of the emergency department with other clinicians to provide unscheduled primary care, mental health and other key health services in one secondary care setting. It’s critical of walk-in or urgent care centres which are “largely unsupported by evidence regarding clinical and cost effectiveness. These initiatives have led to a fragmented system with duplication which evidence shows patients find confusing”.

Read the full manifesto.

Tags: , ,
Posted in Hospital Dr News | 1 Comment »

College sets out pre-election health manifesto

By Mike Broad - 15th March 2010 10:19 pm

The Royal College of Physicians is calling on the next government to continue expanding consultant numbers as part of its pre-election manifesto.

Leading for Quality urges politicians to support consultant delivered care, despite the downturn, and to sustain the numbers of medical students entering the profession.

It says: “Consultants and fully trained doctors, underpinned by the CCT and the national contract, are the foundation of high-quality healthcare.”

While the RCP acknowledges there have been advances in quality, it offers a list of proposals that it claims will drive sustained improvement. Better commissioning, integration of health systems and clinical engagement are dominant themes.

The manifesto calls on the government to ensure greater clinical involvement and leadership in wider healthcare decision making.

“There is a clear need for an effective institutional framework that will allow doctors to be active participants in shaping the landscape of healthcare, and not simply passive responders to prevailing circumstances,” the report says.

“Within local organisations responsible for managing and delivering services, doctors have an additional and critical part to play.”

The RCP also wants to see a more inclusive commissioning culture and reforms that encourage teams to work across traditional boundaries to facilitate better care closer to home.  

This requires “good local clinical networks, strong clinical leadership in primary and secondary care and supportive management structures, and acceptance that the patient needs to be involved in the organisation of individual care plans”.

The RCP wants to see the Payment by Results funding system replaced with aligned incentives that support integrated pathways more effectively.

It says: “Under the current tariff-based system, hospitals are encouraged to treat more patients; while under practice-based commissioning GPs are encouraged to refer fewer patients into secondary care.

“This tension can work against the development of integrated services that provide the best quality of care for patients, as it becomes financially easier to admit the patient rather than manage their condition outside the hospital or commission separate specialist services in primary care.”

The RCP also calls for stronger preventative measures on public health issues, and renewed support of academic medicine.

It warns that major steps still need to be taken to make the NHS more innovative. “Changing models of innovation mean that the talents of the private sector, academia and the NHS will need to be organised differently to meet the dual challenge of competition from overseas for British research talent and investment, and legitimate patient demand for more effective treatments,” the manifesto says.

It calls on the next government to continue investing in medical research and make a service-wide commitment to training and employing research-active physicians in order to preserve the UK’s pre-eminent position in the field of translational research.

The report also suggests that royal colleges should once more have a statutory role in monitoring training standards, claiming that its inspection could well have highlighted recent hospital failings like those at Mid Staffs.

Read the full report.

Tags: , ,
Posted in Hospital Dr News | 2 Comments »

New aptitude test for medical school shows bias

By Mike Broad - 22nd February 2010 10:44 am

A new aptitude test, aimed at increasing diversity and fairness in selecting school leaver applicants for medical school, still has inherent gender and socioeconomic bias, a study finds.

The UK Clinical Aptitude Test (UKCAT) was first used in 2006 as part of the admissions process by a consortium of 23 medical and dental schools. UKCAT’s aim was to make selection to medical school fairer and more transparent. With A Level grade inflation, discriminating between large numbers of highly able applicants on their academic achievement alone has become increasingly difficult, and participation in the profession needs to be widened.

The test is an appraisal of skills such as verbal reasoning and decision analysis, and is designed to ensure that candidates have the most appropriate mental abilities, attitudes and professional behaviours to be successful in their professional careers.

To determine whether this test provides a more equitable assessment of aptitude, Professor David James and colleagues, at University of Nottingham Medical School, analysed data from the first group of applicants who sat the UKCAT in 2006 and who achieved at least three passes at A Level in their school leaving examinations.
They found a modest correlation between A Level and UKCAT scores, which confirms that the test can be used as a reasonable proxy for A Levels in the selection process.

However, the test had an inherent favourable bias to male applicants and those from a higher socioeconomic class or from independent or grammar schools.

“These findings lead us to be cautious about use of the UKCAT and the value of any one specific sub-test within an admissions policy,” conclude the authors. They also call for further research to clarify the practical value of the UKCAT in a wider range of applicants and, importantly, its predictive role in performance at medial or dental school.
In an accompanying editorial, in the BMJ, Professor David Powis, from the University of Newcastle in Australia, says that measuring cognitive ability is a step in the right direction, but it doesn’t tackle “widening participation” - the admission of people from lower socioeconomic groups or those whose education has been compromised by attending poorer schools.
And neither does UKCAT yet provide selectors with information on the non-cognitive characteristics and personal qualities that are fundamentally essential (and those that are undesirable) in the generic good doctor, he adds. This challenge remains for the future.

Read the full paper.

Read more on improving access to the profession.

Tags: ,
Posted in Hospital Dr News | 3 Comments »

Academics must protect their jobs from cuts

By Francesca Robinson - 28th January 2010 9:22 am

Medical academics are being advised to have proper job plans and regular appraisal in order to protect their jobs from funding cuts.  

“We are anticipating a very tough time ahead for many medical schools and academics because of the current economic crisis,” warned the BMA’s medical academic staff committee co-chair Professor Michael Rees.

At the beginning of January Imperial College London made 21 medical academics redundant as part of a restructuring to tackle a £28m deficit. 

Another 14 academics are currently facing redundancy at the Institute of Psychiatry at King’s College London, which has a £5m hole in its budget.

“There is certainly an increase in the generalised threat to academic employment. I can’t quantify the level of that threat but there certainly is a threat,” said Rees.

A three-pronged funding squeeze is putting a strain on medical school budgets. All university budgets will be affected by a £400m funding cut in 2010-11, announced by business, innovation and skills secretary Lord Mandelson in December. Some medical schools will also lose money because of a redistribution of funds following the Research Assessment Exercise (RAE) and a review of the Multi Professional Education and Training (MPET) levy currently being conducted by the Department of Health.

The MPET review is looking to more fairly distribute funds for clinical training. The MPET levy is likely to be replaced with a tariff-based system where the funding follows the student or the trainee.

The BMA fears that this will not equate to posts following the students and could result in academic jobs being axed. Traditional medical schools, particularly those in London, which employ more staff than the newer medical schools, are likely to suffer most from any reallocation of funds.

“The threatened redundancies at the Institute of Psychiatry at King’s are particularly unfortunate because it’s a high flying department, was shown to be a very productive department in the RAE and is an important site for academic training,” said Rees.

He added that the chances of academics finding work by either moving to other universities or NHS jobs were very slim in the current economic climate.

The BMA is publishing new job planning guidance for academics, which will advise them to ensure they have a job plan which clarifies the work they do. They should undergo regular appraisals and ensure they know exactly where the funding for their joint contracts between universities and the NHS is coming from. They are also being advised to avoid any dubious fixed term contracts and to carefully check terms and conditions before accepting any job.

A spokeswoman for Imperial College said they had now agreed a new structure for their Faculty of Medicine that would safeguard their internationally leading research and education activities, and address a significant projected deficit of 28.7m by 2013/14. The deficit was caused by rising salary costs, a cut in central funding and “the difficult economic climate that universities are now operating in”.

“Staff identified as holding posts that were at risk were fully consulted during the process, and every effort was made to avoid compulsory redundancies. In total, 21 academic members of staff and 27 support staff have regretfully been made redundant,” she said.

Read a blog on the future of medical research sector.

Tags: , ,
Posted in Hospital Dr News | 1 Comment »

Snowy crisis? Pah! It’s not a patch on 1947

By Katherine Teale - 10th January 2010 5:31 pm

“There’s no business like snow business”, says the sign above theatre reception. It’s certainly very bad for business, and we’ve all just about had enough now.

One or two days building igloos in the back garden may be fun, but now things are getting out of hand. The supermarket shelves are empty as panic-buyers fight over the last baguette, the streets of Hale and Wilmslow are littered with abandoned BMWs, and  local radio broadcasts lists of all the schools which  are closed even though there hasn’t been any actual snow now for two days.

“Those teachers - how much holiday do they want?” I ask my husband. I think I catch the words “Health & Safety”, but they were a bit muffled by the duvet.

Meanwhile those of us with jobs on the frontline have to struggle in to work. On Tuesday, we had the deepest snow that Manchester has seen for 30 years.

The hospital was on red alert and all elective surgery was cancelled. There goes our non-clinical cancellation target, for a start. In one day we cancelled more operations than we normally do in two months. 

There were many tales of heroic efforts to come to work - my lead ODP (a cycling fanatic) ran 13 miles to work. Gridlock was so bad that one colleague sat for four hours with nothing to do but a Sudoku (not unlike his usual neurosurgical list, he commented). One of my recovery nurses laid all her spare clothes behind the car wheels in order to get off the drive.

Altogether, we managed to keep the emergency service going and a consultant colleague volunteered to be resident overnight. Many nursing staff stayed in local hotels rather than risk the journey home - although, once they’d seen the inside of the local hotels (they have interesting plumbing, I’m told) they probably quite fancied the idea of three hours through black ice.

Needless to say, we did have some other members of staff for whom getting to work wasn’t quite such a high priority, including some who  lived within walking distance of the hospital but appeared to be snowed into their beds.   

Now that the acute emergency is over (for the moment at least) and the blitz spirit has dissipated somewhat, we are in the midst of bitter recrimination. Those who tried to come in on Tuesday but were unable to make it are outraged at the suggestion that they should be docked a day’s annual leave, whereas those who heroically came into work don’t see why their colleagues should get an extra day off. Those who just stayed in bed are keeping their heads down. 

There’s fresh disaster today - ice has prevented the bins being emptied. My elderly neighbour is outraged. “We had a worse winter in 1947 and everything carried on as normal”, he tells me. Events this week demonstrate the pathetic lack of backbone and work ethic of today’s youth, government and society in general.

Perhaps the fact that in 1947 there were only two cars on the road, everyone walked to work and kept hens in the back garden might have had something to do with it. Incidentally, hospitals only carried out three operations a week, and hadn’t just outsourced their sterilising units to Liverpool. Oh for those simple days…

Tags:
Posted in Katherine Teale | 3 Comments »

“Male doctors deserve to earn more”

By Francesca Robinson - 8th December 2009 6:50 pm

Male doctors should earn more than their female colleagues because they are more productive, claims a prominent health economist.

Professor Alan Maynard of York University said on average male consultants manage 10 to 15% more patients than their female counterparts.

The figures come from an analysis of consultants’ activity rates published last year.

He jokes that women see less patients because they spend more time listening to them - unlike their male counterparts: “Thus female consultants may process fewer patients but perhaps their diagnostic skills are superior and this may produce better outcomes for patients.”

Maynard’s comments are dismissed as “completely unhelpful” by Dr Helen Goodyear, a consultant paediatrician at Heartlands Hospital in Birmingham and president of the Medical Women’s Federation.

They follow a BMA report which reveals that men, on average, earn £15,000 a year more than women in medicine.

“There is no evidence for Professor Maynard’s comments. They come from one flawed study which had a number of misconceptions in it,” said Goodyear.

Women often earn less than men because they are not as forceful in their contract negotiations, she explained. “If a woman gets paid for seven sessions she will often actually do nine or ten. If a woman is on a full-time contract of 10 programmed activities her male counterpart will often be on 13 because they are not so shy in coming forward.”

If her pay was linked to productivity, Goodyear said her salary would immediately double.

The solution is for women to take more of the top leadership posts in the profession. “Women need more encouragement and mentorship to take on these roles. We need to do away with the old boys’ network where leaders who are stepping down nominate the next leader, as still happens in quite a number of posts within medicine,” said Goodyear.

But she said there is still a long way to go: “Although more women are coming in at the bottom in medicine, it is going to take at least 20 years for them to reach the top and to change the culture.”

A BMA spokesperson said there was no justification for a pay gap in the NHS of 2009. “Women doctors undertake the same training and perform the same tasks as their male counterparts - and should also receive the same level of pay.”

Tags: , ,
Posted in Hospital Dr News | No Comments »