Doctors, nurses and their training – could the NHS workforce be in need of a makeover?

Medical student Jonny Bowley, a Graduate Assistant at the Foresight Pilot workshop, reports:

I recently attended the Foresight event at Green Templeton College, Oxford. There, I had my opinions on NHS workforce challenged and, ultimately, changed.

The day at Green Templeton was an inspirational exposure to many different people, each bringing unique insight to the issues impacting on the future sustainability of health and care. Over the course of a day comprised of workshops, discussions and excellent food and drink, there were a huge range of topics covered. This blog focuses on NHS workforce and how it might change in response to increasing pressures and limited resources.

It takes (at least) five years to finish medical school, and a further two foundation years working to qualify. At that stage you choose between starting training in surgery, medicine, general practice and psychiatry, to name but a few. Then, depending on specialty, it takes a further five to seven years to reach consultancy. By the time students finish foundation years the cost of training has already reached a staggering £270,000. Much is made of the need to improve efficiency within the NHS, but what about in its training schemes?

It is acknowledged by many doctors that a huge chunk of what we learn at medical school is potentially irrelevant to practice. For example, while complex cell metabolism and the intricacies of drug action may be critical in certain specialties (or indeed research), does it need to be taught to all students? Could the course be streamlined to accommodate only what is necessary in all practice, with specialist knowledge learned as part of a department-specific training course?

Furthermore, during their training young doctors spend time in many departments, such as obstetrics and gynaecology, accident and emergency, and general practice. This sequence, where resources and time are spent working diversely is a great luxury. It allows people the experience to choose with some certainty the specialty they suit best and grants exposure to many aspects of the NHS, potentially encouraging empathetic and constructive work between future colleagues in different areas. However, since many students already have a clear idea about where their interest lies, is it relevant for someone convinced they want to be a surgeon to spend three months working in general practice, and vice versa?

As an even more radical suggestion, could medicine be split into several different courses, each with a more specific vocation in mind? These could include new categories like surgery, general practice and radiology, with greater emphasis on academic courses like biomedical sciences for those who are research-inclined. Of course, there would be some significant overlap between these, but we already see this with courses such as pharmacy and physiotherapy.

The current system was designed when the differences between specialties was less pronounced, where the total medical knowledge was far less and when public understanding of the roles of different doctors was weaker. I wonder if students are in a better position now to choose their specialties, including a potential commitment to generalism, earlier?

A further area of interest during the Foresight event was the blurring of roles between doctors and nurses. For most of NHS history there has been a clear dichotomy between the two, and attitudes related to prestige and training persist. However recent years have seen the rise of the nurse practitioner, a modern role in which many cases (diabetes management for instance) has matched or even surpassed the effective care capabilities of the GP. This move towards nurse specialisation is indicative of the pressure on the NHS to adapt to growing demand and the success of the specialists suggests it is a workable model that could be given more support.

Could new courses or qualifications contained within schools of nursing encourage students’ ambition towards more influential roles within the NHS? Or indeed could new roles, (such as a triage specialist) help to relieve some of the pressure on our workforce and provide young people different routes into important and rewarding work within the health system?

The NHS workforce is in crisis. This phrase has become so much a part of the lexicon of politicians who then do, on estimation, almost nothing about it that it has lost all meaning. But it is true. It is widely known that the NHS is understaffed – by 100,000 as of late 2018 with fears it may reach 250,000 by 2030. It also relies heavily on migrant workers who, with Brexit looming, face uncertainty over their roles, and it is desperately lacking in investment. Once you consider that the burden placed on the NHS is only expected to rise with our ageing population it is easy to reach the conclusion that the NHS is at breaking point. I took a lot from the Foresight event – and hopefully gave something back also. The question still ringing in my ears is whether the gradual blurring of roles between doctors and nurses, or the advent of new, specialised positions and courses with cheaper training costs could help move us towards more sustainable health care?

Jonny Bowley, Medical Student
27 March 2019