Almost every medical specialty in Ireland is undermanned, but the NDTP’s series of workforce planning reports aim to create a robust, evidenced-based framework to correctly align patient needs and medical specialty numbers, according to Prof Eilis McGovern, Director of the HSE NDTP unit.
“We all know that almost every specialty in Ireland is undermanned, so the first thing we look at is unmet need and then, on top of that, future development, and we look at population trends, epidemiology of disease in the particular specialty, models of care coming down the road, technological advances and pharmacological advances, variables like feminisation, which affects part-time work, and emigration,” she told delegates attending the recent Irish College of Ophthalmologists (ICO) Annual Conference in Killarney, where she spoke exclusively to the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>).
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<strong>Prof Eilis McGovern, Director of the HSE NDTP unit</strong>
Prof McGovern said the NDTP’s workforce planning reports are “very powerful tools for specialties, for hospital services, for Hospital Groups, for policy-makers, for them to see that there is evidence and what can they afford to prioritise within that”.
“Now the Programme for Government is talking about multi-annual budgeting for the health service, and a 10-year plan, so now the health service is being enabled to make policy decisions for a number of years, whereas up until now they couldn’t do anything beyond a year because their budget was just for a year.”
In September last year, the NDTP published its first specialty workforce planning report on general practice. The landmark document confirmed there was a major undersupply of GPs in Ireland and that Government policy on introducing universal healthcare meant there would be a huge rise in demand for GP services.
“Workforce planning itself is something that you absolutely have to do, because when there is a clear plan about where the needs are, the Department of Health and the HSE can respond with a longer-term view as to how to address the problems,” Prof McGovern told <strong><em>MI</em></strong>.
“That’s why I think the GP report we did was very powerful, because it was the first time there was a document that was well researched, had good evidence behind it that said ‘this is the scale of the problem’.”
The report had a range of recommendations, which covered the short, medium and long term, and covered various scenarios where substantial numbers of extra GPs would be needed, such as the extension of free GP care to under 12s, under 18s and full universal healthcare. The report showed there was a need to significantly increase the annual intake into GP postgraduate specialist training, as well as for innovative recruitment and retention strategies, Prof McGovern explained.
She welcomed the Government’s recent commitment to increasing the number of GP training places to 250 within the next five years. “I think that is fantastic and I think without that evidence it was unlikely that they would have done that.”
Prof McGovern confirmed that the NDTP’s next workforce planning report is for the specialties of paediatrics and neonatology, which she told <strong><em>MI</em></strong> is due within the next three months, and then emergency medicine, which is due later this year.
“The other one which is about to commence is anaesthesia and critical care. We also plan to cover ophthalmology down the line — all the medical specialties, psychiatry and so on.”
Continuing, Prof McGovern noted how the HSE’s clinical programmes influence medical workforce planning, “as they are the design for the delivery of each specialty for the future”.
“So in paediatrics, their model of care is based around consultant-delivered care with extended consultant presence. Because of that, they will need more consultants and we have responded to that by increasing intake into the paediatric training programme, because we are trying to be ready for when the programme rolls out, that we will have the specialists ready to take up post.”
The need to carry out these “very labour-intensive” workforce planning reports for so many specialties means a requirement for more staff within the NDTP, which currently has just 14 staff to carry out all three of its functions (medical education and training, workforce planning and consultant appointments), Prof McGovern said.
“The content has to be robust and the research meticulous. It is not something that you can do quickly. It takes a long time.
“We are hoping to get additional staff to help us to double-up on those reports, because we are just doing one at a time at the moment and we need to be completing that first cycle of the specialty-specific reports… And then they will be done on a rolling basis, every two-to-three years, but we really need to get that first cycle finished and in order to do that, we need to be able to double-up to do so.”
During her presentation at the ICO conference in Killarney, Prof McGovern highlighted the difficulties that arise when trying to collate accurate information on the amount of consultants working in each specialty in Ireland, which she said varies widely according to each source, such as the Medical Council, postgraduate training bodies, HSE employment data and medical directories.
She said the best source of data on the number of consultants working in the public system is the HSE payroll, which highlighted that there are a number of consultants on contracts of indefinite duration or in locum posts who are not contained in official HSE workforce data on approved posts.
“To find the number in the private sector, we have to go to the medical directory, to Google, to the websites for private hospitals and then we crosscheck with the public/private ones. It is very labour intensive,” Prof McGovern revealed.
The NDTP is now aiming to have captured all consultant and GP posts within a database of its own by the end of the year, “so we won’t be reliant on the payroll one… Which will be much more effective”.
The database, which is being put together with the assistance of the Medical Council and hospitals, will also collate the numbers and breakdown of interns and NCHDs across the hospital system.
“So we will have accurate figures. That will allow us to, number one, produce reports, and number two, to be a resource for people looking for data, both within the health service and externally.”
In addition, because the database will contain details such as the doctor’s date of birth, it will allow better planning for retirements, which has been a long-standing issue in the HSE, particularly with niche specialist consultants.
“At the moment that information isn’t available, so I think that is very exciting. So this will facilitate, ahead of time, imminent retirements so that we can trigger the recruitment process in a more timely way. Everybody agrees there is a need for that. One of the reasons it has been done so poorly up to now is we don’t have the data to support systems that allow us to have a national approach to this. So I think that database will be very useful. ”
<p class=”subheadMIstyles”>Intern controversy
There has been growing controversy over the last few years about the insufficient amount of available intern posts for non-EU medical graduates of Irish medical schools.
However, Prof McGovern is of the view that it is not the State’s responsibility to provide all non-EU graduates with such posts. She said given that there are now 725 CAO and 600 non-EU medical students enrolled every year in Irish medical schools, it was never intended that there be over 1,300 intern places.
“There are so many international students. While there will always be some intern posts for them — but I think their level of expectation has increased — we will never be in a position to deliver one for every one of them. The intern posts are not needed for service — we don’t need any more… but we have already increased from 500 to 727 over the last number of years to accommodate the increased graduates coming out of our medical schools.
“The main rationale for an intern post is to allow the person to get the certification to allow them to get on to the permanent register of the Medical Council. It was never intended to have those posts for all the international students. They are told that from the start. So there are enough posts for our own CAO graduates and there is a surplus, but it is unlikely everyone will be happy [with that].”
However, Prof McGovern said she “sympathised” with the medical schools for taking in so many non-EU students, who are charged high fees.
“They are under-funded by the State and they have to explore the international student market as a method of increasing their funding, as the State has limited and reduced their funding. So we can’t criticise them for then trying to look after the interests of those students. They have been encouraged to take them in so the State’s commitment to the universities can be reduced. So we can’t really turn around and then criticise them for trying to look after their welfare.
“But at the same time, there is a mismatch there in terms of expectations. It was never the State’s position that there would be an intern post for every one of them. They are told at the start that they are not guaranteed an intern post; they might get one, but it is not guaranteed, whereas the CAO graduates are guaranteed a post.”