This document summarizes feedback from a medical workforce strategy engagement event. It identifies 7 common themes that emerged from the feedback: career promotion, cultural change, integration/collaboration, leadership, recruitment, training & development, and use of the multi-disciplinary team. Under each theme, it outlines specific feedback and considerations related to improving Wales' medical workforce strategy. It also provides examples of good practices that were highlighted from different organizations.

1. Introduction
From collation of all of the feedback
provided on the day. Examples of good
practice and 7 common themes emerged:
1. Career Promotion
2. Cultural Change
3. Integration/Collaboration
4. Leadership
5. Recruitment
6. Training & Development
7. Use of the Multi Disciplinary Team.
Career Promotion
There is a need to ensure we are getting
the right numbers into medical school.
Early promotion of medical careers
into secondary schools will promote
understanding of all the different
specialities available. At schools challenge
the perceptions about who can become a
doctor. Promote Wales as a place to train
and work.
Culture Change
Create a culture with capacity for holistic
medical decisions. Challenge behaviours
to adopt best practice. Professional
competence needs to be defined. Tasks
need to be based on competencies &
outcome measures including user and
staff satisfaction. Staff wellbeing is
important and will increase productivity.
Commitment to providing the best care
and make changes to improve quality.
‘Trying to change the wings, whilst
flying the plane’. Some risks highlighted
were loss of good will; escalation
fatigue; failure to act now; increase in
demand and not enough staff to deliver;
understanding the demands of our
population.
Co-production/self care needs to be
explored further; prevention and
population education is needed to help
the promotion ‘to choose well’. Team
working needs to include patient, carers
and also the voluntary sector. Create a
vision of the future to meet expectations
of the patient.
Medical Workforce Strategy
Engagement Event Feedback
26th April 2016 – Cardiff City Stadium
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2. Integration/Collaboration
Need to recognise the problems/
challenges but look at what is working
well and find collaborative building
solutions. Risks highlighted were the
difference in terms and conditions;
lack of integrated workforce planning;
performance managed rather than
quality; engagement between secondary
and primary care medical staff, there
are pockets of good practice but also
variation.
There is a need to disseminate examples
of good practice that is evidence based
to clinicians to support change. Greater
collaboration across Health & Social Care
and Health Board Boundaries; defined
evidence based targets which span
health & social care. More of the same
will not work; need a system view to
allow working across the health system;
identify services which could shift
from secondary care along the patient
pathway; roles based on patient need
that span across primary and secondary
care; new models of care which are social
care focused.
Leadership
Primary Care leadership needs to drive
changes in how secondary care is
delivered. Develop GP’s within cluster
to be leaders. Clinicians continue to
work in professional silos and clinical
leadership models need to ensure we
don’t move to more of the same, but
increase productivity. Understand the
business challenges to work more
effectively and manage the medical
workforce. There are good professionals
in Wales but the system and culture
requires change. There is also need to be
clear about the leadership requirements
within the job description. Leadership
linked to patient outcome, co-creation
of leadership model; have strong role
models; leadership to affect behavioural
change; increase recognition of the value
of medical leadership; create time to do
leadership roles outside clinical delivery
role; better job planning for leaders/
medical staff; create a structure for
leadership in medical roles not just CD’s
but those with interest/experience.
Recruitment/Retention
Need to make sure the contractual
arrangements are competitive within
Wales. Hosting trainees by one employer
can be attractive for mortgages etc
and one employment check. The posts
also need to be attractive which offer
education/management/research
opportunities and work life balance which
is attractive. Build on the good examples
of overseas recruitment and explore
the opportunities for medical training
initiatives for overseas doctors.
Need to make Wales an attractive place
to train and stay and consider if all Wales
rotations are attractive. Retention needs
to be better and we need to indentify
retention issues for doctors and the wider
team. The Primary Workforce Plan is
positive however we have lost GP’s and
it is difficult to recruit. Current models of
Primary care are not attractive to young
doctors.
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3. Extended hours in primary care are not
wanted. When GP’s take up positions in
Wales there is generally positive feedback
- the challenge is attracting GP’s/Trainee
GP’s to small parts of Wales in the first
place. Are we excluding potential GP’s
from the recruitment process into medical
schools by focusing on the higher grade A
levels?
Some potential risks are geographical
variation; impact of tertiary centres on
recruitment in other parts of Wales;
aging workforce; over reliance on
locums; unfilled posts; perception of
Welsh Government by trainees outside
Wales; strategy uncertain with future
configuration of hospital service; future
loss of expertise, mentors/career
development and workforce figures need
to be questioned more by Health Boards.
What is the offer for Wales?
Welsh students undertaking a medical
degree as a second degree having
financial support to do so; marketing the
welsh offer more effectively - debunk
the myths; Incentives for taking salary
GP positions; portfolio career; Tailor one
offering with financial incentives to work
in Wales e.g. fees written off; recruit and
retain Welsh trainees; trainee rotation
between primary and secondary care;
Physician Associates must start.
Training & Development
Having an All Wales Deanery is an
advantage and the standard of training
within Wales is good with a breath of
experience of trainers, good feedback
from students and examples of using
geography as an advantage e.g. Bangor,
ED fellows, MD/PGc. Introduce rural
medicines early in GP training (already in
Powys).
Some of the risks highlighted;
subspecialisation / smaller pool; focus
on service provision with the expense of
training; insufficient numbers through
medical school to meet number of
training posts; deanery timetables and
lead in times to deliver alternatives; route
of entry – a challenge and elitist, hidden
entry criteria; training and workforce
planning not linked; lack of experience of
community skills in hospital environment.
Is medical training and the order
appropriate at medical schools, Shape of
training?
Increase posts in CCT fellowship in GP;
move to a 4 year GP training scheme;
engage doctors in training in quality
improvement; uncoupling of training
& service delivery, to much focus on
trainees to provide necessary service
provision; more flexible be-spoke training
programmes; Review routes into medical
training – more 4 year programmes and
time in primary care; 7 day working
planed medically; focus on trainee
experience and develop strategies in
some specialities; need to expand the use
and pace of technological advances. The
availability of data in primary care and
the understanding of demand/need to
support education numbers is a concern.
#ASMWG
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4. Use of the Multi Disciplinary
team
Continue the development of Advance
Nurse Practitioners, Clinical Nurse
Specialist, Paramedic Practitioners and
Pharmacist Prescribing. The workforce is
aging which may also be an opportunity
to change roles. Decision making is
convoluted there is a need for a whole
system balance to the health of our
population. Understand firstly the needs
of patients in the future, numbers,
expected health statistics. Then consider
the right workforce in the right numbers
to respond adequately to that need.
The work of a GP needs to be more
enjoyable again, workload manageable,
through the use of multi disciplinary team
working. Not focused solely on academic
roles rather what is more suitable?
Challenge the received wisdom about who
can do what. Doctors with an overview
can lead clinical pathways staffed
by other professions. A doctor is the
diagnostic leade but doesn’t necessarily
need to deliver the care. Develop new
roles/working differently and consider
prudent health care.
Understand the role of the doctor, what
are they here to do, what can only be
done by doctors. Look at what skills we
in need in NHS not just professions.
Consider the non medical workforce
skills and the impact on undergraduate
education. Need to expand the multi
disciplinary teams and more thought
required on more permanent layer of
doctors/other professions to fill trainee
positions. Use the medical workforce
wisely.
Examples of good practice
highlighted:
• Chief Registrars Pilot
• Creative solution re gaps – Hywel Dda
• CRT Innovation in Diabetes
• Joint service & academic posts
• Cluster (I-Care)
• Primary Care Support Units
• ‘Spirit’ Gastroenterology Training Focus
• Danish Model
• Southampton University Model
• NUKA Model
• Mountain Medicine
• Scottish Fellowship Model
• Valleys & West Wales GP schemes
• C21 and placements across Wales
• RAID.
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