MR 01
Ymchwiliad i recriwtio meddygol
Inquiry into medical recruitment
Ymateb gan: Phil Jones
Response from: Phil Jones
Thank you for seeking opinions/views on this issue.
I offer my thoughts as a consultant physician born in Cardiff, qualified in Cardiff and working in Aberystwyth for 21 years. I am a geriatrician with an interest in stroke.
To get a qualified consultant or GP working in Wales requires the recruitment to start in secondary schools. We need to enthuse our Welsh pupils about a career in health care (recruitment challenges extend into nursing and therapies). We need to attract students into our Welsh medical schools and we need to expose them in their undergraduate training (or within their postgraduate medical training in Swansea) to working in rural areas. We need training posts to offer placements in rural areas.
At a conference about rural surgery we heard that the Scottish government require 20% of students and 20% of trainees to experience a rural placement.
Rural posts (in Scotland) account for about 10% of all posts so we don’t need many but we do need some.
Our training programmes in medicine are directing doctors into more and more sub-specialisation. In Wales there are only a few (of the some 14 acute DGH sites) who have sufficient mass to need such sub-specialisation skills. Many sites need a cardiologist (for example) who can also cover general medicine – we don’t all need a cardiologist who can provide PCI. This example is generalisable to many other areas.
We need to ensure that the Welsh consultant contract is as attractive as the English version – when people have a choice this might be a deciding factor.
We need to look at our reputation for training and act decisively where we need to so that we ensure we meet the statutory requirements and the trainees experience is good.
We may attract poor feedback/experience through the quality of our accommodation for students and junior doctors – again a remediable issue.
I understand that Cardiff has very few Welsh students – why? What can we do to improve this? Can we offer scholarships from HB/hospital areas to encourage local applications from the community – there is a better chance that they will return.
The Brexit issue is one that I don’t think we can predict with any accuracy. I do think that we should be absolutely clear that NHS Wales welcomes the best applicants for posts from anywhere in the world and it may be that we can look globally to recruit and that may be better than EU only. To my surprise when Greece and Portugal ran into problems we didn’t get an influx of doctors from those countries (at least not in mid Wales). Can we recruit from the commonwealth better than we did from Europe for doctors? We always used to. It would be important to ensure that our valued colleagues in NHS Wales from outside the UK are appreciated and that there is no threat to their continued employment – if we can do that then we would provide a lot of reassurance and prevent loss of staff on top of failure to recruit.
From a local perspective a bigger problem at present is retention of staff. Before the merger into Hywel Dda the hospital at Aberystwyth was well staffed, we recruited and retained well. Whilst I understand the need to reduce from 22 trusts the experience of “merging” has been awful and I believe that poor leadership in the past has left mid Wales in a very precarious position. We cannot undo that which has been done but we must learn from that and in any future organisational change there must be some fixed points that new structures must observe to prevent the erosion of smaller units.
The alternative however unpleasant is to consider whether Wales has too many hospitals and needs a radical rethink of organisation of services to meet current and future healthcare needs.
I haven’t touched on primary care – I don’t feel qualified to do so but I do believe that that is on the brink of a collapse that will cause enormous upset to the safe, effective delivery of healthcare in Wales.
I hope my comments are useful.
Phil Jones