Workforce Challenges

Simon Hodkinson

I have just returned from San Francisco having attended the American Academy of Orthopaedic Surgeons (AAOS) as part of the international duties of the President. This is a fantastic opportunity to contribute to the global development of orthopaedics and to share and learn about approaches to the challenging issues of the day. One of the projects the Carousel is looking at is to work with the World Health Organisation (WHO). The WHO has identified that approximately 1.71 billion people have musculoskeletal conditions worldwide, with musculoskeletal conditions being the leading contributor to disability worldwide.

The UK is not alone in having a growing and ageing population, with the consequence that the number of people living with musculoskeletal conditions and associated functional limitations, is increasing rapidly. Nor are we alone in having a surgical workforce that is not keeping pace with the inevitable demands.

We do not have enough qualified surgeons. On a per capita basis, we are at or near the bottom of the league in T&O workforce in the developed world.

The recently launched 2023 UK Surgical Workforce Census Report highlighted the real issues we have with our current workforce and the acute need to retain what we have.

In my last piece I mentioned talking in Australia to UK trainees who have left our shores to go down under and depressingly whilst at the AAOS I met a final year medical student from the UK who, clearly motivated to follow a career in T&O, is seeking to leave our shores for a residency in the USA.

Reasons for leaving are, I am sure, multifactorial but one message was clear and that was the impression that a future career in the NHS is not good.

This was the message from the AIMS study last year and one we all need to work towards correcting.

At the RCS England recently, I raised the issue of single employers for trainees and was told that this was something that was being worked on. I hope this long needed change in how we employ our trainees in England in particular, comes sooner rather than later. Every little helps as someone once said!

The regulation of the Physician Associate role is taking up a lot of bandwidth in the medical profession and in Parliament. My two colleagues in the Presidential line are working with the RCS England to achieve a consensus and currently the plan is for the BOA to develop the scope of practice and competencies required for such practice within the speciality. This is a hugely sensitive issue with many aspects to consider; we need a careful, considered and well-informed discussion as to how best to ensure that Physician Associates complement existing provision for the maximum benefit of patients.

Our work with the MHRA and NHS Supply Chain continues, and we have tacit agreement from industry to keep the profession informed of potential removal of products from the UK. Industry and the MHRA accept that sudden removal of products is not in anyone’s interest, least of all the patients!

I recently met with PHIN to discuss concerns raised by members. Those of you in private practice will be aware of PHIN and the mandate it holds from the CMA.

You will be aware that limited data on your practice will become publicly available in autumn this year. I would urge any of you who have not checked the data PHIN holds on your practice to do so. Whilst we are the best of all specialities in terms of initial engagement only 50% of us have checked our data.

PHIN has reassured me that if any issue as to the accuracy of data held is raised, it will not be published until the issue has been resolved, but not engaging will be taken as tacit approval of its accuracy.

Finally, some of you will be aware of the forthcoming launch of ‘NCIP’, this will become an important part of our practice, so I commend the article to you.

Spring will be upon us soon so we can hopefully look forward to warmer and drier weather and I hope you enjoy this edition of the JTO.

If any member has a burning issue to raise, then please feel free to contact me at president@boa.ac.uk or the BOA direct.