- The lid comes off the ceiling!

In a letter to College presidents, specialty representatives, postgraduate deans and chief executives of the Workforce Conferations, the ‘allowance’ of 400 new centrally funded and 1516 new locally funded NTNs was confirmed.

This effectively removes the severe ‘ceiling’ restrictions on new posts. The major arguments for this change of heart are:

• The dawning reality of the impact of the European Working Time Directive (EWTD) on acute specialties.
• The need to bolster cancer and surgical services and their supporting specialties.

Funding the new posts
Central funding or a mixture of central and local funding was reserved for a number of shortage specialties, including general and old age psychiatry, histopathology and radiology (as widely anticipated) but did not include geriatrics or any other clinical medical specialties

Locally funded new posts are more numerous with the largest numbers going to general surgery (200), anaesthetics (160), paediatrics (100), respiratory medicine (150), and T&O (90). Local Workforce Confederations are expected to find the funding within trusts from reallocation (e.g. SHO or Trust grade posts) or from new internal money.

Good news for our specialty
At least 2 months ago, we were given strong hints that our manpower arguments in the specialty (well rehearsed in BGS Newsletter articles and greatly strengthened by our internal workforce surveys) had been favourably received. Geriatrics has been awarded 80 NTNs (10 of which have already been allocated). Our allocation, amongst acute medical medicine, runs ahead of endocrinology & diabetes (70), gastroenterology (50), and cardiology (40). The distribution for geriatrics by Workforce Confederation is indicated in the table.

Implementation of the proposals is now being entrusted to the recently established Workforce Development Confederations (WDCs) and local postgraduate deans with advice from the specialty lead deans, in our case Professor Cochran from Glasgow. He has the responsibility of distributing the posts in geriatrics fairly, especially to places offering good training but hitherto denied adequate SpR allocation. It is also expected that there may be some ‘horse-trading’ between WDCs (those who can and can’t support trainee posts): and we also have to grapple with the changed ‘workforce boundaries’ from the old Regional Health Authorties and related deaneries to the WDCs!

Fishing in a shallow pond
This change of heart by the Government gives us significant challenges, not least competing with other medical specialties for good trainees. It will be several years before the expansion of medical schools feeds through to SpR level. To ‘feed’ the SpR grade in the more immediate future, there is a proposal, supported by the Medical Workforce Review Team, to convert up to 1300 SHO posts (all specialties) to SpRs. Distribution of these posts and implementation of scheme is still being finalised. We will continue to rely on overseas graduates and must do all we can to encourage the conversion of non-training grades into trainees. We also need to create new rotations between teaching and non-teaching hospitals.

The nature of the job
The EWTD has already radically altered the nature of the work in acute medical specialties, some would say ‘dumbing down’ of all grades. Already many registrars involved in acute medicine are doing what would hitherto have been regarded as SHO or HP work (on take or covering wards when others are on take) and in national surveys have expressed their dismay at being pushed into shift systems. If large numbers of SHO posts are converted to SpRs, this situation can only worsen. Already training in geriatric medicine has been severely eroded by the dominance of acute medicine and it will be increasingly difficult to put together attractive new training programmes which will fulfil the requirements of the new SpR training programme. So, we still have a few problems to solve!

Alistair Main
Chair, BGS Workforce Committee