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Ian Cumming: ‘The NHS is about careers, not jobs’

Ian Cumming: ‘The NHS is about careers, not jobs’

In an interview with Angela Sharda, Health Education England (HEE)’s chief executive Professor Ian Cumming discusses how the organisation is ensuring the NHS workforce is fit for purpose
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Professor Ian Cumming OBE is the man tasked with fixing the NHS’s recruitment and retention crisis. He became the youngest ever chief executive of Lancaster Acute Hospitals NHS Trust when he was just 29 and was appointed chief executive of HEE in 2012.

Speaking to Angela Sharda, Professor Cumming says the road to better healthcare will be a journey: ‘We are not pretending that it will be easy. It is not; it requires a lot of investment and effort but we believe that is what we need to do.’ But despite the evident pressures of working in the NHS, he thinks there are many rewards and those who join it will be rewarded with ‘many career opportunities that you won’t find in smaller organisations’.

What is the workforce plan for 2017?

We are looking at the number of people we have in the professional groups and regions and comparing that with the demand both inside and outside the NHS to make sure the country is producing the number of people we need for the future.

How are we doing with the target to recruit 5,000 GPs by 2020?

HEE is boosting the training pipeline so we have 3,250 people going into general practice training on an annual basis. The historic average has been to recruit 2,700 doctors to postgraduate GP training. We have increased that in recent years. This year we had a record year; we recruited just over 3,000 to GP training and are now recruiting for starters in 2017. Those numbers are up on the same time last year. We are aiming to get 3,250 doctors in general practice this year.

How are you promoting that?

The Nothing General about General Practice campaign has been successful, exploring the interesting and varied career options general practice can give. We have been looking at targeted recruiting in parts of the country where we haven’t had GP trainees recently. We have been looking at flexible opportunities to link training to working or volunteering overseas – a range of options to make sure that people see this as a rewarding and fulfilling career.

There’s the core GP training, which we offer to everybody, but we have also been looking at giving the opportunity to take an extra year to develop special skills that they could use in general practice – it could be psychiatry, paediatrics, musculoskeletal services, orthopaedics and so on. We are linking these extra opportunities in areas that are under doctored.

What are the biggest challenges for the next 12 months?

I said at the NHS Confederation conference that the biggest challenge is retention of the existing workforce.

In the time HEE has been in existence, we have increased the number of nursing training places every year by 15%, which is unprecedented. We have 1,500 extra medical student places. We have achieved 100% fill rate for postgraduate trainees in emergency medicine. We have started to get the training numbers we want in some specialties. We have more work to do in psychiatry and general practice, although we are going in the right direction.

The training pipelines are building and many of the issues are being resolved. We need to make sure the NHS is seen as an employer of choice as people finish their training, that we are looking after the workforce and that they want to stay with us for the majority of their career.

Retention is critically important and we have a big variation across the country. We need to pay as much attention to keeping the workforce as we do to training anew. 

You have said that millennial GPs are increasingly unwilling to work full time. How do you propose to make the profession more attractive?

It’s not just GPs. The reasons are many. People are wanting a different work-life balance; they are wanting more than one role, perhaps to work in a hospital for part of the time. We have seen a growing number of women coming into medicine, which is something we have been striving for, but women are more likely to want to work part time than men, because they are likely to take more of the childcare responsibilities in the household. Therefore, as the percentage of women in the workforce grows we see the number of hours coming down.

The other trend that has been well documented is that the millennials are not following the same linear career pathway as the baby boomers. They want more of a work-life balance, are less motivated by material possessions, a big house or a big car. They want more time to go on holiday or do something different. I was talking to a doctor recently who had gone through medical school and was now going to travel the world for three years, not working as a doctor, then come back and pick up
a medical career. You wouldn’t have seen this 20 years ago. If this becomes a trend, we need to train more doctors to meet the demand.

We are seeing a growing number of GPs choosing to be salaried. They want clearly defined hours and pay and to know when they will get holidays. 

What is being done to make general practice more attractive?

The key issue is striking the right balance between the number of graduates we train at medical school and the number of postgraduate places we have. Until recently, there has been a mismatch. Last year, we had about 1,500 more postgraduate training places than we had output from medical schools. That meant we recruited 1,000 doctors internationally. We have around 400 vacancies because there are not enough doctors coming through medical school. From 2018, we will be training 500 extra medical school students, and another 1,000 in 2019. As they feed through, we will match the demand for consultants and GPs of the future.

Bright young graduates could be paid double in other sectors, such as IT. If they join the NHS, how will you keep them?

If we take postgraduate medical training, it is widely recognised as among the best in the world, which is why we have so many people applying to train at postgraduate level in this country.

The NHS offers many career opportunities you won’t find in smaller organisations. I started off as a biomedical scientist, did a management training programme funded by the NHS, then worked for a health authority. I have been a trust chief executive, then took an interest in public health, then in education.

The NHS is about careers, not jobs. We want people with the values and behaviours to build a career in the NHS. Taking IT, the opportunities in the NHS are enormous. We must be one of the largest employers of IT staff in the country. If you think about where technology is going in the delivery of healthcare, we need huge infrastructure – being able to share anything from human genome sequencing to MRI scans, second opinions and data following patients. The NHS is probably never going to be the highest payer of IT staff, but it’s a very rewarding career and I think many people are looking for more than just money. There’s the reward of working in healthcare and the career options that go with it.

NHS Improvement chief executive Jim Mackey said that the unremitting pressure on staff is undermining their resilience. How will you tackle the pressures on the workforce?

We need to make sure we are investing in our existing workforce and their education and training. We give people a fantastic opportunity to grow and develop a career. It’s recognised that when money is tight, the opportunities are not as great as they used to be. One of the things we are looking at is how to bring people in as support workers, to get them to demonstrate their commitment to the NHS. In return, we will invest in their education. Nurse practitioners can take a two-year training programme to become a registered nursing associate, and then we give them opportunities to become a registered nurse. We know that people we invest in become loyal members of NHS staff. We need to give people a rewarding and varied career, opportunities to pursue specialty interests, to grow in leadership and management roles. It’s about the whole package of how you look after your workforce. 

How do you see the new models of care, especially the GP-led multispecialty community providers (MCPs) and trust-led primary and acute care systems (PACs), boosting the primary care workforce, especially attracting students to become GPs?

How we deliver primary care is changing very quickly. The model that is working is that of multidisciplinary teams. It’s not just about a GP. A GP is a critical role in the primary care team and is often the leader. But you need other people as well – practice nurses, physician associates, pharmacists. Not only are we focussing on producing 5,000 new GPs, we are also working with NHS England to increase the rest of the workforce – putting 1,000 extra physician associates into primary care by 2020, increasing the support workforce by 4,000.

The problem with the numbers is that we are talking about a net increase – not just what is coming through the training pipeline but to replace people retiring or leaving for other reasons. We are not pretending that it will be easy. It is not; it requires a lot of investment and effort but we believe that is what we need to do.

Angela Sharda is deputy editor of Healthcare Leader

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