This item was published during the term of a previous administration that ended in April 2007
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Review of the NHS workforce
03/07/2002
Looking to the next 10 years and how Scotland's medical workforce is planned are the main objectives of Professor John Temple's report published today.
The report, Future Practice - A Review of the Scottish Medical Workforce, was a commitment in the Scottish health plan to undertake "a fundamental review of medical workforce planning, including the intake of medical students and the possibility of fast-track graduate-entry medical degree courses in Scotland".
In presenting the Report to the Minister, Professor Temple said:
"Change in the service and change in the working practices of the medical profession must go hand in hand. The Working Time Directive will affect all doctors, wherever they work, and this offers us a unique opportunity to take a fundamental look at the Scottish medical workforce, within the context of an integrated healthcare team.
"While this report is issued under my name, it reflects the views and contributions of a great many colleagues who have assisted me and my Advisory Group during this process. I am very grateful to those who have given their ideas so openly and freely. I hope you feel that we are beginning to tackle the very real issues which are evident in Scotland in relation to the delivery of sustainable, quality healthcare. This of course must be done within a UK context."
The report examines the following key themes:
- how doctors work and the impact of changing modes of service delivery on workforce planning
- remote and rural issues
- projected future demands for doctors
- recruitment and retention of doctors
- the supply of doctors through the medical schools
Professor Temple, who is President of the Royal College of Surgeons of Edinburgh, led the review. It was independent of the Scottish Executive Health Department and given the discretion to make whatever recommendations it saw fit.
Professor Temple appointed a small expert Advisory Group, which has taken views from a wide range of interests through a detailed questionnaire and focus group meetings.
The Group has made 10 key messages and put forward 37 recommendations, including:
Picturing the Future
The Scottish Executive Health Department (SEHD) should set out a long term view of the future to guide service and workforce development, and to influence expectations by forecasting expected change in medical science and other factors likely to impact on service provision, providing a vision of the future with mechanisms to refresh that vision regularly, and
establishing data and information flows to support that process involving key partners.
Demand for Doctors
- Confirm and co-ordinate a strategy to move towards specialist delivered services
- Review the hospital career and training grade structures
- Plan the training grades to satisfy the need for doctors, not to provide service
Give service re-design a high priority as a co-ordinated, resources effort covering primary and secondary care:
- review all current acute service configurations
- involve patients and public in service re-design
- promote enhanced services rather than institutions
Identify and pursue opportunities for Managed Clinical Networks:
- ensure that their essential features are clear and agreed
- ensure that they are managed
- develop and co-ordinate networks nationally
- explore the linking of employment contracts to networks
Give the development of teamwork high priority:
- involve the public
- disseminate good practice
- build team skills into training
Define:
- remote and rural practice
- core services for each remote and rural community
- standards by outcome, allowing variation in methods to achieve them
* conduct an option appraisal for maintaining acute services in small hospitals
* establish remote and rural strategies for staff development but linked to proposed regional planning provisions.
* establish working assumptions for the numbers of specialists and other doctors required and keep them under review.
Supplying Doctors
- manage recruitment: set national and local targets.
- promote Scottish medical careers
- facilitate local incentives within a national framework
- promote a positive Scottish identity
- engage schools and educational institutions
* maximises retention:
- delay retirement by step-down and return options
- improve scope for and attitude to flexible training and working
- address morale factors, including positive changes in work practices
* take particular actions for remote and rural areas through:
- selective additional investment
- rural 'packages' for doctors and other health professionals and their families
- targeted recruitment, training and career planning for remote and rural practice
* arrangements for continuing professional development and for maintaining clinical competence.
- explore increased output from Scotland's medical schools by
- quantifying the case for further increase
- providing for mature and improved social diversity
- enabling some or all of St Andrews graduates to complete their clinical training in Scotland
Planning the Workforce - improving the workforce
- develop a coherent, nationally-led medical workforce planning system as a part of the workforce development arrangements in the SEHD in response to Planning Together
- establish much larger managed "health economies" for Scotland than presently exist