Paul Buckley 3a

Every doctor has a story. The data we hold is like a rough sketch or silhouette of their career journey: from medical school, to training, through successive revalidations, until the retirement

For the past ten years we’ve been filling in the detail through The state of medical education and practice in the UK report, with surveys and qualitative studies adding depth to the picture.

To mark the tenth edition of our flagship report, our Director of Strategy and Policy Paul Buckley looks back at some of our milestones.

1. A strategy is born

Ten years ago, we became aware of our potential to derive insight, using our data on registration, education and fitness to practise. Our merger with the Postgraduate Medical Education and Training Board would bridge a vital gap in our intelligence on training progression.

The idea to connect the dots emerged from the review of the implications of that merger led by Lord Narendra Patel who recommended that we look at data differently, across medical careers, to identify specific systemic problems, and inform better policies.

So in 2011, we published our first edition of The state of medical education and practice in the UK  highlighting key registration statistics. The analysis was basic, but it was an important starting point in helping us think more strategically about the workforce.

2. Identifying risk factors

In the early years, the report was very focused on fitness to practise and registration data and policy. We found complaints about probity of a doctor were more likely to meet our threshold for investigation than complaints about clinical care because of the different kinds of concerns they raise. It was also found that previous complaints could be an indicator of future problems.

But the Mid Staffordshire Inquiry, which shone a light on serious system and individual failings in 2013, underscored the need for a cohesive, holistic approach to data about the environment for practice – the workplace – and for data that is tailored to the needs of stakeholders in each UK country and, increasingly, region.

3. Time for training

The state of medical education and practice in the UK is not a stand-alone product. It’s at the heart of a nexus of research and evidence that helps us understand and support the profession.

A major trend highlighted in our studies has been the growing demand for flexible training. Linear progression is no longer the norm for many doctors. And increasingly this is rightly seen as a positive choice rather than a problem – building greater experience, confidence and leadership capability, benefiting trainees and patients alike.

The system has started to respond by growing the number of less than full time training posts. Meanwhile, sustained effort across the system following our 2017 report Adapting for the future has given trainees greater freedom to switch specialities without having to start at square one.

4. Overseas graduates

The story over the last decade has been one of significant growth in the medical workforce. In 2011, the number of licensed doctors in the UK was 226,682. Now there are more than 297,700.

Most of that growth reflects an increase in international joiners, with more and more overseas graduates choosing to live and work in the UK. They make an amazing contribution despite the barriers they often face along the way.

We must make sure they have every opportunity to thrive and develop rewarding careers, so they’re able to be here for the long-term, if that is their wish. Evidence from The state of medical education and practice was instrumental in our decision to launch Welcome to UK practice, our support programme for international graduates.

It has also influenced our thinking about workforce strategies across the health services and the need for reform that could help these doctors more easily progress to roles as GPs and consultants.

5. The lived experience

From the start we were clear there’s no point generating insight for the sake of it. It’s only of value if it’s actionable and can feed into policy development. And there is no point in drawing attention to problems without devoting similar energy to what the solutions might be.

That’s why, in recent years, we’ve been developing a qualitative evidence base on challenges impacting the workforce, such as leadership and workplace inclusion, to help add nuance to the growing store of quantitative data and to influence policy development.

6. A ‘state of unease’

Numbers sometimes don’t provide the whole picture. It’s important we make clear how we are interpreting our findings in a way everyone can understand.

We’ve worked hard to make sure our analysis gives a fair reflection of the pressures doctors face on a daily basis. In 2016 on the basis of the findings of our work, we warned of ‘a state of unease’ in light of growing financial strain and anger over the junior doctors’ contract. In 2017 we said the profession had reached a ‘crunch point’, making good policy decisions absolutely crucial for the future of patient care.

7. Focus on wellbeing

Our annual barometer survey, which informs The state of medical education and practice in the UK , helps us understand more about doctors’ wellbeing and the pressures they’re facing.

It’s surprising and heartening that we’ve seen some reported improvements in key areas of support and teamworking this year.  Over half of doctors (54%) saw a positive changes in the sharing of knowledge and experience between colleagues while nearly two fifths of doctors (38%) reported more visibility of senior leaders in patient care.

But many doctors are feeling exhausted and we’re concerned that more doctors with a high risk of burnout have seen patient safety or care compromised.

8. Need for equality

It’s been a difficult year for everyone in healthcare but it’s disconcerting some groups have been disproportionately disadvantaged.

Our survey revealed that black and minority ethnic (BME) doctors were less likely to share positive experiences of workplace changes this year. Improvements in teamworking were reported by 52% of white doctors, but only 44% of BME doctors.

We’ll keep using our growing evidence base to push for fairness for all doctors. More than half the doctors who joined the medical register in 2020 identified as BME, so change is more important now than ever.

9. Open access

We know our data can make a difference and think anyone who could benefit should have access to the best most up-to-date information.

The state of medical education and practice in the UK is one way we share intelligence but new tools mean we can publish key figures every day.

Our Data Explorer allows anyone to interact with our database and create their own data journeys. Users can get live data on the make-up of our register, including doctors’ nationality, ethnicity, gender and specialist status.

10. The next decade

Data will be crucial to monitoring the long-term impact of the pandemic on doctors.

Our mission now is to ensure the right evidence is provided to the right people at the right time. New technology will enable sharing and analysis on a new level.

Work is also underway to fill key gaps in our data, for example around doctors’ scope of practice and work patterns.

We’re excited to see how the workforce story develops and hope we can be a positive influence by driving changes that benefit doctors and patients.

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