Open letter to the Secretary of State
A copy of this letter has been sent to Secretary of State for Health and Social Care, Steve Barclay
Dear Secretary of State
The Association of Anaesthetists is pleased to see the release of the NHS Long Term Workforce Plan.
At last, this long overdue document presents a set of long-term goals for the National Health Service with a vision of increased staffing and increased capacity to provide care for our patients. Health care professions have been calling for this for a very long time and all of us hope that this signals a real focus on improving the National Health Service both as a place to receive care and as a place to train and work.
Having taken the time to digest the proposals in the plan in full, we have some specific comments on the content that we would like to raise with you:
Retention of workforce
Worrying numbers of doctors leave at the end of foundation or core training, often to work in health services where the terms and conditions are better while other doctors leave at a later stage in their careers, well before their natural retirement age. This problem cannot be solved by recruitment. Huge investment is made in training a clinician to work in the health service – we need to do all we can to make sure the return on this investment is as big as it can be.
It is disappointing that the plan says nothing about the need to address pay erosion as a necessary part of fixing retention. There is no evidence that public sector pay awards contribute to inflationary spirals. Fixing retention without addressing pay will not work.
Huge investment is made in training a clinician to work in the health service – we need to do all we can to make sure the return on this investment is as big as it can be.
The Plan includes a pledge to ‘Work with stakeholders to ensure growth is sustainable and focused in the service areas where need is greatest’. As anaesthesia is one of these service areas with the greatest need, we would be delighted to work with you to develop solutions to this problem.
Medical associate professions
The plan envisages a large increase in this staff group. The Association is well aware of and empathetic to the concerns this generates amongst its members and will continue to advocate in the future. It is of concern that this expansion appears to be planned in advance of regulation. It is also of concern that the majority of anaesthesia associates (AAs) appear to move to the role from the operating department practitioner cadre, itself an important staff group without which theatres cannot function. We reiterate our stance that: AAs must be an addition to the anaesthetic workforce and not a substitute for medically-qualified physician anaesthetists; a robust system of training, examination and regulation must be put in place; the costs of this must not be borne by medically-qualified physician anaesthetists.
Association guidance (produced alongside the Royal College of Anaesthetists), states that it remains for individual departments to decide whether or not they wish to employ AAs based upon their own circumstances and upon assessment of potential impacts on training medical-qualified anaesthetists, which should take priority in any department.
We reiterate our stance that: AAs must be an addition to the anaesthetic workforce and not a substitute for medically-qualified physician anaesthetists; a robust system of training, examination and regulation must be put in place; the costs of this must not be borne by medically-qualified physician anaesthetists.
We understand that the legislative order regulating AAs will be produced by the Department later this year and would welcome the opportunity to work with you in the drafting of this.
Increase in medical school places
We cautiously welcome the increase in medical school places that has been announced as part of the Plan. However, the current workforce crisis cannot be solved by simply adding more people at the beginning of the medical career pipeline – we need to make sure that those starting medical school now stay in the health service by addressing retention issues, including those we mention above.
Changes to medical degrees and medical degree apprenticeships
We have concerns about the introduction of medical degree apprenticeships. We are unaware of any such model being used anywhere in the world and we do not know how any such degree could be delivered. Without knowing much more about this proposal we cannot support it.
While we welcome plans to examine the fitness for purpose of the traditional five-year medical course and believe it may be possible to optimise the time taken from starting medical school to becoming a specialist, some concerns remain.
It is unclear whether apprenticeships and shortened medical degrees would be recognised and accepted by employers outside of the UK and choosing this educational route could leave future clinicians unable to practice abroad. We believe questions around the practicalities and the portability of these qualifications need to be addressed before the policy is developed any further.
Training places
While the commitment to more medical specialty training posts is a welcome one, we are disappointed that anaesthesia was not included on the list of specialties dealing with the greatest shortages. We know from our membership that many anaesthetists are unable to continue their training journey due to the lack of training places at the pinch points of the anaesthesia core and specialty training programmes and would ask you to make sure anaesthesia is included in any planned expansion of training.
Anaesthesia plays a key role in addressing the increasing waiting lists and without an expansion in this workforce, efforts to meet this patient need will be very difficult. We remain concerned that the timeline for the changes suggested are too long.
Alternative Career Pathways
We welcome the acknowledgement that there are a large number of doctors outside of traditional training programmes who need to be offered the opportunity to further advance their careers. We would like to see policies put in place to make sure that all doctors in all departments are offered these opportunities and supported as they progress through them. There needs to be greater recognition of the potential of doctors in SAS and locally-employed posts. They must be given greater opportunities to develop their skills and progress their careers in ways that benefit them and the NHS.
Additions to undergraduate training
We are pleased to see plans to include compassionate leadership and psychological wellbeing as part of updates planned to the undergraduate curriculum. In light of the research carried out by the Association during our Fight Fatigue campaign, we would also like to request that the curriculum for undergraduates includes education about preventing, recognising and addressing the effects of their own fatigue.
Digital Staff Passport
We welcome the announcement that a digital staff passport is planned. We know from our membership that both trainees on rotation and those planning to retire and return have encountered many obstacles relating to their personal and training data when moving employer – many of which could be addressed by a passport. We would like to see this policy enacted asap and believe that the August 2025 deadline mentioned in the Plan is too far away.
We would welcome the opportunity to meet with you to discuss these issues in person. The Association would also strongly welcome invitations to be involved in any working groups that may be developing any of the new policies included in the plan.