NHS will need 190 000 more clinicians unless productivity improves, workforce plan warnsBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5791 (Published 14 December 2017) Cite this as: BMJ 2017;359:j5791
All rapid responses
HEE's draft workforce strategy document (1) is brutally honest in acknowledging the crisis in staffing: 45,000 vacant clinical posts in March 2017, with 36,000 nurse vacancies in September 2017. They also highlight vacancy rates by medical specialty, with Emergency Medicine topping the list (15.6%) followed by Medical Acute Take Specialties (13.9%).
HEE have produced workforce plans for the priority areas outlined in the Five Year Forward View: cancer; mental health; urgent and emergency care; maternity; and primary care. The section on urgent and emergency care focuses appropriately on Emergency Medicine, but there is no mention of Medical Acute Take Specialties. This is despite the worsening staffing crisis in Medical Acute Take Specialties:
- 40% of consultant physician posts not appointed in 2015 due to a lack fo candidates (2);
- falling numbers of registrars (2), likely to deteriorate given 238 (17%) out of 1,428 ST3 posts went unfilled after the 2016 recruitment round, with shortfalls concentrated in specialties contributing to the acute take (3); and
- 134 (9%) out of 1,423 ACCS Acute Medicine / Core Medical Training posts unfilled in 2017, a significant deterioration compared to 2016 (26 (2%) out of 1,334 unfilled posts) (4).
The lion's share of admissions from the emergency department come in under medical acute take specialties. Without tackling the staffing crisis in these specialties, it will be extremely difficult to significantly improve urgent and emergency care.
1. Health Education England, NHS England, NHS Improvement, Public Health England, Department of Health. Facing the facts, shaping the future. 2017. https://www.hee.nhs.uk/our-work/planning-commissioning/workforce-strategy.
2. Federation of the Royal Colleges of Physicians of the UK. Census of consultant physicians and higher specialty trainees in the UK, 2014-15: data and commentary. London: Royal College of Physicians, 2016. https://www.rcplondon.ac.uk/projects/outputs/2014-15-census-uk-consultan...
3. Royal College of Physicians - ST3 Recruitment. http://www.st3recruitment.org.uk/specialties/overview (data taken from the 'Data' tab of each specialty section, accessed 16 Dec 2017))
4. Health Education England. Specialty recruitment: round 1 - acceptance and fill rate. https://hee.nhs.uk/our-work/attracting-recruiting/medical-recruitment/sp...
Competing interests: I am Respiratory Registrar contributing to the general medical take.
Brexit isolationist rhetoric has led to a massive exodus of highly qualified scientists and healthcare professionals from the UK. 
Do NHS managers and Government officials have any long term feasible plans to fill those massive shortages?
Where do the plan to recruit medical doctors from, China, India, Russia, Africa, Australia, the USA, or India?
Are they aware that all these Countries face massive shortages of healthcare professionals, as well? 
 Shortages of medical doctors in the World:
 Shortages of medical doctors in China:
 Shortages of medical doctors in India:
 Shortages of medical doctors in the USA:
 Shortages of medical doctors in Australia:
 Shortages of medical doctors in Africa:
 Shortages of medical doctors in Russia:
Competing interests: No competing interests
Almost a week ago I submitted a rapid response to David Oliver's article (Ref 1): "Seven day service standards in NHS hospitals: thorny problem or blooming success?" but chose to withdraw it soon after.
In it I listed a substantial number of observations demonstrating how doctors are increasing marginalised, disenfranched and disempowered within the NHS, but ultimately the overall tone of my letter was so depressing, demoralising and ultimately unhelpful (even when everything I have written is true)
This article renewed my concerns about the future of doctors in the NHS.
Upon reading the actual HEE report (ref 2), however, I realised that the BMJ headline for this news is very misleading, that the HEE was talking about 190 000 "clinical posts" (in various capacities) rather than "doctors" .
There are 2 main implications to the Health Education England (HEE) paper:
1. HEE is suggesting that current staff in direct clinical roles are not productive, despite admitting that over half of the NHS staff are working unpaid overtime every week. How much blood can the HEE expect to squeeze out of the NHS staff, I do not know, considering that in addition to essential clinical work, the clinicians are also expected to keep track of KPIs, recording data and what-nots, work created by non-clinical staff to justify their existence, and to which many of the data are useless or gamed in order to avoid remedial actions.
Let the clinicians do what they are trained to do, and get the administrators and clerical staff do what they are paid to do and we may have a head-start.
The situation pretty much reminds me of the hospital without patients, doctors or nurses but it does have 500 busy administrators, in the Yes, Minister episode.
2. It is also clear to me that if we do need 190 000 extra staff by 2027, the majority will be filled in by every health professionals except doctors. This is clearly the trend primarily motivated by cost-cutting; yes, there are all the other issues about empowerment of experienced allied health professionals, but these schemes wouldn't pass muster if cost reduction wasn't the key incentive under the current medico-legal climate.
Certainly many nursing and allied health professionals can offer valuable expertise but their enhanced roles should be complimentary in the health care team approach, not at the cost of medical doctors' positions and training. Some of these "enhanced" roles wold obviously reduce the training opportunities and exposure of doctors-in-training particular in direct competition to similar case loads.
Hence, doctors in the NHS are likely to become an endangered species if these trends continue to expand.
Competing interests: No competing interests