EXECUTIVE SUMMARY:
This report, for leaders within the healthcare system, sets out the challenges and opportunities that employers, the medical profession and workforce planners face in relation to the future supply and shape of the consultant workforce. Looking ahead to 2020, the CfWI presents possible future scenarios, the associated risks and opportunities and sets out the need for urgent debate and action.
In 2010 the CfWI carried out a series of events to identify the areas that stakeholders wished us to prioritise when modelling possible future scenarios for the consultant workforce. This report describes the future scenarios that emerged from this process and their impact, should they become a reality.
This leadership report sits alongside the published Shape of the Medical Workforce: informing medical specialty training numbers (CfWI, 2011) which concludes:
- The system should reduce supply in a range of hospital-based specialties.
- The current growth in general practice is not strong enough to meet the predicted need.
- More evidence from service commissioners and employers on service demand would enable the system to make decisions on further specialtyspecific changes across the training system.
The NHS currently relies on service delivery by trainees. A reduction in numbers of trainees would necessitate changes in the way services are delivered. This issue needs to be confronted if we are to continue to invest public money wisely to ensure the efficient supply of the trained doctor workforce.
It is vital that an urgent debate now takes place, to reach agreement on what the system should do next. This should include discussion on the interplay between the current trainee workforce and future service requirements, in the context of what is needed to secure high-quality and highly productive care for patients.
In this report, we share the results of a series of models that we have developed to project the configuration of the medical workforce. The models are built by projecting current trends and introducing a series of alternative scenarios for the future. We detail the scenarios in this report. The table show defines the seven scenarios.
The scenario modelling predicts that unless action is taken to alter the current trajectories, then there could be:
- more fully trained hospital doctors than the current projected demand suggests will be required
- an increase of over 60 per cent in the fully trained hospital doctor headcount by 2020
- an estimated £6 billion spend on total consultant1 salary costs, an increase of about £2.2 billion on the 2010 figure, if all eligible doctors become consultants.
Should the decision be taken to continue the current trends in the supply of fully trained doctors, this offers a range of opportunities. These include the potential to drive up quality through increased competition for consultant appointments and the scope for developing new service models with new roles for doctors in community settings. The modelling also suggests that the numbers completing training overall would offer the capacity to move to a ‘consultant-delivered or consultant-present’ model of service, albeit with the need for significant rebalancing between specialties.
We recognise that discussion of a potential oversupply may raise concerns for hospital-based specialty trainees, many with expectations of employment as a consultant as part of their career progression. It is essential that trainees have access to better information to enable them make individual career choices. This will help secure future supply and a good return on investment, as well as help to maintain morale and motivation for current trainees who need to understand what their future is likely to hold.
This leadership report aims to stimulate a wide discussion and to gain consensus on the key areas of risk, such as unemployment, and the need to improve deployment of trained doctors across the system.
This debate should not continue in isolation. It should take account of wider workforce considerations, including skill mix, learning from successful models of care, and a whole-team approach to planning, already in place across England. In addition, this debate should take account of the work of Medical Education England (MEE):
- Better Training Better Care (2011a): a programme that aims to improve patient care by improving the quality of training.
- The Shape of Training (2011b): a programme that is reviewing the roles and responsibilities of trainees and the day one consultant or GP, and the responsiveness of training programmes to the needs of patients, employers and trainees.
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