Very little is surprising any more in the politics of the NHS.
But last week the Health Services Journal (HSJ) reported that the General Medical Council (GMC) had written to NHSE calling for it to “Directly tackle the perception that there is a plan for the health service to ‘replace’ doctors with PAs (Physicians Assistants) or AAs (Anaesthetists assistants) by convening and leading a system wide discussion on agreed vision for these roles”.
Charles Massey, CEO of the GMC, was “worried about the discourse about medical associates on some social media could impact on the health services ability to attract and retain people in these roles and thereby affect the delivery of the long-term work force plan”.
The HSJ goes on to report that Massey asks that NHSE should be more explicit about plans to safeguard medical training as these roles are expanded.
(There is a specific and important issue about what is happening within the Anaesthetists profession which I will discuss tomorrow).
The GMC seems to see its role as being to amplify the concerns of some doctors about whether they will have a job in the future. It strikes me that rather than providing a megaphone for those concerns they should be dealing with them themselves.
Does the fact that the GMC gave these concerns more traction mean that there are people in the organisation who seriously think there is a secret plan to ‘replace doctors?
And if there aren’t why are they amplifying the idea? Because October 2023 is a very odd time to do so.
If the intention of NHSE, the Government or anybody in a position of power were to ‘replace doctors’ they would have been dismayed by the way in which these same institutions, only a few months ago, committed to the biggest expansion of doctor training ever. The NHS Long-term Workforce Plan – to spend billions of pounds of public money to train more doctors – involves doubling the number of medical degree school places and, by 2031, increasing them by 15,000.
So it would appear that the main evidence we have for a secret plan for replacing doctors is that there is a public plan to spend billions training more of them than ever before.
Given they know there is a public plan to train many more doctors why are people (including the GMC) talking about possible plans to “replace doctors”?
Given that all this is patently absurd what is really going on here?
By writing this letter the GMC is demonstrating that it is taking a side in this debate. It is playing an active role in the argument, which will intensify over the next decade, concerning the skill mix needed to provide health care. (With not only big changes over the next decade but even more in the decade after that, and more again in the decade after that.). All those changes taking place in the working lifetime of a doctor.
The issue is not ‘replacing doctors’; the issues are in part the rest of the workforce plan. On the periphery of the main Long-term Workforce Plan – to spend billions on training more doctors (who will apparently be replaced as soon as they have been trained) – are some calls for radical change.
- There is an argument for shorter medical degrees (so eloquently argued by Lord Darzi).
- The development of medical apprenticeships.
- The greater use of new technology both in the teaching and learning of medical studies and in placements.
- An increase in nursing apprenticeships and yes,
- An increase in associates.
All of these are changes in the skill mix to work in health care. And in the way those skills are attained.
The somewhat bizarre suggestion that all of this is aimed at replacing doctors is a deliberate attempt to discredit these necessary changes.
If this really were a plan to abolish the medical profession, then quite rightly a lot of people would be alarmed.
But it isn’t.
The reality is not that doctors are replaceable but that in the next decade their role will radically change.
Some of the decisions that they now take, based upon their training and experience, will be taken by artificial intelligence. An individual doctor uses their experience of many hundreds of cases to make good decisions. They would argue (and they would be correct) that the more experience they have of making those decisions they have the better those decisions will be.
Artificial intelligence bases its judgement on hundreds of thousands of cases.This isn’t replacing doctors, but it is changing their role. There will be more doctors.
The last 20 years have seen an increase in nurse and pharmacy prescribing. Over the next decade this increase is likely to continue. This will not abolish doctors. There will be more doctors.
In primary care the roles of health trainers and social prescribing staff will increase considerably. This will not abolish GPs, Did I mention that there will be more doctors?
For the last few weeks, I have been using this blog to discuss how we need to develop and implement a long-term plan for the NHS and social care. The issue I will discuss this week is of vital importance to that process.
Given our aging population the next ten years will see more sick people who will live with illness for a little longer.
To allay people’s fears, I promise that there will be enough sickness to keep everyone busy.
But to help treat that sickness there will have to be changes in the roles.
The General Medical Council, along with the Nursing and Midwifery Council, will play an important part in helping to ensure that there are sufficient healthcare professionals to treat all of that sickness.
But not if it wants to debate a fairy tale about how doctors are being replaced.