Philip Braham, Co-Founder, Remedium Partners tells us more… It’s no secret that our NHS is critically short of doctors and, consequently, that it is a real challenge for hospitals to consistently deliver the highest levels of care it aims for. With permanent professionals in particularly short supply, but with no drop in demand for them, Trusts and hiring managers have been turning to the services of locum doctors to fill staffing gaps. However, it’s clear that this is a short term tactic which keeps things ticking, but is not a viable long-term solution. The good news is that there are ways to alleviate the critical workforce challenges faced by the NHS, but they require strategic planning and a collaborative approach between Trusts, the government and medical training providers.
Turning a short-term fix into a long-term solution
The NHS is currently in a situation where workforce managers routinely turn to locums, often extending three month contracts repeatedly. The basic economics of supply and demand has pushed agency fees for these doctors ever higher, with some suppliers commanding fees of more than £150,000 a year for a single individual. Yet despite the high costs involved, the lack of continuity associated with locums, together with the time needed for repeated inductions and handovers, means that the model is less conducive to productivity or providing the best patient care.
The government has already taken an important step to curb this by issuing caps on the amount that Trusts can pay agencies for locum doctors, and its mandate to reduce overall locum expenditure by 2020 means that hiring managers will need to fully consider alternatives. Indeed, although improvements and saving have been made, NHS Improvement’s chief executive Jim Mackey underlined the problem when he said: “ There are far too many agency staff making the most out of the lower tax rates paid via personal service companies and limited liability partnerships. This is a key part of the problem of so many staff choosing to work as agency staff instead of NHS staff.”
In such an environment, it might make sense for Trusts to try to turn as many of these locums into substantives as possible, yet very few hiring managers seem to be asking them if they want to go permanent. Selling the benefits, such as increased access to training and career development, may be vital if a longer contract is to be seen as a more attractive option.
The benefits of securing overseas doctors
One key source of highly-skilled doctors is the rich pool of overseas talent, but for many hiring managers there still appear to be doubts about individuals from this source, including concerns that they will take longer to settle in and become accustomed to NHS practices. But such an approach arguably fails to factor in the long-term benefits of consistency and commitment. Overseas doctors are commonly ambitious, seeking work within the NHS with a view to furthering their careers, and many stay and build their lives here, meaning they play a valuable part in addressing long-term staffing needs. Therefore, Trusts could perhaps look at ways to be more effective in attracting these doctors. Working in partnership with overseas institutions, such as training providers and hospitals is an excellent start. Having a clear induction and initiation programme which recognises the challenges faced by doctors who are relocating is another. In addition, it is important to promote the fact that overseas doctors are proving to be a great success and to be vocal about the reasons for employing them. Having case studies from happy, settled overseas doctors on hospital websites, for example, is a great way to publicise the benefits.
However, the obstacles currently facing overseas professionals who want to work for the NHS are widely reported. It’s evident, for example, from the increasing number of European doctors requesting their Good Standing certificates that Brexit is causing a heightened level of uncertainty. It’s vital, therefore, that Trusts talk to these professionals to find out their plans and aspirations: what would incentivise them to feel valued and want to stay? Are their training and professional development needs being met?
In addition, the ongoing saga of visa shortages and certificate of sponsorship issues is clearly driving demand for locums, as hospitals often can’t employ the doctors that they have sourced. Should these visa issues continue, Trusts are rightly expressing concerns that overseas doctors might be deterred from applying to work for the NHS. However, the government’s assurance that it is looking into this as a matter of urgency means we can be hopeful that this won’t be an ongoing issue.
Supporting juniors – our consultants of tomorrow
A second key issue facing Trusts is the falling number of home grown doctors going through medical school. This is compounded by our ageing workforce. The latest statistics on how long people are living and working certainly reflect this. The Office for National Statistics’ (ONS) latest life expectancy figures stand at 79.3 for males and 83 for females, with this rising to as high as 93.9 for males and 96.5 for females by 2039. The latest stats on average retirement age meanwhile show a steady rise, from 63.8 years to 64.6 years between 2004 and 2010 for men and from 61.2 years to 62.3 years for women (ONS). Aims to dramatically raise the state pension age will cause this to increase by much as six months every year. Senior professionals are approaching retirement without a generation of new doctors – the consultants of tomorrow – to replace them. This highlights just how short sighted it is to focus on plugging staffing gaps with temporary solutions. Unfortunately, repeated changes in government have meant that there hasn’t been any continued consistency of responsibility for the problem and it’s been left to develop.
A significant part of the problem is the widespread publicity about the pressures faced by existing doctors. Therefore, both government and Trusts need to think about long-term strategies for making the profession more attractive to potential recruits. One way could be to focus on their peers – the current juniors – and demonstrate that clear and focused action has been taken to address their concerns and support them, such as providing mentoring and offering the flexibility and time off to study.
What makes doctors happy?
While attracting new staff is key, it’s obviously vital to retain both domestic and overseas-trained doctors already in the system. The starting point should be a strong induction programme and welcome events at their moment of arrival, and then consciously creating an ongoing positive culture through the organisation of regular team and social events. The more integrated different teams from different departments are, the greater the sense of ‘belonging’ and community among staff. This is essential in any workplace, but especially when bringing people together from different backgrounds. It’s here that Trust leaders have the opportunity to lead from the front, by being positive and encouraging involvement and inclusion.
Many Trusts could benefit from taking more time to look at how doctors are recompensed: for example, by speaking to doctors about the kind of packages that would be attractive to them and which work with individual lifestyle requirements, as well as meeting specific career and training goals.
As with all employers, it is also important that hospitals listen to doctors about what makes them happy in their role. What specialisms are they interested in? Asking these key questions in the beginning means that it will pay off in the future and help to increase retention.
Communication between departments is also key. Some of the most effectively run hospitals that we work are the result of hiring managers listening to leaders outside of HR and within the wider organisation, such as operations and finance. This overview is essential for effective workforce planning, yet many departments still work in near-isolation.
Robo-doc? The future of technology
One further development which needs to be factored in to long term workforce planning is the rate at which the healthcare sector is seeing technological advances. With increased use of the likes of surgical robotics and artificial intelligence, plus developments in the methods used to study specialisms such as genomics, tomorrow’s workforce will need to possess the skills to utilise the available technology and current doctors will need to be upskilled so that they keep pace. Long-term workforce planning needs to keep abreast of changes and adjust to the ways that technology might drive the need for evolving skills.
So, while hiring managers and Trusts currently have significant pressures upon them as a result of the current doctor shortage, it’s clear that there are opportunities to develop a viable long-term solution. Embracing a more strategic approach to workforce planning, which is becoming increasingly common among innovative companies within the commercial sector, could alleviate at least some of the pressure on both hospitals and the existing workforce of doctors.
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