MR 22

Ymchwiliad i recriwtio meddygol

Inquiry into medical recruitment

Ymateb gan: Coleg Brenhinol y Seiciatryddion

Response from: Royal College of Psychiatrists Wales

The Royal College of Psychiatrists is the professional medical body responsible for supporting psychiatrists throughout their careers, from training through to retirement, and in setting and raising standards of psychiatry in the United Kingdom.

The College aims to improve the outcomes of people with mental illness, and the mental health of individuals, their families and communities. In order to achieve this, the College sets standards and promotes excellence in psychiatry; leads, represents and supports psychiatrists; improves the scientific understanding of mental illness; works with and advocates for patients, carers and their organisations. Nationally and internationally, the College has a vital role in representing the expertise of the psychiatric profession to governments and other agencies.

RCPsych in Wales is a satellite of the Central College, representing over 550 Consultant and Trainee Psychiatrists working in Wales.

For further information please contact:

Siobhan Conway

RCPsych in Wales Manager

Tel: 029 22 33 1081

www.rcpsych.ac.uk

@RCPsychWales

The RCPsych in Wales is encouraged that the National Assembly for Wales are seeking stakeholder comments into their inquiry into medical recruitment.

This response has been produced in consultation with the members of the College in Wales and relevant stakeholders.

The RCPsych in Wales has previously submitted responses to Welsh Government consultations on workforce which include relevant information on recruitment and retention as below:

· Welsh Government – Health Professional Education Investment review

· Welsh Government (commissioned) - review into the NHS Workforce

RCPsych Workforce Census

· In March 2016 the RCPsych published the results of its Workforce Census

NHS ten- year plan on workforce

In March 2015, the minister announced that a 10-year national workforce plan for the NHS will be developed, bringing together work already underway, including prudent healthcare principles. It will be informed by two areas of work – the primary care workforce plan and the independent review of the NHS Wales workforce (see above).

Inquiry questions:

1. The capacity of the medical workforce to meet future population needs in the context of changes to the delivery of services and new models of care.

The current psychiatry workforce does not have the capacity to meet future population needs in Wales. Psychiatry professionals in Wales work hard to meet the demands of a growing and changing population. They are treating more people with different needs in a variety of settings including hospitals, clinics, prisons, secure units and in the community. With limited funds and few resources, services are at risk of collapse. We are calling for Welsh Government to address workforce issues more generally and within their specialties. It must be Welsh Government’s priority to develop a workforce plan and training programme to attract the calibre of healthcare professionals to meet these demands as stated in RCPsych in Wales Manifesto 2016.

Current numbers of trainees in General Adult Psychiatry and Old Age Psychiatry are particularly concerning. There are gaps in training schemes for these specialties and this shortfall will, in the near future, have an impact on consultant numbers working within these specialties. Workforce demand in Old Age Psychiatry will continue to increase as our population ages and supply is not predicted to meet this demand and a significant shortfall expected. Retirement rates of Old Age psychiatry consultants has increased along with vacancy rates across the UK.

The RCPsych in Wales acknowledges the future changes in the delivery of care in Wales as stipulated by the South Wales Programme Board which is now being implemented. The ambition is to:

· Centralise services and strengthen primary care and community services so people can keep well at home. When people do need hospital care, provide as much as locally as possible but only when it is safe to do so.

· Develop a new system where hospitals work together across health board boundaries to provide high-quality, timely care for patients in the most appropriate place.

· Improve care and standards by concentrating consultant-led services and emergency medicine (A&E) for the most seriously ill and injured in fewer hospitals.

Mental Health service provision in Wales has improved over the last 20 years with most services now being delivered in the community setting. To enable improvements to specific DGH services as detailed above, the psychiatry workforce in emergency/crisis/DGH settings must be robust. There have been improvements in Liaison psychiatry with additional funding from Welsh Government which has been welcomed. However, there are still gaps in services across Wales.

2. The implications of Brexit for the medical workforce.

Brexit is predicted to have a negative impact on the medical profession throughout the UK. The numbers of doctors entering psychiatry in Wales was inadequate before the referendum to leave Europe. The result means that the need for more doctors is now more acute. We would stress that we need to expand the number of Wales’ medical students to ensure a high level of domicile doctors of the future, that are likely to study, train and work in Wales post CTT. Currently, 40% of all UK doctors are trained outside the UK. The College in Wales is acutely aware that this situation is likely to change when Brexit has been implemented.

The future post Brexit is uncertain. We are concerned that doctors from outside the UK already working in Wales, settled in jobs and who have set up homes may consider leaving due to the uncertainty of the future. We are also concerned that the UK post Brexit is now not considered a stable place to come and work due to the ongoing uncertainty.

Brexit puts doctors from EU countries, who thus far relied on their automatic residence rights, into a precarious situation. To make matters worse, the UK Government’s announcements seem to imply that doctors from EU countries will only be tolerated in the UK for a limited period which is essentially until sufficient numbers of British doctors have been trained. This prospect is likely to have a demoralising effect and will make it very difficult to recruit and retain doctors from EU countries. This will add to the difficulty in covering clinical areas which are affected by a shortage of doctors (such as psychiatry, and particularly its subspecialties/ special interest areas) in this interim period. The interim period could easily last for 20 years if not longer, anyone starting medical school now would need at least 20+ years training to replace current experts. It was disappointing not to see a clear response from the Welsh Government on this matter, but hopefully this inquiry will result in representations being made both to the Welsh and the UK Governments.

3. The factors that influence the recruitment and retention of doctors, including any particular issues in certain specialties of geographical areas

Historically Psychiatry has had difficulty in recruiting and retaining staff. It is well evidenced that recruitment into psychiatry is very poor. Psychiatry faces a stigma of its own, with low popularity rates globally. The reasons that medical students choose careers in medical specialties other than psychiatry are well documented. Despite this, the key issues have not been addressed collectively in the UK. Data from the College show that the size of Wales’ consultant psychiatrist workforce only grew by an average of 0.7 FTE (3.5 headcount) per year from 2011–2013.

Psychiatry has very high levels of job satisfaction, which can be attributed to its focus on the bio-psycho-social model with a holistic approach to care and treatment. Psychiatry is regarded to be at the forefront of modern healthcare services, spearheading co-production and service user involvement, psychological as well as medical therapies, and working with physical health and social needs.

Retention of Psychiatrists and trainee psychiatrists is a major issue. Factors that influence this include lack of good quality training experience in some areas, stigma within the medical profession and pressure on services. Wales specifically has issues with the rurality of some areas and some Health Boards have difficulty in recruiting into rural posts. Recent discussions with our membership in Wales have revealed that pay is not the major factor in recruiting and retaining staff in Wales. Quality of service provision, support services, work-life balance and job satisfaction are higher priorities for psychiatrists.

The RCPsych in Wales is aware of the impact that the new junior doctor contract is having in England. We are encouraged that no plans to implement such a contract have been announced in Wales. This would lead to a further reduction in Recruitment and Retention of psychiatry doctors in Wales

4. The development and delivery of medical recruitment campaigns, including the extent to which relevant stakeholders are involved, and learning from previous campaigns and good practice elsewhere

The RCPsych (UK) has recently revised its recruitment and retention action plan. This document provides a detailed set of initiatives developed to improve recruitment and retention across the UK.

The RCPsych in Wales believes that in order to improve rates of recruitment, young people should be targeted at secondary school age and medical schools to be well informed of NHS careers. Work experience, careers fairs and Young People’s debates on Mental Health provide young people the experience and knowledge to make an informed decision about their future career.

The RCPsych in Wales has published its Recruitment and Retention Action Plan 2015 - 2017 and works constantly to improve the rates of recruitment and retention in Wales. We strive to:

· Reduce stigma and promote good mental health within secondary schools in Wales.

· Reduce stigma and promote psychiatry within medical schools in Wales.

· Ensure high quality and supported training at core and higher level within psychiatry in Wales.

The Royal College of Psychiatrists offers Pathfinder Fellowships, which provide a unique and exciting opportunity for medical students in their penultimate year of study who are interested in pursuing a career in psychiatry. The Fellowship Award has expanded to offer 20 places. We are seeking the next generation of psychiatrists to lead the profession into the future.

5. The extent to which recruitment processes/practices are joined-up, deliver value for money and ensure a sustainable medical workforce.

The RCPsych in Wales works proactively on recruitment. We have organised and delivered joint working in this area with Swansea University School of Medicine and Cardiff medical school. The RCPsych in Wales would welcome the opportunity to work collaboratively with other related organisations on improving current rates of recruitment and retention in Wales.

Further comments:

The Welsh Government has just announced the creation of a new body, Health Education Wales, which will lead strategic workforce planning, workforce design and education commissioning for NHS Wales.

This follows the report of the Health Professional Education Investment (HPEI) review.

Key points

· The report proposes a new “arm’s length body” with a board accountable to Welsh Ministers, working within an overall framework provided by the Welsh Government.

· It proposes members of the board be appointed for their expertise in specific areas such as understanding changing health needs, workforce planning, educational design, quality assurance and equity.

· The removal of boundaries between medical and non-medical planning, workforce design and commissioning will provide new opportunities for multi-professional approaches.

· The focus on widening access, raising awareness about more than 300 different roles and opening up more flexible career pathways needs a co-ordinated national approach, supported with local initiatives.

· Overseen by a board, the new HEW body will deliver a national co-ordinated approach to delivering workforce education and training to meet the specific geographical needs of Wales.

The Welsh Government expects the body to be in place by 1 April 2018.

The RCPsych in Wales stresses the importance of having robust support in place whilst the planning and implementation of the new body is taking place. We would be concerned to see a break or any disruption to recruitment of doctors in Wales in this crucial time period.

The College in Wales would welcome the opportunity to assist Welsh Government and the National Assembly for Wales on issues around recruitment and retention of doctors in Wales.

November 2016