Workforce: planning for the future
We want NHS England to set out clearly, to Health Education England by 2020, what staff are needed to provide high quality care for people with lung disease. NHS England should work with other professional bodies, but it must take overall responsibility for providing the staff needed to deliver future plans.
We also want health care professionals to be given the opportunity to make the most of their training and experience. This means giving them the jobs that allow them to use their knowledge and skills. It also means expanding training and development throughout their careers. We need to do more to retain older, experienced health care professionals in the workforce for longer.
Our recommendations for specific parts of the workforce
GPs play a key role in caring for people with lung disease. At the moment, we don’t have enough GPs and the shortage is getting worse because many are retiring and leaving the health service. NHS England says we need another 5,000 GPs simply to keep up with demand. But recruitment has been slow, and more GPs are choosing to retire or leave the health service for good.
This is why we want NHS England and Health Education England to do more to retain GPs, as well as recruiting new ones. Having more GPs will make it easier for people with worrying symptoms to get a diagnosis and begin timely treatment.
If lung health is going to have a higher priority in the health service, this will create a heavier workload for already struggling specialities. We need more consultants to deal with this increased workload.
There are high numbers of empty respiratory consultant posts. Respiratory medicine is a core speciality, but not enough trainees choose to go into this area of medicine. And when they do it takes new trainees at least nine years before they reach consultant level.
We want to make sure that an additional 100 respiratory speciality training posts are created over 5 years (20 per year).
We need more nurses to help deliver better care for patients with lung disease. They are involved in all aspects of care, from helping smokers to quit and giving flu jabs to supporting people at the end of their lives.
However, there is a serious crisis in staffing levels on the horizon, with almost half (44%) of nurses set to reach retirement age within 10 years. This outlook has been made more difficult by removing the bursaries that many trainee nurses rely on to support themselves while they are in training. We are also concerned that budgets for on-the-job training, which helps nurses acquire new skills, are being cut.
We want NHS England and the government to think again about funding, to make sure more people are able to choose nursing as their career. We also want more money made available for career development to help nurses fulfil their potential to the benefit of patients.
Homerton University Hospital is located in Hackney, one of the most diverse London boroughs. The population has a high incidence of lung disease, with high rates of smoking.
The local clinical commissioning group has made a strong commitment to lung health, supporting a team of about 25 health care professionals in the Adult Cardiorespiratory Enhanced and Responsive Service (ACERS). There are about 10 outpatient clinics a week covering the different specialist areas, where experts in their various fields consult with people on their particular health issues. They are an integrated service and work closely with the respiratory ward, a 28-bed unit, with four side rooms for particular types of illness.
ACERS includes a hospital at home service to support people to remain at home during an exacerbation and an early supported discharge service.
Debbie Roots, Cardiorespiratory Nurse Consultant, says that having a comprehensive service in place makes a significant contribution to the community. “Our work has made an impact on hospital admissions, which is good for patients but also helps the hospital.
“Our approach is quite innovative and over time we have added pulmonary rehabilitation and an oxygen service, and incorporated a heart failure service. We also now have two psychologists to support people with lung conditions.
“Our experience at Homerton shows the benefits of investment in people with the skills to help people live with the challenge of a lung condition. It is about reaching out to the community, understanding their need and building a service with the capacity to support them.”
We want to see more physiotherapists working with the NHS. They play a critical role in the treatment and management of people with lung disease, from emergency admissions and intensive care, to disease-specific services for children or adults.
Physiotherapists deliver pulmonary rehabilitation (PR). This is one of the most effective treatments for lung disease and we want more people taking part in PR courses. We need at least 600 more physiotherapists over the next five years simply to meet current demand for PR. However, if more patients are referred, many more physiotherapists will be needed.
Extra places for physiotherapists are being made available at university, which is good news. We know that this is a good start to keep up with the needs of the growing number of people with lung disease.
Radiologists play a vital role in diagnosing and managing lung disease by carrying out imaging and interpreting scans. But more than 10% of radiology consultant posts are currently vacant. Only 3% of radiology departments report completing all work within normal hours, which risks interpretation being rushed, delayed or inaccurate.
We want NHS trusts to invest in the workforce to make sure all radiology departments are reporting at the speed of the fastest in the country. Creating a regional network would help radiologists learn from one another.
Sam Hare, a consultant thoracic radiologist and lead for chest radiology at the Royal Free London NHS Trust, says that the recruitment of more clinical radiologists must be a priority, with a particular focus on chest radiologists to improve the nation’s lung health. “In 2017 there was a shortfall of approximately 1,000 full time radiologists in the UK,” says Sam. “Over the next five years that is forecast to increase to 1,610 – it’s vital that this supply and demand gap is addressed.”
There is broad support for a national lung cancer screening programme for those people who are at high risk, but it will require a significant commitment to the radiology workforce. The appointment of respiratory physicians needs to be accompanied by investment in support services. “It is one thing to have a CT scan performed, but only when it is accurately reported by a radiologist does it really become meaningful.”
At present reporting delays may mean that many patient CT scans are unreported by the time their clinic visits come around. Often, this results in under-resourced radiology departments producing quick, provisional scan reviews and reports which may subsequently be shown to be inaccurate, causing distress to patients. Sam says: “It takes five to six years to train a chest radiologist, so decisions have to be taken now if we really are committed to accurate diagnosis and improving care.”
Respiratory physiologists carry out a range of tests which are vital for diagnosis, such as spirometry. There are a high number of respiratory services running without enough qualified staff. 16% have only one qualified specialist, and 69% have fewer than four.
This can risk delays for patients, especially if staff are sick or on leave. A third of services report not meeting their targets for performing tests.
We want to see 500 more training places made available by Health Education England, so we can make sure we have enough respiratory physiologists to meet the needs of people with suspected lung disease.
If commissioners are hiring new respiratory consultants, they should make sure there are enough physiologists to support their work in diagnosing and supporting patients.
We want to have enough pharmacists to care for people with lung disease in the community, in GP practices and in hospitals. Pharmacists supply and advise on medicines, offer stop smoking advice, give flu jabs and help people to monitor and manage their condition. Making sure we have the right number of pharmacists will help to give people the support they need while reducing pressure elsewhere in the health service.
NHS England’s target is for there to be 2,000 pharmacists based in general practice by 2020-2021. Although progress is being made, there were still only 708 in 2018. More needs to be done, particularly in promoting respiratory as a specialism to hospital and integrated care pharmacists.
We also want to see an increase in the number of consultant pharmacists, who can prescribe independently and can also run their own clinics. At the moment there are only 80 consultant pharmacists and the Chief Pharmaceutical Officer says we need 10 times as many to meet patient demand.
Anna Murphy is one of just four consultant respiratory pharmacists in England and Wales. She has been in her accredited post at University Hospitals of Leicester since 2008.
The clinical aspect of Anna’s post offers assessment, medicines optimisation, monitoring and advice to people with respiratory disease, working both in hospital and primary care. Working across Leicestershire, the post includes education and training and the development of services for people living with lung conditions. “Gradually more pharmacists are specialising in respiratory medicine,” says Anna. “The specialisation is becoming more recognised but further work is required to encourage trusts and CCGs to create posts for specialist respiratory pharmacists. It is still unusual for trusts to appoint a consultant respiratory pharmacist. Pharmacy plays a critical role in caring for lung health, from helping people to stop smoking to supporting people to manage lung disease and live their lives as fully as possible. As a consultant, I also have the opportunity to help develop how we provide care in hospital and in the community to improve outcomes.”
It is important for patients to see that respiratory pharmacy is recognised in the same way as other specialisations, says Anna. It also provides a pathway for career development for pharmacists looking to specialise.
Measures of success and recommendations
- NHS England to provide a vision of required health care professionals for a developed workforce for quality provision of respiratory care to Health Education England by 2020, with evidence of progress towards achieving this within five years
- Expand the NHS England drive to ensure that as many health care professionals as possible work at the highest end of their remit, for example advanced clinical practitioners and assistant practitioners
- NHS England and Health Education England to refresh GP strategy with a focus on retention as well as recruitment
- Create an additional 100 respiratory speciality training posts over five years (20 per year)
- NHS England and the government must focus on recruitment and retention of nurses, including reviewing the funding mechanisms for training and continuing professional development programmes
- The Royal College of Radiologists, supported by the British Society for Thoracic Imaging, to introduce national standards for speed of reporting
- Invest in sufficient workforce and equipment to ensure all departments are reporting at the speed of the fastest
- Create regional thoracic imaging networks to share expertise between hospitals
- 500 additional training places to be made available by Health Education England, and delivered by the National School for Healthcare Science, to fill the current gap in the respiratory and sleep physiology/health care scientist workforce, with commissioners and providers being aware that business cases for new respiratory consultants should include the need for greater respiratory and sleep physiology/health care science workforce capacity to support them
- Continue to increase physiotherapy training places to meet target of at least 600 additional physiotherapists over five years
- Where appropriate, commission joint community rehabilitation services (for instance linking with cardiac rehabilitation) to support patients with co-morbidities while making best use of the workforce
- Provide more training places for pharmacists in GP practices
- Include consultant pharmacist posts in strategic workforce plans