I read the latest edition of JTO with interest and noted the comments from the Editor regarding 'physician associates', as well as the feature by Anandu Nanu. Certainly it is possible that other allied healthcare professionals can be used to provide valuable service and this can potentially improve the training of junior doctors; perhaps medical support workers can be more cost effective and useful in this regard than physician associates, as much potential junior doctor training time is wasted doing many lowly skilled bureaucratic tasks.
The significant underlying barriers to improving training remain unaddressed by the introduction of more allied staff however. The fundamental root problems include government enforced austerity, the resultant widespread NHS deficits, huge budget cuts to HEE and an unfunded service expansion being pushed amidst a drive for an utterly unachieved £22bn of 'efficiency savings'1-4. Then combine this government ineptitude with a perfect storm in terms of an unpopular inadequate new junior doctor contract which is only catalysing a marked deterioration in junior doctor recruitment and retention5,6. The overall result is an inevitable deterioration of the quality of surgical training.
Training can only be improved with adequate government investment which may then both address the dire recruitment and retention of staff, as well as increasing staffing levels to absorb the less useful service provision currently performed by junior doctors. In the current financial and political environment, the introduction of more allied health professionals can only be of benefit to training if they are in addition to the current workforce. In the current environment it is far more likely that junior doctors will be replaced, rather than added to by these new staff; and this can potentially harm training further by increasing the burden on the remaining doctors. Fundamentally without adequate funding, training quality is only going one way.
1. CBS. Written evidence to the Public Accounts Committee by Cass Business School. February 18th 2016.
2. PAC. Managing the supply of NHS clinical staff in England. Fortieth Report of Session 2015–16. 27th April 2016 2016.
3. Dunn P MH, Murray R. Deficits in the NHS. The King's Fund. 2016;http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Deficits_in_the_NHS_Kings_Fund_July_2016_1.pdf.
4. Campbell D. Secret documents reveal official concerns over 'seven-day NHS' plans. Guardian. 2016;https://www.theguardian.com/society/2016/aug/22/secret-documents-reveal-official-concerns-over-seven-day-nhs-plans.
5. Campbell D. Almost half of junior doctors reject NHS career after foundation training. Guardian. 2015;http://www.theguardian.com/society/2015/dec/04/almost-half-of-junior-doctors-left-nhs-after-foundation-training.
6. Dean b. The new junior doctors' contract will create a staffing crisis in the worst possible places. Telegraph. 2016 2016;http://www.telegraph.co.uk/news/2016/04/28/the-new-junior-doctors-contract-will-create-a-staffing-crisis-in/.