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Effective strategies in recruitment and clinical orientation programme to manage NHS junior doctor workforce shortfall: a district general hospital experience

Syed Quadery, Hamid Roodbari, Pradeep Pardeshi, Dilip Shah and Simon Winn
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DOI: https://doi.org/10.7861/fhj.7.1.s65
Future Healthc J February 2020
Syed Quadery
AEpsom and St Helier University Hospitals NHS Trust, Epsom, UK
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Hamid Roodbari
BUniversity Of Sheffield, Sheffield, UK
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Pradeep Pardeshi
AEpsom and St Helier University Hospitals NHS Trust, Epsom, UK
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Dilip Shah
AEpsom and St Helier University Hospitals NHS Trust, Epsom, UK
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Simon Winn
AEpsom and St Helier University Hospitals NHS Trust, Epsom, UK
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Introduction

There are significant vacancies of qualified medical professionals across the UK.1 This has partially been filled by locum doctors causing a major financial burden on the NHS.2 To address workforce shortages, the British government has proposed to open five new medical schools to expand national intake by 25%.3 The step rise in medical workforce is unlikely to be felt before 2025.3 International medical graduates (IMGs) currently contribute significantly towards the NHS care provision.4 Recently there has been an increase in the number of IMGs applying to take the UK medical licensing examinations.5 Recruitment of more new entrant IMGs may be the short- to medium-term solution to the junior doctor shortfall. However, IMGs seeking first-time employment in the NHS face multiple challenges.6 A robust orientation programme would anticipate and mitigate such challenges and facilitate smooth transition into productive working in the NHS.7 There is no standardised orientation programme available for IMGs working in departments of general internal medicine (GIM) in the NHS.

Methods

We performed quality improvement interventions of recruitment and a clinical orientation programme (COP) for new entrant IMGs in our organisation employed between December 2017 and April 2019 and developed a framework to anticipate outcomes of these interventions using the realist evaluation methodology.

Results

Twenty-three IMGs were recruited, 96% successfully completed the COP with a mean contract duration of 13±5 months. To date, 83% of eligible IMGs have successfully completed their formal annual appraisal. Over the intervention period from academic year 2017/2018 to 2018/19, the mean junior doctor position occupancy has risen from 54±3 junior doctors to 73±4 (p<0.001). There has been a £1.9 million reduction in agency and locum junior doctor spend in the division. Exception reporting by trainee junior doctors has fallen by 56%. Formal complaints from patients and their families have fallen by 11%. Length of stay has reduced from 9.3±16.4 days to 8.9±15.6 (p=0.035) over the same intervention study period. For the first time since its inception, the Care Quality Commission has rated our organisation including the medicine division as ‘Good’ (from ‘Requires Improvement’) during the academic year 2018/2019. Context-mechanisms-outcomes configurations detailing the methodology of the behavioural changes implicit to the quality improvement work are shown in Table 1.

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Table 1.

Methodology of behavioural changes

Conclusion

Our recruitment strategy and structured COP provides a stable, trained, and financially sustainable junior doctor workforce. Application in broader NHS settings is recommended.

Conflicts of interest

None declared.

  • © Royal College of Physicians 2020. All rights reserved.

References

  1. ↵
    1. Hughes D
    , Clarke V. Thousands of NHS nursing and doctor posts lie vacant. BBC News 2016. www.bbc.co.uk/news/health-35667939 [Accessed 21 May 2019].
  2. ↵
    1. Moberly T
    . Number of locums has doubled since 2009. BMJ 2016;355:i6207.
    OpenUrlFREE Full Text
  3. ↵
    1. Al-Attar M
    . 5 new medical schools to open in England. The Medical Portal. www.themedicportal.com/blog/five-new-medical-schools-open-england [Accessed 16 May 2019].
  4. ↵
    1. British Medical Association
    . The contribution of international medical graduate doctors to the NHS. BMA, 2015 [Accessed 20 May 2019].
  5. ↵
    1. General Medical Council
    . The state of medical education and practice in the UK. GMC, 2018. www.gmc-uk.org/somep2018 [Accessed 08 May 2019].
  6. ↵
    1. Bhat M
    , Ajaz A, Zaman N. Difficulties for international medical graduates working in the NHS. BMJ 2014;348:g3120.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Hashim A
    . Educational challenges faced by international medical graduates in the UK. Adv Med Educ Pract 2017;8:441–5.
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Effective strategies in recruitment and clinical orientation programme to manage NHS junior doctor workforce shortfall: a district general hospital experience
Syed Quadery, Hamid Roodbari, Pradeep Pardeshi, Dilip Shah, Simon Winn
Future Healthc J Feb 2020, 7 (Suppl 1) s65-s66; DOI: 10.7861/fhj.7.1.s65

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Effective strategies in recruitment and clinical orientation programme to manage NHS junior doctor workforce shortfall: a district general hospital experience
Syed Quadery, Hamid Roodbari, Pradeep Pardeshi, Dilip Shah, Simon Winn
Future Healthc J Feb 2020, 7 (Suppl 1) s65-s66; DOI: 10.7861/fhj.7.1.s65
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