By Jeremy Groves, Consultant Anaesthesia and Intensive Care

“Sometimes when the high and mighty make big plans they don’t always think about the fine detail

Mrs Ogg – from “The Thief of Time” by Terry Pratchett

Making room for 25 % more trainees. I  absorbed Jeremy Hunt’s announcement in his speech to the Conservative party conference that there will be “up to 1500” more trainee doctors a year, thus increasing medical student places by “up to a quarter”, with mixed feelings.  Surely more doctors, in view of our current shortages, particularly in general practice and in acute specialities such as emergency medicine and intensive care , must be a good thing.  So why the mixed feelings?  Well there are several reasons.

When I started my career in ITU in Chesterfield in the mid 90s, I was frequently the only ‘medic’ on the floor.  Periodically we would have a trainee attached and, for maybe 6 weeks a year, a medical student.  Now the situation has changed.  Admittedly the unit has expanded considerably but occasionally there are six of us: two consultants, one on the unit and one for follow up/HDU, the night registrar, the day registrar, an F1 or F2 (occasionally both) and a medical student. This morning we had, in addition to our excellent pharmacist, two trainee pharmacists.  All of these individuals (and I include some of my colleagues here) need training and sometimes, dare I say it, restraining!

Because of the national shortage of medical trainees we are struggling to cover our HDU.  The proposed solution is to use a non-medical workforce such as advanced critical care practitioners or equivalent.  Now I’m all for developing the skills of  our nurses and therapists, and my colleagues and I were even discussing this on our unit last week, as we have some advanced care practitioners in the pipeline.  But the question we are grappling with is how they will be trained and who will train them?

I already struggle with DOPs, CBD’s & mini CEX for the medical workforce we’ve got.  Add a 25% increase to the number of medical students (who will become junior doctors) and how will we satisfy the additional training needs?  You can bet your bottom dollar that although there may be plans afoot to build more medical schools or cram more students into the existing ones, the next stages of training will be left to chance.  There’s unlikely to be more money to facilitate it and no more veins for them to train on!

There is another issue that Mr Hunt didn’t allude to in his speech.  How to retain existing staff, both doctors and nurses?  I’m starting to think about retirement being in the fortunate position that I’m likely to be able to retire early.  I don’t dislike what I do, but if the working environment was better, and if I wasn’t subjected to constant doctor bashing in the popular press and I didn’t get so many exhortations from NHS England to work more for less, I and many others like me, could be more inclined to stay on for a few years.

Now that could significantly enhance the medical workforce.

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