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banner Monday, 18 February, 2002, 10:18 GMT
The NHS workforce
It takes years to train doctors, nurses, therapists and other health professionals. Within these constraints, there will now be an unparalleled increase in the number of key staff over the next four years

Pivotal to the success of the reforms are plans to boost the number of doctors, nurses, midwives and other health workers.

The government cannot cut waiting times or open new hospital beds without the trained people to staff them.

Government target: 7,500 more consultants - an expansion of 30% - and 2,000 more GPs by 2004. In April 2002, this was updated to 15,000 doctors by 2008.

There was a net increase of 242 GPs in the NHS in 2000/2001, a workforce survey suggests, coming on top of an extra 130 GPs in the previous 12 months.

This rate of increase, coupled with a jump of 13.5% in the numbers of doctors in GP training, suggest that this target could be met, provided there is no surge in GPs leaving the profession.

However, the 2001 figures reveal that while the overall number of doctors increased, the rise in the number of part-time GPs meant that only the equivalent of 18 new full-time GPs joined the NHS.

An extra 1,390 consultants are working in the NHS in the year ending September 2001, on top of 1,100 extra in the previous year.

Bigger yearly increases will be needed to meet the 2004 target.

Organisations such as the British Medical Association maintain their claims of a "workforce crisis" in the NHS - and suggest reforms have had little impact.

Large numbers of doctors are preparing to retire early, it says.

Government target: By 2004, 20,000 more nurses in the NHS. In April 2002, this was updated to 30,000 nurses by 2008.

Provisional figures (December 2001), show an overall increase of 10,000 in nurse numbers for 2000/2001.

The target of 20,000 extra has been met early, say ministers.

There are still worries over the ability of the NHS to recruit and keep nurses, particulary in areas of the country where property prices are prohibitively high.

Some have suggested that the figures have been boosted by an over-reliance on recruitment of nurses from abroad.

There are also worried that while the overall headcount increase is large, many of the new nurses are part-timers - so the number of extra full-time equivalents will not be quite as impressive.

Government target: By 2004, 6,500 more "allied health professionals" (e.g. therapists or chiropodists) in the NHS.

Figures for 1999/2000 show a 1,400 increase, and in the year up to September 2001 there was an increase of just under 2,000.

However, other figures suggest that creation of new posts is vastly outstripping supply - with a vacancy rate of 4.3% - an increase of 21.6% in a year.

Government target: At least 1,000 extra medical school places announced by ministers before the NHS Plan, plus, by 2005, an additional 1,000 on top of this.

By October 2001, medical school intakes had risen by 950.

Training places for nurses and midwives had risen by 1,300 in 2000-2001.

Government target:A new body called the Medical Education Standards Board to oversee the quality of further training for qualified doctors.

This has not yet been set up - a consultation paper on the form it will take was published in December 2001.

The government pledged to "fundamentally overhaul" the contract by which consultants are employed by the NHS - with a new one in place by April 2001.

It says that newly qualified consultants should have to forsake the extra earnings of private practice for the next seven years, and devote themselves entirely to the NHS.

Negotiations are still in progress on this contract, and on a new contract for GPs, which should be unveiled by April 2002.

The British Medical Association expects progress on the consultant contract by spring 2002, with the contract implemented at the earliest in the summer - but says there are still significant issues to be overcome.

Chief among these is the present - and future - workload of consultants, whose hours have in general increased as reductions in junior doctors' hours have begun to bite.

The government also promised to reform the current "merit award" scheme - which pays lucrative bonuses to the UK's top consultants.

Changes to this scheme should have been put into place in April 2001 - but this has not yet happened.

The government thinks that one way to ease the shortage of doctors and nurses is to make it easier for mothers to combine NHS work and family life.

This includes targets to build 150 new hospital nurseries by 2003 - 20 by April 2002.

Affordable staff accommodation has also been prioritised - by April 2002, there should be 1,500 new units.

So far, 70m has been made available for the nurseries, although it is not clear how many have been set up already.

In the London region, 800 extra accommodation units have been provided with lower than market rate rents.

In addition, the Starter Home Initiative, launched September 2001, will provide health workers with interest free loans of up to 10,000 to get a foot on the property ladder.

Ministers pledged an "ethical" recruitment campaign in the short term, particularly from countries where there is a surplus of doctors or nurses.

It wants 1,000 doctors and 2,000 nurses recruited from overseas by 2004.

Since then, it has signed an agreement with Spain (November 2001) to provide some of these.

Nurses have also been recruited from other countries, such as the Phillippines, but there have been accusations that the drive is draining much-needed staff from health systems which can ill afford this.

By April 2002, every hospital in the NHS should have senior nurses who are in charge of a group of wards - and identfiable to patients - so-called "modern matrons".

The government says there will be 500 in post by that date - with more to follow.

Hundreds of "super nurse" posts have been created - but the government admits that many of them are as yet unfilled.

There are also accusations that in some cases, trusts have been forced to turn to charities to fund the posts.