{"id":39763,"date":"2017-08-01T17:57:16","date_gmt":"2017-08-01T16:57:16","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=39763"},"modified":"2017-08-09T11:02:06","modified_gmt":"2017-08-09T10:02:06","slug":"billy-boland-isnt-it-time-for-something-radical-to-sustain-our-mental-health-workforce","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/08\/01\/billy-boland-isnt-it-time-for-something-radical-to-sustain-our-mental-health-workforce\/","title":{"rendered":"Billy Boland: Isn\u2019t it time for something radical to sustain our mental health workforce?"},"content":{"rendered":"

The reality of fewer psychiatrists is a problem that is not going to go away<\/p>\n

<\/p>\n

\"billy_boland\"<\/a>August is here, which means that, usually, consultants up and down the country are ready to welcome new trainees into the fold. It\u2019s an exciting time, and it\u2019s always a pleasure to see enthusiastic new recruits who are keen to help patients, to learn, and to get on with the job. Only this year, many can put a hold on getting the bunting out. No one will be coming.<\/p>\n

Recruitment into core training is looking pretty dire for a lot of specialties, like mine in psychiatry. I\u2019ve had a look at the figures for national recruitment so far<\/a> and it is not good. Round one shows that the fill rate for core training in psychiatry for 2017 is a piffling 69%. Compare that to the 82% we had last year and the outlook doesn\u2019t look promising.<\/p>\n

As far as I can see there are going to be a lot of rota gaps, a lot of outpatient clinics unmanned, and a lot of wards without their ward doctor. Fill rates have been over 80% fairly consistently since 2009, peaking at 91.3% in 2013, although 2014 then saw a slump to 65%, before recovering to 82% again in 2015.<\/p>\n

Yet with rising access to mental health services and a rapidly aging population who are more vulnerable to mental health problems, the reality of fewer psychiatrists is a problem that is not going to go away. So what are we going to do? It\u2019s not like me to not be optimistic, but I\u2019m struggling to see the “green shoots” here. There is no “magic junior doctor tree,” to corrupt a phrase. We may just have to manage without this year. And, with no increase in recruitment numbers in sight, we better brace ourselves for the long term.<\/p>\n

Enter Stepping forward to 2020\/21: The mental health workforce plan for England<\/em>,<\/a>\u00a0which was published by Health Education England earlier this week, and which sets out the latest strategy to address this. There are some great ideas in here. Proposals include the use of personal assistants to support doctors, physician associates to complement teams, and a major recruitment campaign planned for 2018. The report announces 21 000 new posts in mental health, but do we have any\u00a0confidence they will be filled?<\/p>\n

It\u2019s clear some good people are doing good work to try and sort this out, but I can\u2019t see that it will have real impact in time for recruitment next year. The report recognises the effect of the loss of mental health officer status, which used to see\u00a0those working in mental health offered earlier retirement, and which I have previously written about<\/a>. Yet I can\u2019t see a meaningful offer to attract doctors to psychiatry and halt this miserable decline.<\/p>\n

The picture is patchy, with places like London and Wessex doing well (at 100%) to fill their places. However, other regions do much worse, like the North East where I\u2019m originally from, which has a fill rate of only 25%<\/a>. Should we start to offer additional benefits, such as a golden handshake, higher salary, or earlier retirement\u2014particularly in less attractive areas\u2014to encourage doctors to train there and stay? Trainee distribution is radically inequitable across the country, isn\u2019t it time for something radical be done to redress this?<\/p>\n

Billy Boland<\/strong>\u00a0is a consultant psychiatrist and associate medical director for quality and safety at Hertfordshire Partnership University NHS Foundation Trust. You can follow him on Twitter\u00a0@originalbboland<\/a>.<\/em><\/p>\n

Competing interests<\/strong>:\u00a0I am vice chair of the general adult\u00a0psychiatry faculty at the Royal College of Psychiatrists.<\/p>\n","protected":false},"excerpt":{"rendered":"

The reality of fewer psychiatrists is a problem that is not going to go away […]<\/p>\n

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