A view to the future: integrated healthcare

Integrated working in healthcare is being lauded as the future of healthcare – and a system that can meet growing demand on the NHS. Getting into shape: Delivering a workforce for integrated care, published by Reform, argues just this and suggests that this new and connected way of thinking can build a framework that supports an integrated medical workforce and patient-centred care

The research describes government policy on medical training as a series of ‘short-term fixes’, including a £1.3bn annual spend on agency staff and an over-reliance on foreign doctors. The report calls for the abolition of Health Education England with local NHS leaders taking over responsibility for both training and levels of pay for NHS staff.

The report says that government policy, based on a cap on doctors’ training places, has delivered an inadequate pool of labour for the NHS, difficult working conditions and a powerful staff body, many of whom choose to work for expensive agencies. The UK is the sixth biggest importer of foreign trained doctors, with 26% of its doctors recruited from overseas, at a time of global shortages in clinical staff. According to the report, Jeremy Hunt will not deliver on his 2016 pledge to build an NHS ‘self-sufficient in doctors’. Last month, NHS England announced an increase in overseas recruitment from 500 GPs to 2,000.

The government should remove the cap on medical trainees so that the NHS can produce a sufficient or excess number of trained individuals it could employ. Such a policy will reduce the annual spend on agency staff. Reform also identifies significant savings in the cost of training, with some institutions delivering training for £162,000 compared to the Department’s figure of £230,000. The report estimates that medical students should pay back around £12,000 per year for each year spent working for a non-NHS employer or locum agency for up to 10 years. The Government has already removed similar caps for nurses and pharmacists.

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The report calls for an end to the national pay cap since local health managers are best able to judge the salaries and other incentives that will recruit and retain staff.  Local managers should take full responsibility for improving performance management of NHS staff which remains highly variable, especially for lower paid workers and those in social care.

The NHS is striving to reduce the pressure on hospitals by developing new services in primary care and the community. New evidence for the report shows, however, that only six per cent of hospital consultants work in the community each week. Since 2009, the number of consultants has risen by a third while the number of GPs has fallen. The report warns of a “snobbish” attitude in medical schools to general practice.

The report criticises over-regulation of medical staff which needlessly restricts the number of employees who can work in different roles. It recommends a new Skills Pass so that all NHS and care workers, with sufficient training, can undertake low-risk tasks such as simple wound dressing or cannulation.

You can access the full report here.

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