The ferret's guide to Tooke: Part 3

"Recommendation 11 DH should have a coherent model of medical workforce supply within which apparently conflicting policies on self-sufficiency and open-borders overproduction should be publicly disclosed and reconciled. The position of overseas students graduating from UK medical schools needs to be clarified with regard to their eligibility for postgraduate training."

Recommendation 12 DH Workforce should urgently review its medical workforce advisory machinery to ensure that it receives integrated and independent advice on medical workforce issues to inform/complement SHA and local deliberations. Both national and devolved workstreams must be adequately resourced. The medical workforce advisory machinery should also take account of national policies impacting on the workforce such as the shift of more care to the community. Revisions to the current arrangements need to reflect the following principles:

• Medical workforce planning needs to embrace the consensus view of the role of the doctor referred to in Recommendation 5
• Plans should be based on robust information on available and projected medical specialist skills, requiring relevant databases.
• Whilst recognising that doctors are just one part of the workforce, sufficient attention and resource need to be devoted to medical workforce planning reflecting doctors’ crucial roles and the expense involved in their development.
• A national perspective needs to be integrated with regional requirements, particularly with regard to the maintenance of sufficient subspecialty expertise to meet the needs of the nation, and the overall health of clinical academia. Consideration should be given to the creation of an arm’s length body, a National Institute for Health Education, NIHE, mirroring NIHR to undertake commissioning of higher specialist training that is not required in every locality. The criteria for the award of such training positions should reflect the Trust’s performance in relation to training, innovation and clinical outcomes.
• Professional advice to the medical workforce advisory machinery needs to include that from doctors at the cutting edge of their discipline with the foresight to project potential developments in healthcare.
• Regional workforce plans should be subject to a national oversight and scrutiny advisory committee with service, professional and employer representation. Such oversight should encourage local responsiveness and acknowledge issues facing the devolved administrations whilst ensuring national consistency on roles and standards.
• Modelling capacity should be enhanced by drawing on the expertise in the University sector, e.g. health economists, epidemiologists, modellers etc. The assumptions underlying projections should be subject to professional scrutiny and regular review."

The DoH should sort out its incoherent workforce planning, no argument with these recommendations.

"Recommendation 13 The Panel recommends that DH should work with the GMC to create robust databases that hold information on the registered/certificated status of all doctors practising in the UK. This will provide an inventory of the contemporary skill base and number of trained specialists/subspecialists in the workforce as well as those in training for such positions to inform workforce planning."

This is something that should have been done a long time ago, the GMC should be made to do something useful for the massive amounts of money it receives.

"Recommendation 14 The content of higher specialty training and the numbers of positions will be informed by dialogue between the Colleges, employers, and medical workforce advisory machinery to allow finer tuning of the nature of the specialist workforce to reflect rapidly evolving technical advances and the locus of care."

Strangely there is no mention of the medical unions here, I am of the opinion that the unions must be involved in this key area.

"Recommendation 15 Explicit policies should be urgently developed and implemented to manage the transitional ‘bulge’, caused by the integration of eligible doctors into the new scheme, with appropriate credit for prior competency assessed experience."

This is far easier said than done, for example PMETB are unable to manage their current workload; this complex task would certainly not be managed adequately by them.

"Recommendation 16 DH should recognise the burgeoning supply of medical graduates it has commissioned and make explicit its plans for the optimal use of their skills for the benefit of patients. It is recommended that sufficient numbers of Core Specialty training posts (see Recommendation 33) should be made available to accommodate doctors successfully completing FY1 and the use of commissioning funds for this purpose should be monitored."

The DoH must be held to this, graduates from the UK must have training opportunities available to them.

"Recommendation 17 Career aspirations and choices should be informed by accurate data on likely employment prospects in all branches of the profession and the likely competition ratios based on historical data, supplemented by professionally agreed foresight projections. Such information should be updated annually by the redesigned medical workforce advisory machinery and made publicly available so as to inform would be medical students, students and trainees. Medical schools should play a greater role in careers advice including i) information in prospectuses concerning career destinations and likely competition ratios, ii) offering selective components of the programme to allow experience in discrete specialties, iii) formal personalised advice/ mentoring."

Not much to quibble about here, the workforce machinery should start doing it's job properly. Overall this seems to be the them from this section, the DoH should start damn well doing its job properly.