In the July Newsletter (p9), I mentioned your Workforce Committee’s efforts to increase the numbers of trainees for our specialty.

In our representations to the Workforce Numbers Advisory Board (WNAB) we emphasised our concern that no new posts had been offered last year despite our estimate that we would need an increase of 125 trainees a year to meet projected consultant numbers. We highlighted the extra demands as a result of the European Working Time Directive, a higher proportion of SpR time spent performing general medical duties, and new services arising from the NSF for Older People

The headline results of the consultant recruitment survey (pages 14-15), confirm that these pressures are already being felt and are resulting in substantial consultant recruitment difficulties in parts of the country.

Can we increase the numbers of trainees?
The Government’s plan to increase the number of doctors by 15,000 over the next few years is widely known. WNAB has recognised the increased pressures on doctors in the NHS. In July 2002, its chairman wrote to Postgraduate Deans, announcing that in addition to the 300 SpRs currently being dis-tributed (none to geriatrics), there would be new funding for an additional 400 SpRs and 200 GP Registrars for 2003-4. However beyond 2004, no new funding is planned and the share for our specialty of the new posts for 2003/4 is likely to be small (10-20 nationally). Furthermore, new central funding is likely to be focused (as this year) on shortage specialties likely to embarrass the Government by pushing up waiting lists (path-ology), or stacking up people in A&E Departments (radiology). So the impact of new funding on our specialty is likely to be small, and numbers of new NTNs allocated to our specialty is also likely to be small despite the impetus and pressure resulting from the NSF for Older People.

WNAB has developed the notion of ‘floors and ceilings’ for new posts. The floor for the specialty is the minimum number of newly funded SpRs in a particular year (2002/3) – none for geriatrics. The ceiling is the number which can be funded by 2004 (funded and unfunded) - 10 for geriatrics nationally, distributed by discussion between the lead dean for the specialty (in our case Professor Cochran in Glasgow), and advised by the SAC. So far, rather disappointing.

However new ‘flexibilities’ in the ways in which new NTNs can be created are being introduced, provided that local funding can be found, and these may be used to increase the floor target and hence the total numbers.

So how can we increase our numbers of trainees and their conversion into consultants?

Make the cake bigger
The Workforce Committee has been and is arguing, not just for a larger share of the ‘cake’ but for a larger cake! The arguments most likely to hold sway are to do with the ‘acute access’ agenda – around the way that new posts would contribute to the smoother working of acute hospitals, e.g. specialist input into A&E Departments to assess frail patients or support for admission avoidance schemes in Intermediate Care.

Use the new “flexibility”
Under the new ‘flexibility’ arrangements, unfunded NTNs can be developed by converting current educationally approved posts into SpRs. Money used for Trust grade doctors could go to fund new SpRs and recognised SHO posts could be converted to SpR posts.

Increase the “flow” out of SpR schemes
We could encourage Visiting Trainees to stay (as many in our specialty wish). We could also minimise the training period by critical review of the need for ‘out of programme‘ training. Finally, we could convert ‘LATs’ into accreditable potential consultants.

Using what we have got
We need to capitalise on the welcome focus on older people in the wake of the NSF, but in the short term, demand for consultant time is likely to outstrip supply. Nice for the trainees, not so good for the rest of us!

In the longer term it is emphasised (as highlighted in our last Study Day) that an increase in trainees is not the only measure to be taken to reduce the pressure on doctors. We can adopt changes in skills mix and more imaginative cross-cover arrange-ments. To inform the process of using the new ‘flexibilities’, WNAB is undertaking a scoping exercise via the Postgraduate Deaneries to assess the feasibility of offering new SpR posts to Trusts in all specialties. The timetable is tight, and if you haven’t heard about it by now it is probably too late for this year. However the exercise is to be repeated periodically.

In a subsequent article I will report to you the early experiences of establishing a new weapon in the armoury – the GP with a Special Interest (GPSI) in Older People (for now, see President’s column ) .

Alistair Main
Chair: BGS Workforce Committee