CHMS welcomes the Health Committee’s recognition of the need for greater involvement with education providers - education is indeed the only route to a more flexible and productive workforce – an objective which we applaud.
We concur with the conclusion that the new SHAs lack capacity for workforce planning, and, having been at the receiving end of cuts in the educational levies, remain sceptical that SHAs will be motivated to champion effective workforce planning, as recommended by the Report. There is a very significant danger that this will instead result in multiple evidence-free experiments in developing new and amended roles.
CHMS is extremely concerned that the Report has fallen into the trap of extrapolating the work done on competence frameworks to all NHS staff - with the implication that 30 different competences at four different levels would be sufficient for optimal patient care.
It needs to be understood that clinicians, including doctors, are far more than a set of competences. An ageing population, suffering from multiple conditions and taking large numbers of different drugs needs to be cared for by clinicians who understand the scientific basis of disease and of the treatments available and who are capable of dealing with the complexities of diverse interactions. Simple protocols which could be delivered by staff with minimal training cannot be written for such patients.
The Committee heard evidence that skill mix changes have often been poorly conceived and have not improved productivity and yet proposes that role substitution is the route to greater productivity. This puzzles us.
CHMS believes that there must be flexibility but that greater productivity will come from an intelligent assessment of the components of optimal patient care, leading to a re-configuration of service such that each of the professions spends effective and productive time delivering the type of care for which it is most qualified.
CHMS acknowledges that education providers need to be responsive to the needs of the health service and the patients served but rejects the proposal that SHAs be given greater say in the precise content of medical education and control over the number of medical students. The Government’s White Paper; Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century, re-confirmed only last month that ‘Education for health professionals in the UK is demanding and its exacting standards have been crucial in ensuring continuing high levels of public and patient confidence in the clinical practice of those who care for them.’ The Medical Act of 1983 makes clear that the Education Committee of the GMC has to promote high standards and co-ordinate all stages of medical education. This should not change and this there is no role for SHAs in becoming directly involved in the content of the medical curriculum.