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It is clear to staff and patients alike that NHS Wales is facing unprecedented challenges. Increasing patient demand, coupled with decreasing investment, has put a growing pressure on NHS services and the dedicated professionals who deliver them.
Knowing the present day challenges makes it even more important to plan effectively for the future. At a time where it is clear that the system isn’t able to deliver as effectively as it needs to, as professionals and service users, we must come together to consider how we can make sure that the health service of the future is a better one.
To begin with, it is important that we understand and challenge where we are now. We cannot escape the fact that the capacity of the medical workforce is failing to keep pace with demand. Patient waiting lists continue to grow, whilst there are serious concerns around the recruitment of doctors. Quite simply, there are not enough doctors and other medical staff to cope with the demand for services, in both primary and secondary care. In secondary care difficulty recruiting within certain specialties has been a key driver for service reconfiguration proposals.
Given that we know things aren’t working, it is important to look at the evidence when determining how bad the situation is. After all, if we don’t know the nature and extent of the problem, how can we begin to put it right?
There are a number of indicators that tell us that the current workforce here in Wales isn’t sufficient. Some of the most compelling evidence includes the growing use of locum doctors and increasing overtime costs for medical staff being reported by health boards. BMA Cymru Wales has used Freedom of Information (FOI) requests, to collect data on locum consultant usage. These revealed that 7.5% of whole time equivalent consultant posts are filled by locums.
Moreover, The Welsh Government-commissioned NHS Wales Workforce Review reveals that there has been a fall in the number of doctors per head in Wales to 2.8 per thousand population from 3.1 last year. According to Global Health Observatory data from 2013, Spain has 4.9 doctors per thousand, Germany 3.8 and France 3.19.
Vacancy rates for doctors rose sharply from 2014 to 2015, and existing staff are having to undertake additional work to cover for vacancies and rota gaps. As a result, there has been an increase in costs for overtime payments for consultants in Welsh hospitals.
Combined, these indicators show that the workforce is struggling to provide for current health needs. If we look to the future, it is clear that without intervention these challenges will not decrease in the medium to long-term without targeted and considered intervention.
There are a range of factors which we can use to predict future pressures on the medical workforce. One particular area that is already causing concern is the age profile of certain sections of the medical workforce, where an increasingly disproportionate number are nearing retirement age.
In 2014, 23.4% of Welsh GPs were aged 55 and over and figures recently published by the Royal College of Radiologists suggest that around 30% of Welsh consultant radiologists will retire between 2015 and 2020.
Looking to the future, underinvestment and workload pressures are impacting negatively on the attractiveness of general practice as a career choice for new trainees. This mix doesn’t bode well for the future of the profession.
In considering what needs to change, we must first decide what our health service may need to look like in 10-20 years before we can start planning to staff it. It takes 5-6 years to train a medical student into a doctor; and a further 6-7 years thereafter to train a GP; and perhaps 10-12 to train a Consultant. We certainly need lots more GPs to bolster primary care but until we realise a vision for our hospital services we will not know what staffing they will need. We also need to consider how we can better provide hospital services, particularly along the M4 corridor, who are already failing to staff their specialist rotas despite best efforts to recruit.
It is impossible to plan appropriately if we don’t know what we are planning for. As part of our evidence to the National Assembly’s health committee inquiry into medical recruitment, we have called for the urgent development of a clear strategic vision for the future. This vision must not be words put on paper that are then left on a shelf. A true vision will provide a dynamic, patient-centred route forward to taking action now, to ensure that the services of the future are fit for purpose.
Dr Trevor Pickersgill is chair of BMA Cymru Wales consultants committee