New skills will bring new challenges for #FutureNHS. But the biggest will be the need for speed.

Over the next decade the NHS will only thrive if we develop a better skill mix in every aspect of health care. If we are to achieve this with much more speed and confidence most of the system will have to change.

Yesterday’s post raised questions about why the General Medical Council (GMC) had asked NHSE to deny that they were planning to ‘replace doctors’. I raised serious concerns about why the GMC might want to frame the debate in this way.

Today’s post, still developing the importance of skill mix in the present and future NHS, argues that part of their specific problem is that the GMC has been let down by the rest of the system – including successive Governments. I don’t like slogans as a way of describing issues, but this really is a ’whole system’ problem.

Over the next decade, and in the decades after, there will, with ever increasing speed, be substantial change in the skill mix that works on the ways in which the building blocks of health are created and the way in which health care is delivered.

Intellectually everyone agrees that’s the case. Technology will change and change again, and how we all work with new science will change our work yet more.

What that means in practical terms is that very different people will be carrying out very different activities in health development and health care delivery. As I suggested yesterday, in 10 years’ time, in the NHS, there willbe many more doctors. And alongside them there will also be a larger and more varied workforce working on the health care journey,

Existing categories of staff will still be carrying out their activities, and new categories of staff will be working alongside them. A few carrying out existing activities, and many new ones. For this to work effectively we need a system which will work speedily and with the confidence to not only help the present workforce change and the new one work alongside them, but also to ensure that the public are part of the process.

If the whole system does that well the NHS will thrive. If it doesn’t, we will be in big trouble.

And, as we shall see this really is a ‘big whole system’ problem.

But the current row about physician and anaesthesia associates is a pretty poor augury for our ability to help these changes run smoothly.

“Doctors have launched a campaign to curb the rise of unregulated assistants being deployed as a short-term fix to plug gaps in the NHS workforce”.

Daily Telegraph 26/08/2023.

There is already a general unease about associates working with doctors, and the current big row is about anaesthetists’ associates.

Far be it for me to suggest that the Telegraph is wrong, but the row has not been caused by associates plugging a gap in the workforce it has been caused by part of the Long-term Plan suggesting that they are not plugging a gap – in a temporary sort of way – but are here to stay.

They have been plugging a gap for nearly 20 years. The problem, in the summer of 2023, is that the Government planned – and NHSE agreed – that there would be 2000 of them by 2036/7. The Long-term Work Force Plan demonstrated that they would be a part of the workforce for a long time. (there’s a clue in the title).

It is this permanence that has led to the problem – culminating in their 17th October 2023 meeting where thousands of members of the Royal College of Anaesthetists passed motions hostile to this growth in numbers of associates.

These associates have been working with their colleagues since 2004. That’s nearly 20 years of working together where one of the aims of their introduction was to “enhance the working lives of our members of the perioperative team by freeing them up to work outside of theatres”.

But recently there have been some social media activity which has left these members of staff feeling very uneasy. After 20 years of working together.

If those people who say there will be radical changes in the skill mix of the workforce are right (and they are in the majority), this is an example of the organisational politics of this issue going in the wrong direction and we cannot afford this.

What can be done to make this change smoother?

First of all, it is a bit shocking that these members of staff (new 20 years ago) are still not fully regulated.

In July 2019 DHSC supported by all 4 national governments asked the GMC to begin the process of regulation. Their helpful outline of the process shows the work they are doing on this. These processes will however need legislation which has not yet been introduced.

If I and others are right and there are to be a large number of different new jobs and roles in the next decade, they must be working in regulated conditions. But we can’t have to have a new Act of Parliament for each one. It may seem a boring part of the process, but we need legislation which gives the Secretary of State the right, every year, to ask the GMC and the NMC to develop regulation for a range of new jobs,

We need to be able to commence the whole process speedily and not have to wait for the drafting and passage of a Bill on each occasion. The creation and passage of legislation is a very slow ‘big system’ issue that hampers the smooth day-to-day changes the NHS needs to treat as business as usual.

If, for example, the legislation is not in the King’s speech next week this present mess will worsen for another year – which we really can’t afford. Staff, and increasingly patients, will be made anxious.

In future years the Secretary of State will need to be able to ask the GMC to get on with regulation speedily as the issue will arise again and again.

Tomorrow, I want to stay with this issue but move from the mechanics to the need to have strong arguments in favour of the new.