This page outlines NHS Employers' vision of the future medical workforce.
In January 2007, we published a discussion paper in consultation with key stakeholders, including members of the NHS Employers medical workforce forum.The paper aimed to bring together the key issues and engage employers in the debate by setting out broad thought provoking questions about how they believe these are shaping the future role of doctors in the health service in England.
We held a workshop with employers in September 2007 to examine these priority areas in more detail. Our position paper, based on the feedback received from the discussion paper and the workshop, was then published in October 2007.
NHS Employers worked with employers and stakeholders on the actions arising out of the position paper throughout 2008, which culminated in the October 2008 publication of a new briefing: Medical training and careers - the employers' vision
. This briefing sets out employers’ vision for the future direction of medical careers, ensuring that we are training the doctors that we need to provide high quality healthcare for all.
The briefing was informed by the recommendations in the Tooke report, and explored what else was needed to help employers to develop a cohesive medical workforce across all grades that would meet their local needs.
In late 2008 and following Sir John Tooke's Inquiry into Modernising Medical Careers which called for the profession to speak with a coherent voice and to define the role of the doctor, NHS Employers joined a number of organisations including unions, deaneries and patient groups to reach a consensus on the ever-evolving role of the doctor. The statement
built on earlier work by the signatory organisations and was seen in the context of the duties of a doctor as defined by the GMC in Good Medical Practice.
Developing graded responsibilities: the role of credentialing
This information was created in October 2009 in response to the call from the (then) Postgraduate Medical Education and Training Board (PMETB) for individual and stakeholder views on their draft policy statement Future Doctors, launched on 1 October 2009.
NHS Employers noted the reference in that document to specialty grade doctors which said:
" ... the support for and training of (these) doctors should be on a more formal footing, overseen by national standards. Their training should be recognised within a transparent regulatory framework. In the longer term, it may be that credentialing will be part of a range of solutions to doctors who wish to have their experience recognised."
Responding on 11 September to the earlier draft Future Doctors statement, NHS Employers had reaffirmed its support for the themes outlined, based upon its earlier Briefing Paper 52. We agreed with PMETB's policy intention that 'The regulator will promote flexibility within training to support the aspirations of trainees and the requirements of healthcare providers, but not at the cost of undermining the fundamental skill and knowledge required of a doctor in practising independently'. We said this strikes exactly the right balance between a more flexible approach towards training and career progression and the maintenance of independently regulated standards. It also makes an appropriate link between service requirements and the influence of these on trainee doctors’ aspirations.
We added further support to the intention that 'PMETB shall articulate and promote the concept of graded responsibility'. NHS Employers recognised that to do this 'PMETB will press for clearer legislative powers which will provide a structure for the support and recognition of specialty and other non-training-grade doctors'. We anticipate that these are issues that will be considered as part of Lord Patel’s review on the future role of the merged regulator and we will contribute our further views to this, in consultation with our medical workforce forum and other service managers.
Employers had previously told us that, whatever the future role of CCT holders and their equivalents (and employers remain committed that the CCT and equivalence routes should be the standard that says a doctor is capable of full independent practice in their specialty), they will also continue to look for, recruit and use other sorts of doctors to deliver some service, predominantly in what are traditionally called the ‘middle grades’. Having some regulatory standards that support graded responsibility for these doctors, including where appropriate any defined areas of practice where they may be deemed capable of some independent practice, will - we believe - be in the interests of those doctors, their employers and patients.