At the tail end of last year, the Government launched a separate consultation optimistically titled - Liberating the NHS: Developing the healthcare workforce. I read these proposals, as did many of my colleagues, with a deep sense of dismay.
At the core of the ‘vision' there were five key objectives:
- Obtaining the security of supply - getting the right skills in the right place at the right time.
- A workforce responsive to patient needs.
- High quality education and training that support high quality care and greater flexibility
- Value for money
- Widening equitable access to education, training and development.
Within these objectives was a major criticism that postgraduate deaneries within SHAs managed medical workforce planning and education in isolation from the planning and commissioning of education for other healthcare professionals.
The consultation proposed that workforce planning and management functions would be better undertaken by local provider skills networks, taking on deanery functions. Although recognising that the Royal Colleges have an important role to play in devising and delivering education in their specialties, it proposed greater freedom for local education commissioning.
There was also to be a shift from the current training and development funding to a levy-based system with all providers funding the education of their healthcare professionals. A newly formed Health Education England (HEE) would take a strategic overview of the funding priorities.
Deaneries, the pivotal organisation in overseeing training and education were barely mentioned apart from stating that their functions are to be taken on by local provider skills networks. There is, remarkably, no mention of continuing medical education after completion of GP training. Whatever happened to the concept of life long learning? One can understand the rationale behind making education and training more responsive to changing health care demands. But shifting the emphasis to a service provision driven agenda is a high-risk strategy.
We should also not forget that deaneries don't just do education and training. They have central roles in continuing professional development and supporting the quality agenda in clinical commissioning. They can provide essential support for the appraisal process and ensuring standards –a crucial role if the revalidation agenda is to be successfully delivered.
Some deaneries support new GPs coming into the workforce, manage and administer retainer, returner and induction schemes as well as roles in GP performance support. What would be the fate of these schemes if deaneries were destined to disappear?
Parking deaneries within other NHS organisations for six months will also do nothing to prevent their splintering. There will be a sustained loss of skills and expertise, while the loyalty and commitment of educationalists continues to be eroded. As deaneries and SHA's disappear, the ensuing fragmentation and resultant loss of a strategic overview of workforce needs will not result in quality improvement or an increase in flexibility, but will have the opposite effect. Employers will necessarily need to take a short-term view to meet service requirements and ensure contract performance.
The BMA put concerns about the Government's plans directly to the Future Forum, and the Government has conceded that more work needs to be done to develop and revise their plans. However, what we really need is an assurance that deaneries will remain in the long-term.
It is important that we recognise that there are areas where we can improve not just what we do, but how we do it. As members of the medical profession we are ready to work with colleagues, managers and the Government to make this happen. But it is now up to ministers to grasp this opportunity and make sure that we avoid a messy mass reorganisation that needlessly squanders the real benefits that deaneries can deliver to education and training.
Dr Vicky Weeks is a GP in West London, is on the GPC and member of the BMA Education Training and Workforce Subcommittee.
