Introduction

From collation of all of the feedback provided on the day. Examples of good practice and 7 common themes emerged:

1. Career Promotion 2. Cultural Change 3. Integration/Collaboration4. Leadership5. Recruitment6. Training & Development 7. Use of the Multi Disciplinary Team.

Career Promotion

There is a need to ensure we are getting the right numbers into medical school. Early promotion of medical careers into secondary schools will promote understanding of all the different specialities available. At schools challenge the perceptions about who can become a doctor. Promote Wales as a place to train and work.

Culture Change

Create a culture with capacity for holistic medical decisions. Challenge behaviours to adopt best practice. Professional competence needs to be defined. Tasks need to be based on competencies & outcome measures including user and staff satisfaction. Staff wellbeing is important and will increase productivity. Commitment to providing the best care and make changes to improve quality.‘Trying to change the wings, whilst

flying the plane’. Some risks highlighted were loss of good will; escalation fatigue; failure to act now; increase in demand and not enough staff to deliver; understanding the demands of our population.

Co-production/self care needs to be explored further; prevention and population education is needed to help the promotion ‘to choose well’. Team working needs to include patient, carers and also the voluntary sector. Create a vision of the future to meet expectations of the patient.

Medical Workforce Strategy Engagement Event Feedback

26th April 2016 – Cardiff City Stadium

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Integration/Collaboration Need to recognise the problems/challenges but look at what is working well and find collaborative building solutions. Risks highlighted were the difference in terms and conditions; lack of integrated workforce planning; performance managed rather than quality; engagement between secondary and primary care medical staff, there are pockets of good practice but also variation.

There is a need to disseminate examples of good practice that is evidence based to clinicians to support change. Greater collaboration across Health & Social Care and Health Board Boundaries; defined evidence based targets which span health & social care. More of the same will not work; need a system view to allow working across the health system; identify services which could shift from secondary care along the patient pathway; roles based on patient need that span across primary and secondary care; new models of care which are social care focused.

Leadership

Primary Care leadership needs to drive changes in how secondary care is delivered. Develop GP’s within cluster to be leaders. Clinicians continue to work in professional silos and clinical leadership models need to ensure we don’t move to more of the same, but increase productivity. Understand the business challenges to work more effectively and manage the medical workforce. There are good professionals in Wales but the system and culture requires change. There is also need to be clear about the leadership requirements within the job description. Leadership linked to patient outcome, co-creation of leadership model; have strong role models; leadership to affect behavioural change; increase recognition of the value of medical leadership; create time to do leadership roles outside clinical delivery role; better job planning for leaders/medical staff; create a structure for leadership in medical roles not just CD’s but those with interest/experience.

Recruitment/Retention

Need to make sure the contractual arrangements are competitive within Wales. Hosting trainees by one employer can be attractive for mortgages etc and one employment check. The posts also need to be attractive which offer education/management/research opportunities and work life balance which is attractive. Build on the good examples of overseas recruitment and explore the opportunities for medical training initiatives for overseas doctors.

Need to make Wales an attractive place to train and stay and consider if all Wales rotations are attractive. Retention needs to be better and we need to indentify retention issues for doctors and the wider team. The Primary Workforce Plan is positive however we have lost GP’s and it is difficult to recruit. Current models of Primary care are not attractive to young doctors.

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Extended hours in primary care are not wanted. When GP’s take up positions in Wales there is generally positive feedback - the challenge is attracting GP’s/Trainee GP’s to small parts of Wales in the first place. Are we excluding potential GP’s from the recruitment process into medical schools by focusing on the higher grade A levels? Some potential risks are geographical variation; impact of tertiary centres on recruitment in other parts of Wales; aging workforce; over reliance on locums; unfilled posts; perception of Welsh Government by trainees outside Wales; strategy uncertain with future configuration of hospital service; future loss of expertise, mentors/career development and workforce figures need to be questioned more by Health Boards. What is the offer for Wales? Welsh students undertaking a medical degree as a second degree having financial support to do so; marketing the welsh offer more effectively - debunk the myths; Incentives for taking salary GP positions; portfolio career; Tailor one offering with financial incentives to work in Wales e.g. fees written off; recruit and retain Welsh trainees; trainee rotation between primary and secondary care; Physician Associates must start.

Training & Development

Having an All Wales Deanery is an advantage and the standard of training within Wales is good with a breath of experience of trainers, good feedback from students and examples of using geography as an advantage e.g. Bangor, ED fellows, MD/PGc. Introduce rural medicines early in GP training (already in Powys).

Some of the risks highlighted; subspecialisation / smaller pool; focus on service provision with the expense of training; insufficient numbers through medical school to meet number of training posts; deanery timetables and

lead in times to deliver alternatives; route of entry – a challenge and elitist, hidden entry criteria; training and workforce planning not linked; lack of experience of community skills in hospital environment. Is medical training and the order appropriate at medical schools, Shape of training?

Increase posts in CCT fellowship in GP; move to a 4 year GP training scheme; engage doctors in training in quality improvement; uncoupling of training & service delivery, to much focus on trainees to provide necessary service provision; more flexible be-spoke training programmes; Review routes into medical training – more 4 year programmes and time in primary care; 7 day working planed medically; focus on trainee experience and develop strategies in some specialities; need to expand the use and pace of technological advances. The availability of data in primary care and the understanding of demand/need to support education numbers is a concern.

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Use of the Multi Disciplinary team

Continue the development of Advance Nurse Practitioners, Clinical Nurse Specialist, Paramedic Practitioners and Pharmacist Prescribing. The workforce is aging which may also be an opportunity to change roles. Decision making is convoluted there is a need for a whole system balance to the health of our population. Understand firstly the needs of patients in the future, numbers, expected health statistics. Then consider the right workforce in the right numbers to respond adequately to that need.

The work of a GP needs to be more enjoyable again, workload manageable, through the use of multi disciplinary team working. Not focused solely on academic roles rather what is more suitable? Challenge the received wisdom about who can do what. Doctors with an overview can lead clinical pathways staffed by other professions. A doctor is the diagnostic leade but doesn’t necessarily need to deliver the care. Develop new roles/working differently and consider prudent health care.

Understand the role of the doctor, what are they here to do, what can only be done by doctors. Look at what skills we in need in NHS not just professions. Consider the non medical workforce skills and the impact on undergraduate education. Need to expand the multi disciplinary teams and more thought required on more permanent layer of doctors/other professions to fill trainee positions. Use the medical workforce wisely.

Examples of good practice highlighted:

• Chief Registrars Pilot• Creative solution re gaps – Hywel Dda• CRT Innovation in Diabetes• Joint service & academic posts• Cluster (I-Care)• Primary Care Support Units• ‘Spirit’ Gastroenterology Training Focus• Danish Model • Southampton University Model• NUKA Model• Mountain Medicine• Scottish Fellowship Model• Valleys & West Wales GP schemes • C21 and placements across Wales• RAID.

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