Scottish Government

1. Picturing the future

1 The Scottish Executive Health Department (SEHD) should set out a long-term view of the future to guide service and workforce development, and to influence expectations by:

• forecasting expected change in medical science and other factors likely to impact on service provision;

• providing a vision of the future with mechanisms to refresh that vision regularly;

• establishing data and information flows to support that process; and

• involving key partners.

2 SEHD should publicise, promote and revisit the vision.

2. Demand for doctors
2.1 How doctors work

3 Confirm and co-ordinate a strategy to move towards specialist-delivered services.

4 Promote the recognition of generalist skills as desirable for all doctors.

5 Review the hospital career and training grade structures: This is urgent

• include the staff and associate specialist grades;

• take account of recommendations to modernise the SHO grade;

• consider how short-term service appointments can contribute to the provision of services and the development of the workforce; and

• consider different models for specialists using listing on the Specialist Register of the GMC as the basis for identifying a trained doctor.

6 Plan the training grades to satisfy the need for trained doctors, not to provide service.

7 Give service re-design high priority as a co-ordinated, resourced effort covering primary and secondary care:

• review all current acute service configurations;

• involve patients and public in service re-design; and

• promote enhanced services rather than institutions.

8 Identify and pursue opportunities for managed clinical networks:

• ensure that their essential features are clear and agreed;

• ensure that they are managed;

• develop and co-ordinate networks nationally; and

• explore the linking of employment contracts to networks.

9 Establish a clear position on intermediate care:This is urgent

• explain it to the public; and

• secure the support of the public and the professions for it.

10 Give the development of teamwork high priority:

• involve the public;

• disseminate good practice; and

• build team skills into training.

11 Encourage the provision of more flexible opportunities for employment and career development:

• pursue a more proactive approach to the professional development of all doctors.

12 Address the reallocation of administrative and other tasks currently carried out by doctors, to maximise the use of doctors' clinical skills.

2.2 Doctors in remote and rural areas

13 Define:

• remote and rural practice;

• core services for each remote and rural community; and

• standards by outcome, allowing variation in methods to achieve them.

14 Conduct an option appraisal for maintaining acute services in small hospitals.
This is urgent

15 Politicians, managers and professionals to engage with and involve the public in the process of determining effective, sustainable services. This is urgent

16 Maximise effective use of all staff through flexible arrangements for service provision supported by networks:

• accelerate and extend use of managed clinical networks.

17 Establish remote and rural strategies for staff development but linked to proposed regional planning provisions.

2.3 Understanding the demand for doctors

18 Establish working assumptions for the numbers of specialists and other doctors required and keep them under review. This is urgent

19 Gear the numbers of doctors in training posts to the future numbers of trained specialists required.

20 Address pressures on working hours and how they may be resolved. This is urgent

21 Explore the role of non-training experiential posts below the level of specialist.

22 Address shortage specialties and their direct and indirect effect on service.
This is urgent

23 Pursue:

• service re-design;

• teamwork; and

• managed clinical networks.

24 Increase the recruitment of doctors: establish how that is best achieved.

25 Identify ways in which the use of IT can lead to more effective use of doctors' time.

3. Supplying doctors
3.1 Recruitment and retention

26 Manage recruitment:

• set national and local targets; and

• establish authority and accountability of those responsible for meeting targets.

27 Promote Scottish medical careers:

• facilitate local incentives within a national framework;

• promote a positive Scottish identity; and

• engage schools and education institutions.

28 Maximise retention: This is urgent

• delay retirement by step-down and return options;

• improve scope for and attitude to flexible training and working; and

• address morale factors, including positive changes in work practices.

29 Take particular actions for remote and rural areas through:

• selective additional investment;

• rural 'packages' for doctors and other health professionals and their families;

• targeted recruitment, training and career planning for remote and rural practice; and

• arrangements for continuing professional development and for maintaining clinical competence.

30 Maintain and support the contribution of overseas doctors:

• include their interests in reviews of career and training grades.

31 Support academic and research medicine:

• recognise its needs and accommodate within workforce planning processes.

3.2 Supply from the education sector

32 Explore increased output from Scotland's medical schools by: This is urgent

• quantifying the case for further increase;

• providing for mature entry and improved social diversity; and

• enabling some or all of St. Andrews graduates to complete their clinical training in Scotland.

33 Review student support systems to facilitate wider access to medicine:

• particularly for mature students.

34 Review funding for additional cost of undergraduate teaching (ACT):

• seek a new system for ensuring sufficient high quality clinical teaching; and

• recognise that ACT funding largely supports acute services in the teaching centres.

4. Planning the workforce - improving the process

35 Establish much larger managed health economies for Scotland than presently exist covering workforce planning and all services except those highly specialised services which have to be managed at a national level.

36 Take action to ensure that workforce data and information is generated, collected and validated in a timely way. This is urgent

37 Develop a coherent, nationally-led medical workforce planning system as a part of the workforce development arrangements in the SEHD response to Planning Together.