Addressing health inequalities through alternative workforce models

Our duty to patients, taxpayers and our NHS people is to ensure education and training funds are used effectively and distributed fairly in relation to patient need. Across the NHS, this means we must have open and honest conversations, based on evidence about effectiveness, outcomes, and value for money, about how this money is currently spent and whether it can be spent better.

An example of this is the funding of postgraduate medical training posts, which have so far been distributed across England, based on historical arrangements. These posts are sometimes not well aligned with patient needs and this means they don’t provide the level of some of the services required by local populations. The distribution also does not reflect the availability of clinical opportunities for training.

While doctors in training provide services to patients and are therefore an integral part of the workforce, they are one of many parts. We must take the opportunity to align the numbers of doctors in training with the development of wider multi-disciplinary teams. Better utilisation of the unique and shared skills across our professions enables us to better meet the overall healthcare needs of local populations, regardless of geography.

Over the past 18-months, COVID has shown the extent of health inequalities even more starkly than before and has emphasised the need for us to take action on the fairer distribution of medical specialty training posts based on population need and the better realisation of the potential of all of our workforce.

Health-care workers are critical as agents of social change for inequalities. Public health is everyone’s business. The pandemic has created an opportunity to rethink how we work across all professions to ensure we rebuild more equal services, with public and population health addressing health inequalities as much a part of conversations in emergency departments as it is in primary care.

HEE and NHS England and Improvement are working together to support organisations and systems to build high-quality multi-disciplinary teams, with the right education, training, experience and behaviours.  This will ensure a more equitable distribution of training places across England and the realisation of the potential across all of our professions, supporting providers and systems to transform and redesign workforce models.

An example of this is the Extended Surgical Team. This is a trained multi-professional team, supporting patients across the entire surgical care pathway. It is made up of a multi-professional group of staff bringing together consultant surgeons, doctors in training, SAS doctors, with our extended team of advanced clinical practitioners (ACPs), physician associates (PAs), prescribing pharmacists, surgical care practitioners (SCPs) etc. Teams are tailored to the trusts and specialty pathway and our workforce transformation teams are on hand to facilitate these discussions.

The programme is being introduced through eight HEE supported Extended Surgical Team pilots across England and will be evaluated to enable shared learning and adoption at scale. The first-year report is due to be published at the end of the year.

However, changing the distribution of training programmes is a long-term project that is starting in 2022 and will allow us to better align doctors in training with service and patient and population need in the future. By transforming and shaping modern workforce models in a fully integrated multi-disciplinary way, we will ensure together we can tackle health inequalities, realise the potential of all professions and create a workforce fit for the future.

Best Wishes

Professor Wendy Reid, Director Education & Quality, Medical Director

Professor Mark Radford, Chief Nurse

Beverley Harden, Allied Health Professions Lead