RCSI suggests ways to fix medical staff recruitment and retention problem

Separating acute and scheduled surgery must be part of the solution to address difficulties in recruiting and retaining medical staff, the Royal College of Surgeons in Ireland has urged.

The RCSI wants advanced nurse practitioners and physician associates to play a greater role in supporting doctors in the diagnosis and management of patients. Upskilling pharmacists and physiotherapists will also help address complex issues faced in medical workforce planning and better serve patients' clinical needs.

The recently published National Doctors Training and Planning working group acknowledges that smaller hospitals' reliance on junior doctors poses a threat to patient safety. The report acknowledges the risk to the safety and viability of smaller hospitals with a disproportionate number of non-consultant hospital doctors in non-training roles.

RCSI president, Kenneth Mealy, said the college's national clinical programme for surgery has made the same point over many years:

Non-training roles offer limited training opportunities to staff. Where these are not available, the challenge of attracting both consultants and non-consultant surgical staff is apparent.

“We have repeatedly said that these complex issues can only be addressed by reconfiguring our surgical services, separating acute from elective or scheduled surgeries. In addition, we need to look at the expansion of non-medical grade roles such as advanced nurse practitioners and physician associates, as well as the upskilling of pharmacists and physiotherapists. In many cases, the care delivered by healthcare professionals in these roles are more appropriate to serve the clinical needs of patients.”

Mr Mealy said medical workforce planning is challenged worldwide with the increasing complexity of care required by many patients and changes in societal expectation: “If we fail to grasp the logistic impossibility of staffing small hospitals which can neither offer high-quality care for complex patient needs or satisfy reasonable career satisfaction and advancement for our medical workforce, we will continue to repeat the failed workforce planning models of the past and perpetuate the compromised delivery of acute surgical services seen in this country”.

The working group which drew up the report included clinical lead Prof Des Carney of the Mater Hospital in Dublin and Prof Frank Murray, director of the HSE National Doctors Training and Planning (NDTP) service.

Mr Mealy welcomed the endorsement of the NDTP report by the Board of the HSE: “We look forward to supporting the recommendations of the report in order to create a sustainable health service workforce”.