In-depth review of the acute medical care workforce Final report

Executive summary

The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) and Health Education England (HEE) to conduct an in-depth review of the acute medical care workforce in England. The review covered all fully trained physicians who contribute to acute medical care including, acute medicine specialists, geriatricians, and physicians from a number of other specialties. The CfWI analysis focused on doctors with a certificate of completion of training (‘CCT holders’) or equivalent. Typically these specialists are employed in the NHS as consultants.

The CfWI looked ahead 20 years to 2033 to assess whether, under a range of plausible future scenarios, there is likely to be a balance between patient/service demand and supply of CCT holders. The CfWI’s projections show there is considerable uncertainty about both demand and supply, leading to a suggestion of no change to current acute medicine training numbers until more information is available.

The key benefits of this work are to:

 support longer-term workforce planning on issues relating to this workforce, up to 2033  support robust decision-making, taking account of future uncertainties  help decision-makers be more alert to the emerging risks to this workforce as the future unfolds.

Context and explanation of key terms

‘Acute medical care’ is a branch of secondary healthcare in which a patient receives active but relatively shortterm care for an episode of acute medical illness or an urgent medical condition. This care generally comprises the first assessment of an acutely ill patient including initial supportive treatment, relevant diagnostic tests, diagnosis, assessment of the severity of the illness and initial treatment, which may include referral to more specialist services including, on occasion, surgical services. The quality of this initial, acute medical care is an important determinant of clinical outcomes.

Acute medical care is generally considered to last for the first 48 to 72 hours of a patient's admission to hospital with an acute medical condition, or a shorter period should the patient be discharged or die. Such services are generally, but not exclusively, delivered in Acute Medical (admissions) Units (AMUs) or Emergency Medical (admissions) Units (EMUs). The CfWI identified a wide range of names for such units during the course of this review and a configuration of services that also varied, but to a lesser extent. The daily patient intake to such a unit is colloquially referred to as ‘the acute take’, so we have used this terminology in this report. Acute medical care is provided by doctors from several medical specialties (sometimes called ‘physicianly specialties’), as discussed in this report. Units providing acute medical care generally have key interfaces with emergency medicine (A&E) and critical care (including intensive care) facilities.

During the course of this review the CfWI identified acute medical care specialist services that may have important workforce implications in the medium to longer term. These include not only the almost universal provision of coronary care services (for suspected myocardial infarction and other critical cardiological conditions) but also, for example, specialist stroke services and those for acute gastrointestinal haemorrhage. The medium to longer term impact of these developing services on workforce demand and supply in acute medical care has not been possible to estimate in this report as such services are far from universal and their actual configuration is highly variable. The CfWI believes these services will require additional attention over the next five years or so, as data becomes available, as they have the potential to impact significantly on the acute medical care workforce and on demand for undifferentiated acute medical care services. Some of these points are picked up in the future participation rate estimates made by the expert panel (see Section 6).

The CfWI approach

For this review, we drew on the expertise of more than 70 stakeholders including those who participated in horizon scanning, scenario generation and elicitation workshops. The CfWI engagement was complemented by desk research. For previous recommendations by the CfWI about this workforce, please see section 1.3 of the report.

Key research findings

 The groups of doctors which contribute most to acute medical care and which, therefore, are included in the CfWI modelling are: o Acute medicine specialists (single CCT holders) – note that this is a relatively new specialty o Geriatricians (the majority of whom are dual CCT holders)

www.cfwi.org.uk