Hospital medical staffing in Scotland: the Shaw report

Abstract

In wake of publication of Hospital Medical Staffing: Achieving a Balance: Plan for Action1 a different but for Scotland equally influential report on medical manpower has been published. Officially titled Staffing Service?the Next Decade, report is colloquially known as Shaw review after chairman of review's steering group, Dr Gavin Shaw, a consultant physician.2 The review is different from Plan for Action because rather than providing a bird's eye view of medical staffing, as many other centrally conceived reports have previously done, it has been built from within specialties and hospitals of Scotland. It goes much further than Plan for Action in that it makes specific recom? mendations for changes in medical staffing on a hospital by hospital basis to be achieved over next five to ten years. The main points from review are in box, and table summarises projected staffing changes for next decade. In 1983 profession, together with chief administrative medical officers of Scottish health boards and Scottish Home and Health Department (SHHD), set up a working party on medical staffing structure. This endorsed a comprehensive review with aim of correcting imbalance between number of doctors in training and consultant grades. There was strong feeling within profession that if it did not take steps to rectify imbalance others might do so. It was agreed that steering group for review would be set up jointly by SHHD and Scottish Joint Consultants Committee. The group had no formal remit apart from working party's report, which gave certain guidelines, one of main ones being that the service would be consultant led with expectation that in many specialties an increasing proportion of patient care will be provided by consultants. There were two principal objectives: firstly, that patient care should be maintained and improved; and, secondly, to realign and restructure medical staffing so that doctors had acceptable career prospects and workloads, without which patient care would inevitably suffer. Seven specialty subgroups were set up with a balance of academic and National Health Service representatives, each group also containing two members from training grades. Generally all main teaching and general hospitals in Scotland were visited in wake of a questionnaire sent out in advance?180 visits were made in all. The chairman of each of specialty subgroups checked main facts in each specialty report; figures were also verified by checking with those held by information services division of Scottish Office. The detailed recommendations for staffing are elaborated in volume II of review, where specialty reports are published. Volume I carries a statement of main principles underlying review together with a discussion of roles of various grades; it also contains a summary of each of specialty reports.