Background
The NHS has witnessed an unprecedented growth in staff numbers over the past decade, with overall numbers rising by just under 300,000 since 1998. However, this staffing growth has now tailed off and the NHS faces increasing funding constraints. There have also been changes in the contracts for NHS staff and changes to professional regulation affecting all health care professionals.
The NHS Plan, published in 2000, identified staff shortages as one of the main constraints facing the NHS. It set a series of targets to increase consultants by 7,500 and GPs by 2,000, as well as an additional 20,000 nurses and 6,500 therapists. In order to achieve these increases the previous government increased the numbers of training places and improved the pay and conditions for staff. The NHS has also continued to recruit a significant number of staff from overseas.
There have been new contracts negotiated for GPs and consultants, which attempt to link pay to performance. Agenda for Change, which was implemented in 2006, rationalised the pay and conditions of more than one million health care staff as well as linking career progression to education and development through the Knowledge and Skills Framework. Between 2004 and 2008 the NHS pay bill rose by £7.5 billion (35 per cent).
The new contracts have helped to standardise pay and are intended to encourage greater flexibility in job roles, but research by The King’s Fund, published in Assessing the New NHS Consultant Contract: A something for something deal?, and by the National Audit Office have highlighted that implementation has been costlier than anticipated, and full benefits have not yet been realised. In 2006 the Department of Health admitted it had underestimated the true costs of the agreements with nurses and doctors by £610 million.
In addition there have been concerns about the way that doctors are trained and how well they perform after they begin to practise.
Modernising Medical Careers (MMC) aimed to rationalise training and recruitment for junior doctors. When it was implemented in 2007 32,000 newly qualified doctors from the UK, EU and overseas found themselves competing for 23,000 posts.
In response to the failings of MMC, the then Secretary of State, Patricia Hewittt, asked Professor Sir John Tooke to lead an independent inquiry. Aspiring to Excellence, the report from this inquiry, recommended the creation of a new national organisation to oversee the training and career development of junior doctors. One recommendation of the report was the setting up of a new body with a remit to cover medical education and training and workforce planning. Following the NHS Next Stage Review’s examination of workforce and education issues in A High Quality Workforce, Medical Education England (MEE) was established. MEE is an advisory body which aims to bring coherence and high level scrutiny of workforce planning, training and education.
The last decade has also witnessed significant public and political concern over well-publicised medical failings such as the baby deaths at Bristol Royal Infirmary and the murder of more than 100 of his patients by GP Harold Shipman. Responding to the concerns these incidents generated, in 2007 the previous government published a White Paper, Trust, Assurance, Safety: the Regulation of Health Professionals in the 21st Century, that proposed a number of changes to the regulation of doctors and other professionals including a requirement for increasing lay representation on governing councils, requiring professionals to be revalidated to practice at regular intervals. These proposals are now being implemented.
