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No quick cure for doctor problem

Has the Scottish Government performed a U-turn over trainee doctors?

It seems clear that a change of direction has taken place. Additional training posts are being brought online in emergency medicine, acute medicine, paediatrics and anaesthesia.

In 2009 these were identified as specialisms which were to be prioritised so reliance on junior doctors could be reduced.

Additional posts are being created in a number of other areas where there are now shortages. It appears to be a problem of the Government's own making. In moving towards making the NHS less dependent upon doctors-in-training, the Scottish Government committed in 2009 to the presumption that services would be delivered by trained doctors. This was a laudable goal and welcomed by many in the medical profession.

The British Medical Association concurs that the principle of ensuring services are delivered increasingly by qualified doctors is a valid one. However the policy seems to have been undermined by a failure to recruit sufficient consultants to make up for the falling numbers of junior doctors, as health boards followed directions to cut trainee posts by up to 40 per cent.

Without sufficient senior doctors to support a smaller number of trainee doctors, junior doctor posts in parts of the NHS such as accident and emergency departments have become extremely stressful and unattractive. Turnover is high, as are vacancies. This is a vicious circle and the sooner it can be reversed, the better.

The Scottish Government is now talking of a need for balance and continuing to encourage trainees to come to work in Scotland.

This follows health secretary Alex Neil's announcement this week that he wants to make Scotland more attractive than anywhere else in the world for junior doctors to work.

Whether that amounts to a U-turn will be debated by Mr Neil and his political opponents. But it seems plain there is a crisis in recruitment in key specialisms.

Workforce planning is not the easiest task, especially in medicine where training a new doctor can take the best part of a decade.

However ministers appear to have tried to bring about change too rapidly and fallen foul of the laws of unintended consequences.

Additional training posts in a range of specialisms may help, but there is no quick fix.

In some parts of the NHS 48 per cent of training posts are currently being filled. Increasing the number of posts in itself plainly will not solve this.

The power of word of mouth is strong and when departments or specialisms have acquired the reputation of being bad or stressful places to work, that will take time to rectify.

Attracting more junior doctors from overseas may well help, but needs to be combined with a fresh look at rotas and work-life balance.

Fewer demands placed on doctors, especially at an early stage in their careers, can only be of benefit to the health service.

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