Intended for healthcare professionals


Reshaping the NHS workforce

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1023

Necessary changes are constrained by professional structures from the past

  1. Lesley Doya, professor in health and social care,
  2. Ailsa Cameron, research fellow
  1. School for Policy Studies, University of Bristol, Bristol BS8 1TZ

    Education and debate p 1067

    The staffing problems of the NHS continue to make headlines.1 Junior doctors are threatening to strike, consultants are voicing their frustration, and nurses are voting with their feet.2 Though their concerns are less visible, physiotherapists, radiographers, occupational therapists and other members of the professions allied to medicine are also facing major challenges.3 The problems have been well rehearsed but solutions seem as far away as ever.If the healthcare needs of this new millennium are to be met, more radical approaches to collaborative working will need to be explored.

    By its very nature the healthcare labour force is an interdependent one. The different occupational groups did not develop in isolation from each other but as part of a complex and interdependent system capable of carrying out the many activities that make up a modern health service. Yet despite this obvious reciprocity, the different elements of the NHS labour force are still planned and managed in isolation. This continuing fragmentation has a major impact on the quality of patient care and on the wellbeing of health workers themselves.4

    Since the 1970s there have been irresistible pressures towards collaborative working across traditional boundaries. More health workers are now organised into multiprofessional teams, and many nurses and those in the professions allied to medicine …

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