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The Future Healthcare Workforce

• If the NHS is to provide the quality of care that patients expect, it must continue to change. The BMA supports sensible, fully considered reforms. We also believe that many more doctors and nurses are needed in the NHS. Although more staff are planned, these increases will not be enough to meet demand.
• In the future, pressure on the medical workforce will increase, as the reduction in junior doctors' hours becomes law with the implementation of the European Working Time Directive. In the longer term, demand for all health professionals will increase as medical technology becomes able to do more for patients. Meanwhile, patients want a system that is responsive to their needs, in which they are treated with respect and given the attention they deserve.
• The BMA has therefore looked at how the existing medical workforce might be better deployed so as to respond more effectively to the needs of patients and to make best use of the skills of the healthcare team.
• We have developed a model in which nurses co-ordinate the care around a patient. Doctors have the skills for this task, but they are a more expensive resource and should be concentrated on the areas where their skills can be best used.
• In primary care, the first point of call for most patients could be a nurse practitioner, who would provide the patient with information and guide the patient to the relevant service. Often this may be a consultation with a GP, but it might also be with a community pharmacist, a family welfare worker, a benefits advice worker, or a combination of these.
• In secondary care, a clinical nurse specialist would be responsible for co-ordinating the care given by other professionals including doctors, and would also have an advanced clinical nursing role.
• The community nurse would also have an expanded clinical role, undertaking a wider range of interventions and so preventing the need for the patient to always attend the GP surgery or outpatients, or stay in an acute bed unnecessarily.
• This model would:
  - provide a high quality of care that is responsive to the needs and wants of patients and their families,
  through the involvement of staff with high levels of training in all aspects of a patient’s care
  - make more efficient use of doctors’ time by allowing them to devote more time to tasks which require
  their advanced levels of clinical training and specialisation
  - address the patient’s desire for continuity
  - simplify the current array of nursing grades and reduce the fragmentation of care that occurs when
  tasks are delegated to unqualified staff
  - provide a much needed career structure in clinical nursing which will improve morale and recruitment.
• Efficiency will be improved by making:
  - the best use of doctors’ clinical skills
  - better use of time with less referrals, fewer handovers and less time spent locating other professionals.
  - better co-ordination of services and prevention of repetition and overlaps
  - better provision of information to patients and their families, preventing re-hospitalisation.