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Medicopolitical Digest

Medicopolitical digestSteps needed to solve NHS workforce problemsGMC wants to improve SHOs' trainingHealth action zones receive boostBMA would oppose single NHS pay spine

BMJ 1999; 318 doi: (Published 30 January 1999) Cite this as: BMJ 1999;318:335

Steps needed to solve NHS workforce problems

In its latest evidence to the House of Commons health select committee into the NHS workforce the BMA says that several solutions are needed to solve the current problems in supply. There should be improved working conditions; support for flexible working; better pay; realistic workforce planning and consultant expansion; and more student exposure to general practice.

The association points out that the numbers of doctors working in the NHS are insufficient for the activity expected of them. Simply replacing the 2000 doctors who leave the hospital service and general practice each year takes around 45% of the output of United Kingdom medical schools. But the BMA believes that because of increased activities and increased demand for care about 80% of medical school output is spoken for before any account is taken of complicating factors. These include the fact that over half of new graduates are women and over a lifetime will supply less full time hours of work than those they are replacing; the demotivating effect of medicine as a career means that many doctors will choose to reduce their commitment; and the working time directive and the pace of social change will ensure that long working hours will be increasingly unacceptable.

The Campbell committee's recommendation of an extra 1000 doctors a year should help, but these doctors will take several years to come on stream and will do nothing during the next five to 10 years to address the problems.

The Department of Health has submitted evidence to the doctors' and dentists'review body that the proportion of consultants taking early retirement has increased over the past 10 years. Wastage could be reduced through more flexible working arrangements that enable doctors to continue to contribute their skills to the NHS in a reduced or different capacity.

GMC wants to improve SHOs' training

The General Medical Council's education committee has published new guidance to try to improve senior house officers' (SHOs) training.

After consultants SHOs are the second largest group of hospital doctors in the United Kingdom, and many receive inadequate educational supervision and guidance; face heavy service commitments; and receive poor personal and professional support.

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The Early Years sets out the key principles of SHOs' training and the responsibilities of the competent authorities, the royal colleges, the postgraduate deans, and the educational supervisors. The guidance points out that all experienced doctors have a responsibility for the personal and professional development of the SHOs with whom they work, and that training programmes should be tailored to meet the needs of individual trainees. SHOs must have access to occupational health services, counselling facilities, and careers guidance. The additional needs of overseas doctors employed as SHOs must be recognised.

To ensure high quality training all SHOs should have their education overseen by a designated supervisor; have appropriate clinical supervision at all times; develop personal training objectives; have an educational programme, which is relevant, learner centred, and patient based.

The chairman of the education committee, Professor Sir Charles George, and the chairman of the working group on SHO training, Professor Andrew Elkington, said, “We believe that the current system can be greatly improved through a change in attitudes to educational and service issues, without necessarily requiring additional resources. There are opportunities for greater cooperation between the bodies involved with postgraduate education and training, as well as scope for certain functions and services to be rationalised.”


The Early Years is available from the GMC, 178 Great Portland Street, London W1N 6JE

Health action zones receive boost

The first 11 health action zones being set up to tackle health inequalities in England have been allocated their share of the £78m government funding over three years to develop new ways of improving local health services. They will cover a population of six million people, mostly in deprived areas.

The minister for health, John Denham, said that the emphasis would be on partnership between local agencies and central government to achieve benefits for communities.

The package includes more flexible arrangements for developing primary care premises. Health authorities in the action zones will be able to acquire a joint venture freehold interest in land intended for private sector premises.

Local projects in health actions zones will focus variously on diabetes, breastfeeding, healthy food, cardiac rehabilitation, telemedicine, parenting skills, out of hours support, and smoking cessation.

BMA would oppose single NHS pay spine

The BMA has expressed renewed support for the doctors' and dentists' review body and opposed the introduction of a single pay spine for all NHS workers, which may be suggested in the government's forthcoming proposals on pay reform (2 January, p 10).

The association believes that the differences in training, skills, and responsibilities are too great to encompass all health service workers in a single system, and would like to see other health service colleagues offered their own review body. As the NHS is almost a monopoly employer a single pay spine would reinforce a pattern of internal pay comparisons, which would create a downward spiral for NHS staff.

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