INTRODUCTION

  The key issues which were highlighted by the BMA in June 1998 in response to the Select Committee's previous request remain our primary areas of concern. This memorandum therefore serves merely to update the information provided four months ago, and to add further emphasis on the areas to which we would like to see the Select Committee give particular attention.

NUMBERS OF DOCTORS

  The Association has welcomed the Government's acceptance of the recommendations of the Standing Medical Workforce Advisory Committee for substantial expansion in the numbers of medical students. However many of the workforce problems that we have highlighted are of an urgent nature and we remain concerned about the need for recruitment and retention measures to solve the immediate crisis, particularly in general practice. We would wish to see a more open acknowledgement by the Government of the urgency of these problems; the announcement in July that 7,000 more doctors were to be provided proved on further scrutiny to refer largely to the increased medical school output that had already been anticipated.

  Meanwhile the mechanism for implementing the Campbell Committee's recommendations needs to be resolved urgently, since it may require the establishment of at least one new medical school, a process that would clearly require much planning and organisation, and has in itself workforce implications in relation to the need for more medical academic staff. The BMA looks forward to the opportunity to take an active part in discussions on this issue.

OVERALL MEDICAL WORKFORCE STRATEGY

  Whatever specific measures are taken to deal with the immediate problems, there are two long term aims that we believe should form the foundations of policy on medical workforce planning. First, the UK must aim towards self-sufficiency in medical staffing; reliance on doctors from overseas, particularly from developing countries which need their expertise, is not an acceptable strategy. We note that currently the majority of new registrations with the GMC are overseas doctors. Second, we are convinced that the tendency for doctors to seek greater flexibility in the organisation of their work can only increase and represents a permanent change in the nature of the medical workforce. If the resources available are to be fully utilised through more successful recruitment and retention, employers will need to acknowledge this by offering more part-time opportunities and taking greater account of doctors' family and other non-professional commitments when planning workforce needs.

GENERAL PRACTICE

  Recruitment of doctors into general practice remains a major problem which is exacerbated by the competing demands of the hospital sector. New concerns arise from the development of Primary Care Groups, which seem likely to make additional demands upon general practitioners both in terms of the new skills they will need to acquire and in terms of the extra work they will involve. The General Practice Committee's workforce task group's report (which was submitted to the Select Committee with the BMA's earlier memorandum) is currently being updated. Further documents demonstrating the trends in general practice are referred to in the footnote[1].

WORKFORCE PLANNING MACHINERY AND CONSULTANT EXPANSION

  The most recent medical workforce figures published by the Department of Health (August 1998) have highlighted once again that the central plank of hospital medical workforce planning strategy, the need for substantial expansion of the consultant grade, is failing. Between 1992 and 1997 the annual increase has averaged only 4.3 per cent (compared with the 7 per cent per annum necessary for implementation of the Calman training changes) while the increases in non-consultant career grade doctors have been 7.3 per cent, 26.6 per cent and 14.2 per cent for associate specialists, staff grade and "other ungraded staff" respectively.

  The reasons for this failure are complex, but the essence of the problem has been that while the need for expansion has been stated and documented, the Government has not given priority to the policy and has not been prepared to support it financially. Thus the freedoms granted to NHS trusts in 1990, and the power of purchasers driven largely by financial considerations have acted directly at local level against the national aim of consultant expansion, to which little more than lip service was paid. When the Specialist Workforce Advisory Group in 1996 identified the need for 4,000 additional training posts to achieve the requirements of Calman training programmes and reductions in juniors' hours, only 2,000 were actually provided because funding was not available for the remaining 50 per cent. Similarly, at trust level monies required for new consultant posts have clearly been diverted into an expansion of non-consultant career grade posts because the priority at local level has been simply to maintain the service in the face of cash shortages. There is now a need for controls on the numbers of such posts to be re-established, either through the strengthening of Local Medical Workforce Advisory Groups or through the re-introduction of a national mechanism. One noticeable result of the failure of national policy has been the current problem in obstetrics and gynaecology, where there has not been sufficient consultant expansion to accommodate the numbers of trained specialists available, leading to an imbalance that is both wasteful of resources and frustrating—potentially disastrous—for the careers of the doctors concerned.

  The BMA wishes to emphasise again the importance that it attaches to consultant expansion. The Annual Representative Meeting this year supported the establishment of a consultant based service which would lead to a higher quality of care for patients. Until this is achieved the existing medical workforce is under severe pressure; studies undertaken for the Office of Manpower and Economics, whose results will be available later this year, are likely to show increases in the hours worked by consultants and in the intensity of that work, while a report from the BMA's Health Policy and Economic Research Unit in 1998 has documented work-related stress among junior doctors. The introduction of clinical governance and the new emphasis on audit and mechanisms for specialty assurance can only add to this pressure.

SCOTLAND

  The Select Committee's initial request, earlier this year, was for information relating to England only. While we have not been able to obtain confirmation in writing from the Select Committee, we understand that the current inquiry relates to the UK. We are therefore attaching, as an appendix to this memorandum, a note on medical workforce issues in Scotland.

Jackie Williams and Maureen Baker (University Department of General Practice, University of Nottingham). Back