NHS will need 190 000 more clinicians unless productivity improves, workforce plan warns

Dear Editors

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.

Reference:

1. http://www.bmj.com/content/359/bmj.j5552
2. https://www.hee.nhs.uk/sites/default/files/documents/Facing%20the%20Fact...