This is the third of four blog posts about the current issues facing Liverpool Women’s Hospital. The two ealier posts were about the Maternity Services and Gynaecological Oncology The fourth post is about partnership working with Liverpool Univesity Hospitals NHS Foundation Trust
The issues discussed here affect Doctors’ training nationally and need consideration in that way too. Women’s health care matters and requires specialist input. Specialist hospitals exist in the NHS alongside the large acute hospitals. The acute hospital model is not the only option.
The Age Profile of Consultant Medical Staff. Full document here
Doctors pursuing a career as a specialist in the UK must follow nationally recognised training pathways to gain relevant clinical experience and to obtain their advanced professional qualifications. These pathways have evolved over the years. The Calman reforms in the 1990s and Modernising Medical Careers in 2005, for example, funneled doctors into their chosen specialty at an early stage in their careers while the European Working Time Directive in 1998 reduced the year-on-year volume of clinical work that doctors were exposed to while working towards consultant status.
These changes may have improved consultants’ specialised knowledge and skills but they have also made them more reliant upon cross-specialty working when dealing with patients with multiple medical or surgical co-morbidities.
Put simply, consultants who were born before 1970 could be described as being ‘multi-skilled’ whereas consultants who were born in 1970 or later could be described as being ‘hyper-specialised.’
In obstetric, gynaecological and anaesthetic practice, an increasing number of women with significant medical and surgical co-morbidities are now presenting for care who would not previously have done so. In a medical environment populated by hyper-specialised rather than multi-skilled consultants, patient care must therefore be delivered by a range of specalists in a co-ordinated manner, yet this cannot be provided on LWH’s Crown Street site.
This In 2018, 24/47 consultants in the trust’s three acute adult specialties (just over 50%) could have been described as multi-skilled rather than hyper-specialised. In a simplistic model of recruitment and retention, if we accept that one hyper-specialised Consultant will be recruited each time a multi-skilled Consultant retires in coming years, then: · By 2023 around 40% of our consultants will be multi-skilled · By 2028 around 20% of our consultants will be multi-skilled · By 2033 none of our consultants will be multi-skilled. The data show that in the absence of relocation onto an adult acute site, the shift towards a hyper-specialised consultant workforce will add to the clinical risk associated with the trust’s physical isolation in an incremental manner in coming years.
In the absence of relocation, a partial solution to the conundrum of a changing skill set amongst the trust’s consultant workforce would be to increase the opportunities for the trust’s clinical activities to take place in a multidisciplinary environment: (a) Switching work that we presently do at Crown Street onto an adult acute site (b) Bringing specialists from other disciplines onto the Crown Street site. The CEOs of LWH and LUH have agreed to form a Partnership Board in order to address the trust’s accumulating clinicial risk, including the element of risk posed by its changing consultant profile. Details about the proposed Partnership Board model have been provided below, with elements of (a) and (b) above included. Similarly germane, the trust’s ability to recruit new consultants and to retain its present consultants has also been considered later in this paper.