Training for doctors ‘could be shortened’ to tackle NHS staff shortages

Training for doctors could be shortened, the chairman of the NHS has said, as officials draw up national plans to tackle staff shortages.

An NHS workforce strategy is expected to set out plans for thousands of medical and nursing apprentices, as well as medical assistants, taking on tasks normally done by doctors.

The 15-year-plan, expected within weeks, comes amid record shortages of NHS staff, with more than 130,000 vacancies across England.

Richard Meddings, chairman of NHS England, said a radical overhaul was needed to plug gaps, suggesting too many doctors receive more training than they actually need.

Many tasks now being done by medics could be fulfilled by an expansion of more junior roles such as “physician’s associates,” he suggested.

Quicker training

At a Social Market Foundation event, Mr Meddings was asked if it should be possible to train a doctor in less than the seven years it currently takes.

“I would have thought so,” he said, continuing: “Or you go to physician associates - so you change the skill levels.”

“At the moment we train [doctors] to full skills and the way we work in the system most of the doctors don't get to work to their full skills. So actually there is a need to change that,” said the former banker, who took up post at NHS England a year ago.

While the standard medical degree in the UK is five years, it is followed by two foundation years’ of training.

There are currently around 3,500 physician associates employed in England, largely in hospitals, with existing plans to train 1,000 more annually.

The job, usually targeted at science graduates, involves two years’ training - rather than the seven years it takes to become a doctor, and clinical placements in hospitals and GP practices.

Health officials are currently consulting on plans to expand their role, giving them prescribing powers. They also want to see far more use of the assistants in GP practices, doing jobs traditionally done by the family doctor.

The first apprentice schemes for NHS doctors are also expected to start later this year, enabling trainees to do more learning on the job, and start earning sooner.

Major expansion in staffing needed

Mr Meddings said the NHS needed a major expansion in staffing, comparing its workforce unfavourably to other Organisation for Economic Co-operation and Development countries.

“We have 15 per cent fewer doctors and 25 per cent fewer nurses than the OECD average relative to population,” he said.

Meanwhile, new census data shows that nearly half of all hospital consultants in England and Wales were born outside the UK, along with two in five GPs.

The Office for National Statistics (ONS) figures show 47.5 per cent of specialist doctors in England and Wales, such as an oncologist or cardiologist, were born outside the UK.

Those born in the Middle East and Asia account for more than a quarter of such doctors, with nine per cent from Africa and around six per cent from Europe, the figures show.

Some two in five GPs in England and Wales were born outside the UK, according to the data.

Mr Meddings said far more medics should be trained in the UK, saying: “I’m struck that we have some of our brightest and best young people applying to be doctors but what’s the percentage getting places at medical school? Last year it was 15.6 per cent of applicants. And so then we rely upon international recruitment,” he continued, warning this left supply chains vulnerable.

'Not about reducing the quality'

His comments came as former health minister Lord Warner, a minister under Tony Blair, called for radical changes.

Lord Warner said: “What we’ve never done in this country is look at whether we need to take seven years to train a doctor.  France does it in five years - and we have never done on any scale physicians’ associates .. if you go to America you are likely to be seen by a physicians’ associate much of the time.”

In France, trainee medics normally start working on wards in their fourth year of training.

Think tanks have called for the rollout of shorter medical degrees, for graduates, while Labour has pledged to double medical school places, in order to train more medics from the UK.

Professor Dame Helen Stokes-Lampard, chairman of the Academy of Medical Royal Colleges said new routes to become a doctor, such as apprenticeships, would not mean a drop in standards.

She said: “This is not about reducing the quality – the required standards to qualify as a doctor will be identical for those doing a medical degree via the apprentice route or a traditional university degree. But it will provide additional routes of access to training and broaden the appeal of training to be a doctor.”

She said an expansion in roles such as physicians’ associates and surgical care practitioners to take on tasks that could only now be done by fully qualified doctors was necessary, given the shortages of staff.

Prof David Strain, the chairman of the BMA medical academic staff committee, said: “There is a serious workforce crisis in the NHS that needs to be urgently addressed, but compromising the time taken to train and educate medical students is not the solution.”

“Any reduction in the length of training time would “compromise education, and reduce the comprehensiveness of patient care,” he said.