Reshaping the NHS workforce

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Abstract
Structural problems Much effort has been put into team building and improving communication skills, but attempts at working together continue to be constrained by differences in styles of learning, in career patterns, in models of working, and in regulatory mechanisms. Moreover, there is still little or no movement of individuals between professions. It is no easier for a highly skilled nurse to become a doctor, for instance, than it was 30 years ago. If the appropriate human resources are to be available to meet the healthcare needs of the coming decades these structural problems need to be addressed. Current social and demographic trends are likely to continue into the foreseeable future, with the ageing of the population and the rise in chronic diseases leading to greater demand for health care in both hospitals and the community. At the same time, the development of new technologies will require more practitioners willing and able to pioneer new ways of working. The emphasis on evidence based practice will also continue so that each occupational group will have to justify its place in the healthcare team. The likely overall effect of these trends is to intensify the pressures towards reconfiguring clinical care. Moves towards even greater flexibility in the labour force will have obvious advantages for those responsible for managing the delivery of services. However, they will also pose significant problems. As the “core” skills and responsibilities of the different groups change, the organisation of the NHS labour force will be increasingly out of line with the traditional map of the healthcare professions. The resulting tensions will not be amenable to solutions devised by individual directorates or trusts or by the different professional bodies working alone.7