Pressures on the workforce are going to be one of the big challenges for the NHS in a pandemic. One strategy which might help with this problem is to draw upon retired health professionals, who could fulfil a number of possible roles. This approach has been suggested in a number of pandemic influenza plans which we reviewed in Scotland, but little appeared to have been done about working through the practicalities.
We thought that it might be helpful to run a pilot training session in Tayside, which could clarify what is needed to recruit and train retired GPs, pharmacists, dentists and optometrists. The Scottish Government Health Department funded the exercise and, by a fluke of timing, we had set the date for the last week of April 2009.
There were a number of learning points which came out of the exercise. The first issue was identifying and recruiting retired practitioners. GPs, optometrists and dentists were relatively straightforward to find with the help of the Tayside Health Board. Retired pharmacists were more difficult to identify, and in the end this was done partly by word of mouth. It is clearly important for local health agencies working with the professional regulatory bodies to id
entify lists of retired professionals at an early stage, if they are going to be able to call upon these individuals in a timely basis as a pandemic develops.
Our training course consisted of four interactive sessions delivered over a (long) half day:
- Infection control, delivered by a nurse in the public health unit
Resuscitation skills and I-V cannulation, delivered by a GP from the BASIC medical education trust
- Respiratory medicine update including CURB scoring, delivered by a consultant in respiratory medicine
- A brief session on pandemic plans and the potential problems of rationing care, which we delivered ourselves
All of the occupational groups were combined together for the course, and each session was delivered to a group of eight or nine people at a time.
The response from the participants of the course was very positive, although some queried whether the resuscitation session was likely to be relevant for their roles in a pandemic. The approach of combining professional groups together was felt to have worked well.
The participants were pleased that the training provided an opportunity to meet other retired professionals, and that they would be able to keep in touch for peer support. Possible areas in which additional training might be necessary included IT and training systems, and more specific details about the local health board pandemic influenza plan.
There were two areas of discussion which arose from the session. The first was around registration and indemnity issues. The GMC has confirmed that they will be able to register practitioners in a timely fashion, but the issues of risk and indemnity are not entirely clear and remained a concern for the participants. If retired professionals are employees of a board or trust and receive indemnity in that capacity, this may address the issue.
The other area of discussion was about the actual roles which retired professionals might be able to fulfil. Among the suggestions of the participants were: returning to general practice and to community pharmacies to help with pandemic planning and preparation; returning to care for patients with long term conditions routinely and so “freeing up” others to cope with ‘flu patients; helping with telephone assessment services; supporting GPs with a counselling and mentoring role; counselling people pre and post bereavement and providing a reassuring presence in the community based on their experience. Other roles which have been mentioned include death verification and certification.
The retired workforce of health professionals have enormous potential to help meet the challenge of a pandemic, but if we expect them to contribute their expertise and experience they will need suitable training and support some of which can be provided in advance.
Dr Mairi Scott is Director of the Professional Development Academy of the University of Dundee where she is responsible for the delivery of educational programmes for community based health care professionals.
Tom Love has a background in health services research and management. Since moving to Scotland from New Zealand in 2003 he has completed the MSc from the Scottish Graduate Programme in Economics while working on a PhD thesis in the Division of Community Health Sciences at Ninewells Medical School in Dundee.