The Nicholson challenge was set out in 2009 as a project for the NHS to make efficiency savings of £20bn, and it is often misrepresented as a drive to cut services to do less of the same. But it is, in fact, something more challenging – the need to spend £20bn of what we have in an entirely different way.
Part of that must involve changing the balance of medical staffing. There is clear evidence that the majority of health and social care need is in long-term conditions, and yet we still run a health service designed around emergencies and elective admissions.
The number of doctors completing training in secondary care is projected to increase from 35,100 in 2010 to over 61,000 in 2020, and yet there are already insufficient consultant vacancies.1
Secondary care continues to encourage applications in order to fill posts, with little realism about the future. As a result, we
waste millions of pounds training graduates who choose to emigrate or retraining them on high-grade salaries in lower-grade
High-quality primary care and the design of effective integrated pathways reduce the need for hospital admissions, but clinical commissioning cannot function effectively without an adequate workforce.
Even in the South West, where GP vacancies were once unheard of, there is now a vacancy rate of 12% and locums are in short supply.
A combination of an ageing workforce nearing retirement, where 22% are 55 or over, and an increasing percentage of women more likely to work part time are contributing to the pressure.2
We have to persuade half of all medical students to opt for general practice. The ‘carrots’ should be the challenge of generalism and the opportunity for continuity of care that few secondary care posts can offer.
Alongside the increase in GP numbers, there must also be a disinvestment in specialist training posts beyond those required in the long term. Those planning rotations should not duck the workforce challenge.
Some specialists continue to portray primary care as an isolated backwater that treats only minor illnesses, but as the balance of clinical need shifts further towards the elderly with long-term conditions and as GPs take control of commissioning, medical staffing must be adapted.
General practice is an astonishingly varied field. More medical students and junior doctors should be introduced to it and encouraged to apply.
Dr Sarah Wollaston is MP for Totnes in Devon, a member of the House of Commons Health Committee and a former GP
1 Centre for Workforce Intelligence. Recommendation for medical specialty training. 2011. cwfi.org.uk
2 Deloitte UK Centre for Health Solutions. Primary care for today and tomorrow. 2012. deloitte.com