Recruitment and Retention of Health Care Providers in Remote Rural areas

7 Education and Training

7.1 Medical Education

Undergraduate medical training is the responsibility of Universities throughout Scotland. Workforce planning for intake numbers to University is the responsibility of the Scottish Government Health Department, informed by local NHS Board workforce planning. NHS Education for Scotland (NES) are responsible for the design, development, commissioning and Provision of post graduate medical training in Scotland. The delivery of postgraduate medical training requires a partnership approach between Deaneries, NES and local Health Boards. The quality of the training is overseen by the General Medical Council (GMC). There are four Deaneries in Scotland – the North Deanery is responsible for 5 Health Boards: Western Isles, Orkney, Shetland, Grampian and Highland. All North of Scotland Deanery Foundation Programmes (134 posts) offer as a minimum 4 months in a remote or rural placement, Aberdeen-based with a placement in one of the 6 Rural General Hospitals (RGHs). NHS Western Isles works with the North Deanery and is a Local Education provider – offering training placements across all specialities for doctors in Foundation years (FY) one and two and Specialist Trainees (ST). Modernising Medical Careers (MMC) and the new junior doctor appointments process, UK MMC Career Framework, effective from 01 August 2007, have resulted in delays in matching junior doctors to training positions and have left boards with unfilled posts. This appears to have had a disproportionately large effect on remote and rural and island Health Boards.

Stirling University Campus is sited within NHS Western Isles Hospital. The University delivers pre and post registration nurse training. Members of staff from Stirling University have honorary contracts with NHS Western Isles and NHS Western Isles staff have honorary contracts with Stirling University. The funding for nursing and midwifery students comes from the Scottish Government's Health budget. The NHS commissions the number of nursing and midwifery students using mechanisms calculated to meet the healthcare sector's workforce requirements for the future. At present the non means tested bursary is £6578 p.a. On average the NHS Western Isles campus recruits 17-20 undergraduate nursing students p.a. Recruitment comes mainly from the local area, with applications received from: school leavers, Further Education and Higher Education graduates, mature students, those who have completed Access courses, from those who are revising their career aspirations and re-joining the workforce.

Other types of health care education can be studied across Scotland and the United Kingdom; placements for students are available in many of the Allied Health Professions in NHS Western Isles. Most of the health care professionals are trained at a university level. Most university studies take minimum 4 years at Bachelor level.

8 Vulnerability and sustainability of services:

8.1 Medical

The Board faces significant recruitment challenges in Medical training grades and succession planning of some trained medical and surgical posts. A number of initiatives are being developed via key work streams of the Acute Strategic Planning group – particularly in relation to Paediatrics, Orthopaedics, and Obstetrics and Gynaecology. Work is ongoing in conjunction with the North of Scotland Planning group (NoSPG), the Remote and Rural Implementation group (RRIG) and the Remote and Rural Healthcare Alliance (RRHEAL) to look specifically at medium to long term workforce needs and solutions. and with other Health Boards via the development of Service Level Agreements and Obligate networks.

Specific examples where recruitment has proved challenging for NHS Western Isles include;

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  2009. Failure to attract a single applicant to interview or a Consultant Surgeon vacancy.
  
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  2010. Failure to attract a single candidate to interview for a Consultant Physician vacancy.
  
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  2011. Three vacant posts for Junior Doctors in training. Despite repeated advertisements, only one of these posts is currently filled.
  
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  Variable quality and suitability of locum doctors; as the health care environment – covering multiple specialties in very small teams – is unfamiliar to many doctors whose experience has been previously in large teaching centers. This has meant that even though the doctors have the necessary skills and competencies on paper, they often find it challenging to adapt quickly to the local situation and require a significant amount of additional support and supervision, and have, on a number of occasions, decided to leave before the conclusion of their contracted period.
  
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  Vacancies for Island GPs requiring repeated adverts, and successful applicants leaving after a relatively short period.
  
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  Retention of some key staff has been problematic for non professional (family) reasons.
  

There have been problems recruiting to registered/qualified Pharmacy posts from November 2000; some current vacancies having been vacant since March 2007, filled by successive locums. Difficulties include distance to mainland centres, cost of travel, and perceived isolation both socially and professionally; this coupled with the national shortage of specialised clinical pharmacists has placed us at a disadvantage when recruiting to these posts. Various approaches have been used to fill these posts including reviewing and re-grading of posts and development of the service to improve the skill mix within the department Locums have been used for long periods, but these are also becoming increasingly difficult to obtain. Community Pharmacy can and do offer more lucrative packages for newly and recently qualified staff than NHS are able to offer which causes additional difficulties in attracting staff to these posts. These packages are not always just financial but also provision of accommodation has also been used to attract staff. If newly qualified pharmacists want to work in Secondary care and are willing to move around the country etc to gain valuable clinical experience then locum opportunities are many and varied, the locum gets paid more with little or no responsibility to the employing organisation.

NHS Western Isles experiences recruitment difficulties/challenges across a number of health care staff involved in both direct and indirect patient care, particularly in the more remote and rural areas. For example – recruitment of nursing staff in Lewis and the Western Isles hospital does not present a problem – but, in Uist and Barra recruitment to nursing and Health Care Assistant posts can be a challenge. Recruitment and retention of Domestic Assistants and other support staff is a challenge in the smaller remote hospitals and clinics.

JOB FAMILIES & SUB JOB FAMILIES (NHS Scotland)