MR 12

Ymchwiliad i recriwtio meddygol

Inquiry into medical recruitment

Ymateb gan: Bwrdd Iechyd Prifysgol Aneurin Bevan

Response from: Aneurin Bevan University Health Board


Our Ref: JP/RB/jr


18 November 2016



Ms Zoe Kelland

Health, Social Care and Sport Committee

National Assembly for Wales


Dear Ms Kelland


Health, Social Care and Sport Committee’s Inquiry into Medical Recruitment


I am pleased to provide below a response from Aneurin Bevan University Health Board in relation to the Committee’s inquiry, as outlined above.


The capacity of the medical workforce to meet future population needs, in the context of changes to the delivery of services and the development of new models of care


The Health Board has been developing and refining it`s medical workforce model across all sites to ensure that safe and effective services are provided. This has involved the development of new roles and ways of working to address local and national recruitment challenges.


The decreasing number of trainee junior doctors allocated to the HB has and will have an impact on services. Consequently the Health Board has looked to new ways of delivering care and supporting medical rotas, for example, the use of. Hybrid Consultants Medical Training Initiatives (MTIs) Clinical Fellows   and Responsible Clinicians under the Mental Health Act.  Non-medical roles have been developed to reduce pressure on medical time such as Advanced Practice Nurses and Physicians Associate.


To help address gaps in the medical workforce the Health Board has continued to engage in overseas recruitment and this remains an important part of our resourcing strategy.  Where we have been unable to recruit to substantive positions we have relied upon the use of locum and agency staff and the commitment and good will of our Consultants and juniors to provide cover.


General Practice is under pressure through an increase in demand for its services. This is compounded by a national shortage and ageing profile of GPs. 25% of GP`s in Wales are at retirement age now. .  Additionally the increased feminisation of the GP workforce will present challenges in accommodating more flexible working practices.  The Health Board has taken a number actions to help reduce GP workload  for example the introduction of practice based Pharmacists and the use of  advanced practice nurses within GP practices  These interventions  have evaluated well and will continue to be a keystone of our  approach to supporting general practice and our strategy of providing care closer to home.


We also recognise the need to develop our Clinical Leaders both now and in the future as they are critically important in delivering service transformation. Accordingly we continue to review and develop our Clinical Leadership training and development programmes.


The implications of Brexit for the medical workforce


The exact implications of Brexit are unknown. The decision to leave the EU will have potential implications for the workforce as around 6% of people working within NHS Wales are EU migrants many of whom are medical staff. Any changes to their employability to work in the UK will have implications for all services. Protecting NHS employee`s rights to remain in the NHS is crucial for long term sustainability. The recent example of capping the number of tier 5 certificates of sponsorship for MTI doctors from abroad is a case in point.


The factors that influence the recruitment and retention of doctors, including any particular issues in certain specialties or geographic areas

·         Factors that influence the retention and recruitment of doctors are;

  • Doctors need to feel they are appropriately remunerated and valued
  • Wales must be considered a good place to work train and live. The national recruitment campaign sponsored by Welsh Government has started to address these issues. Local recruitment campaigns will support and underpin this approach. It is important that the Aneurin Bevan brand is about being an employer of choice and to this end the quality of the training experience as well as clinical research opportunities offered will be important.  Some of the more deprived areas e.g. Blaenau Gwent are less attractive in terms of recruitment and special packages may be necessary to encourage staff to work and remain in these areas
  • In addition to training and research opportunities the values of the organisation must be appealing to applicants and evidenced by the actions of  the Health Board


  • The opportunity to work in areas of special interest will help attract candidates i.e. a blended /flexible approach to their employment experience
  • The effects of the new junior doctor contract in England need  to be fully assessed for the implications for NHS Wales


The development and delivery of medical recruitment campaigns, including the extent to which relevant stakeholders are involved, and learning from previous campaigns and good practice elsewhere

The Welsh Governments recent launch of ‘Train, Work, and Live’ needs to be kept as a vibrant and dynamic brand.  It could be developed further by bringing local businesses to promote what Wales can offer (I.e. private nurseries, letting agents, schools). We need to build on the campaign and evaluate its success in attracting the medical workforce to Wales.


The development and delivery of overseas recruitment campaigns on an all Wales basis.   Providing overseas doctors with specialty training outside of the MTI scheme could incentivise the prospects of working in Wales. This could also be offered to those UK doctors that have come out of the training programme to develop skills rather than just ‘plugging gaps’ on a rota.


More work needs to be undertaken to promote the medical profession as a career choice. Delivering sessions to schools and sixth form colleges to promote the medical career path and provide more opportunities to growing our own.   Special attention needs to be given to encouraging interest in medical careers from children in deprived areas as they are more likely to want to work and live in these areas


Recruitment campaigns needs to be delivered in a variety of different ways to ensure we capture the younger generation. Better use of social media need to be used to capture a technically savvy audience. 


The extent to which recruitment processes/practices are joined-up, deliver value for money and ensure a sustainable medical workforce


The recruitment process for Consultants is very traditional and needs modernising embracing the concept of values based recruitment used elsewhere in NHS recruitment.


The numbers of doctors going into training are inadequate and the handing back of unfilled posts from the Deanery to the Health Board are often at short notice.  This creates particular issues when adhering to the 28 day resident labour market test. Unfilled vacancies leave rota gaps that are then covered by locum/agency. This is not ideal from a service or patient perspective.


Employment checks are an essential part of the recruitment process but greater portability of checks would ensure a slicker recruitment process and a better experience for the candidate.




I hope the above information is helpful to you.  Should you require any additional information on any of the matters outlined above, please do not hesitate to contact me.


Yours sincerely




Judith Paget

Chief Executive/Prif Weithredwr