I read the latest edition of JTO with interest and noted the comments
from the Editor regarding 'physician associates', as well as the feature by
Anandu Nanu. Certainly it is possible that other allied healthcare
professionals can be used to provide valuable service and this can potentially
improve the training of junior doctors; perhaps medical support workers can be
more cost effective and useful in this regard than physician associates, as
much potential junior doctor training time is wasted doing many lowly skilled
bureaucratic tasks.
The significant underlying barriers to improving training remain
unaddressed by the introduction of more allied staff however. The
fundamental root problems include government enforced austerity, the resultant
widespread NHS deficits, huge budget cuts to HEE and an unfunded service
expansion being pushed amidst a drive for an utterly unachieved £22bn of
'efficiency savings'1-4. Then combine this government ineptitude with
a perfect storm in terms of an unpopular inadequate new junior doctor contract
which is only catalysing a marked deterioration in junior doctor recruitment
and retention5,6.
The overall result is an inevitable deterioration of the quality of
surgical training.
Training can only be improved with adequate government investment which
may then both address the dire recruitment and retention of staff, as well as
increasing staffing levels to absorb the less useful service provision
currently performed by junior doctors.
In the current financial and political environment, the introduction of
more allied health professionals can only be of benefit to training if they are
in addition to the current workforce. In
the current environment it is far more likely that junior doctors will be
replaced, rather than added to by these new staff; and this can potentially
harm training further by increasing the burden on the remaining doctors. Fundamentally without adequate funding,
training quality is only going one way.
1. CBS. Written evidence to the
Public Accounts Committee by Cass Business School. February 18th 2016.
2. PAC. Managing the supply of NHS clinical staff in
England. Fortieth Report of Session
2015–16. 27th April 2016 2016.
3. Dunn P MH, Murray R. Deficits in the NHS. The King's Fund. 2016;http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Deficits_in_the_NHS_Kings_Fund_July_2016_1.pdf.
4. Campbell D. Secret documents reveal official concerns
over 'seven-day NHS' plans. Guardian. 2016;https://www.theguardian.com/society/2016/aug/22/secret-documents-reveal-official-concerns-over-seven-day-nhs-plans.
5. Campbell D. Almost half of junior doctors reject NHS
career after foundation training. Guardian.
2015;http://www.theguardian.com/society/2015/dec/04/almost-half-of-junior-doctors-left-nhs-after-foundation-training.
6. Dean b. The new junior
doctors' contract will create a staffing crisis in the worst possible places. Telegraph. 2016 2016;http://www.telegraph.co.uk/news/2016/04/28/the-new-junior-doctors-contract-will-create-a-staffing-crisis-in/.
