National Health Service Employers Research Articles

Aspirations of unemployed international medical graduates in the UK

The trials and tribulations of immigrant professionals such as international medical graduates (IMGs) to the UK have been a topic for discussion and debate over many years. Many challenges faced by immigrant doctors have been reviewed and reformed over time and many rules pertaining to the registration and induction of international doctors to UK practice has been modified to facilitate safe delivery of care in the UK National Health Service (NHS). The General Medical Council (GMC), NHS employers, and the UK Home Office contribute to a three-tier filtration sieve for selecting suitable IMGs who aspire to either education and training or pursue a career in the UK health and care sector.
 This article pertains to the cohort of IMGs, who have been cleared by immigration regulations to reside in the UK but have not been able to initiate a career or active employment in a medical profession. The process of GMC registration referred to and discussed in this article is based on GMC rules prior to Jan 2021. The perspective from which some of the attributes of the current system has been observed has shown it to be efficient but not uniform, robust but not considerate, thorough but not perfect. During the research for this article, we realised that there are many different opinions or conflicting views on this topic, which have all developed either from an individual or a group’s own experience in the UK. There are similarities and differences in opinions and thus to broaden the scope of the discussion, we report the results of a survey exploring where and how the IMGs (currently resident in the UK) are at the start of their careers in the UK.

Is it discriminatory to require hospital staff to be clean shaven to facilitate the effective wearing of personal protective equipment?

National Health Service employers are subject to legal duties to protect the health and safety of their employees and third parties who come into contact with their staff. In order to discharge these duties, National Health Service employers must implement a range of protective measures to mitigate risk. One such measure is to require staff to wear personal protective equipment, including respiratory protective equipment, in certain circumstances. This is of particular importance during the Covid-19 pandemic. However, the presence of facial hair has a negative impact on the effectiveness of respiratory protective equipment. This article discusses whether a requirement to be clean shaven could amount to discrimination under the Equality Act 2010.

Experiences of newly qualified clinical psychologists in CAMHS

Purpose There is a gap in the literature regarding the experiences of newly qualified Clinical Psychologists (NQCPs) working within Child and Adolescent Mental Health Services (CAMHS) in the National Health Service (NHS). This paper aims to explore three aspects of newly qualified Clinical Psychologists’ experiences: their transition and development; working in multi-disciplinary teams located in large organisations; and support and coping in the role. Design/methodology/approach Seven participants each engaged in one semi-structured interview, and an interpretative phenomenological analysis was conducted. Findings Three super-ordinate themes emerged from the analysis: A big jump, the transition from trainee to NQCP; The support of home comforts, old and new; and Acknowledging and desiring ongoing development. Originality/value Implications and recommendations for both Clinical Psychology training programmes and NHS employers are discussed, to support the development and wellbeing of this staff group, and in turn the clinical population they serve. These include gradually increasing caseloads on training, a staggered workload at the outset of the transition, and CAMHS teams ensuring appropriate supervision for NQCPs.

‘Care Under Pressure’: a realist review of interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care

IntroductionMental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service...

Sedentary behaviour in NHS staff: implications for organizations.

Background Prolonged sitting is associated with an increased risk of chronic ill-health. Although high levels of sedentary behaviour are documented in desk-based workers, there are few data examining this in organizations with greater job diversity such as the National Health Service (NHS). Aims To assess the association of occupational and non-occupational sedentary behaviours with key demographic and occupational characteristics of NHS workers to help inform policy development. Methods A cross-sectional survey conducted in a large NHS teaching hospital in the north of England. Volunteer members of staff were asked to complete a web- or paper-based version of the Workforce Sitting Questionnaire. Demographic and occupational data collected included age, gender, ethnicity, educational attainment, occupational group; full-or part-time status and whether the participant reported their job as desk-based. Descriptive statistics and 95% confidence intervals were calculated to compare sedentary behaviour across demographic and job characteristics. Results Clerical and desk-based NHS workers were more sedentary at work than other colleagues. New findings identified that NHS workers aged under 30 and those without educational qualifications had high levels of sedentary behaviour outside work. After adjusting for working hours, part-time employees were significantly more likely to be sedentary. Conclusions Our results have implications for those developing strategies to reduce sedentary behaviour in the NHS workforce. Whilst standing desks have received much interest, alternative approaches may be attractive to NHS employers in reducing workplace and non-occupational sitting time. These may also be relevant to other organizations.

Nursing staffs' emotional well-being and caring behaviours.

To examine the relationships between structural factors (work stressors), individual factors (demographics and the personal resources of resilience and social support) and transactional factors (appraisals and coping), and nursing staffs' levels of burnout, psychological distress and caring behaviours. A further aim was to examine the relationships between nursing staffs' levels of burnout and psychological distress and their caring behaviours. Burnout and psychological distress levels have been found to be high in National Health Service nursing staff and furthermore this emotional distress has been found to affect patient care. In a National Health Service striving to provide high-quality patient-centred care, it is essential that factors affecting nursing staffs' well-being and their caring behaviours are examined. A cross-sectional correlation-based survey design. A sample of 102 nursing staff from an Acute National Health Service Trust were recruited in 2010. Participants completed the questionnaires: Nursing Stress Scale, Social Support Questionnaire-Short Form, Connor and Davidson Resilience Scale-2, Occupational Coping Self-Efficacy Scale for Nurses, PsychNurse Scale, Maslach Burnout Inventory, The Hospital Anxiety and Depression Scale and Caring Behaviours Inventory-revised. Due to the nonparametric nature of part of the data, Spearman's Rho correlations were used for analysis. Demographics were not found to be regularly correlated with nursing staffs' burnout, psychological distress or caring behaviours. Work stressors, coping strategies and self-efficacy were found to be significantly correlated with nursing staffs' burnout and psychological distress. Caring behaviours were also correlated with coping strategies and self-efficacy. Importantly, correlations were found between caring behaviours and nursing staffs' burnout and psychological distress. It is extremely important that the emotional well-being of nursing staff is supported, both for them, and for the effect this has on patient care. Action points are suggested for National Health Service employers to enable this to happen. To address the poor emotional well-being found, it is suggested that changes are needed within current clinical practice, for example through provision of enhanced training, use of model-based clinical supervision and reviews conducted on staffing levels and workload issues.

"No one has yet properly articulated what we are trying to achieve": a discourse analysis of interviews with revalidation policy leaders in the United Kingdom.

To analyze prevailing definitions of revalidation (i.e., a recently instituted system of ongoing review for all physicians in the United Kingdom), the circumstances of their origin, and proposed applications, after a protracted and sometimes difficult decade in development. This was to support a more consensual approach to revalidation policy before its launch in 2012. In 2010 and 2011, the authors carried out a critical discourse analysis of interviews with 31 medical and legal revalidation policy makers. These individuals represented the main stakeholder bodies, including the General Medical Council, Academy of Medical Royal Colleges, British Medical Association, National Health Service Employers, and the departments of health from across the United Kingdom. The authors identified two overarching discourses: regulation and professionalism, held together by patients as "discursive glue." Regulation frames revalidation as a way to identify "bad apples," requiring a summative approach and minimum standards. Professionalism looks to revalidation as a process by which all doctors improve, requiring evolving standards and a developmental model. These two discourses were not mutually exclusive; indeed, most interviewees used them interchangeably. However, they are in some regards at odds. Their coexistence has been supported by a shared discursive formation around patients. Yet the authors found little patient-centered policy in revalidation in its current form. The authors concluded that patients need to be recognized, making them present with an active voice. They also stressed the importance of established and ongoing evaluation of medical regulation as a policy and process.

A phenomenological study of the effects of clinical negligence litigation on midwives in England: The personal perspective

Objectiveto explore how midwives' personal involvement in clinical negligence litigation affects their emotional and psychological well-being. Designdescriptive phenomenological study using semi-structured interviews. Settingin-depth interviews were conducted in participants' homes or at their place of work and focused on participants' experience of litigation. Participants were recruited from various regions of England. Participants22 National Health Service (NHS) midwives who had been alleged negligent. Findingsunfamiliarity with the legal process when writing statements, attending case conferences and being a witness in court provoked significant stress for midwives. This was exacerbated by the prolonged nature of maternity claims. Support ranged from good to inadequate. Participants who no longer worked for the defendant Trust felt unsupported. Stress could manifest as physical and mental ill-health. Some midwives internalised the allegations of negligence believing their whole career had become worthless. Previous knowledge of the legal process ameliorated the experience. Midwives also exhibited anger and resentment when litigation concluded and some took years to heal from the experience. Key conclusionsmidwives come from a caring and relational paradigm. When interfacing with the adversarial and contentious paradigm of tort law, midwives can abreact and suffer emotional, physical and psychological harm. Support for midwives experiencing litigation must be improved. Implications for practice: Understanding the effects of personal involvement in litigation is important in order to improve the quality of support for this group of midwives. It will also aid development of targeted education for undergraduate, post-graduate and in-service midwives. In the longer term it may help policy makers when considering reform of clinical negligence litigation and NHS employers to structure support mechanisms for staff involved.

Building the Genetic Counsellor Profession in the United Kingdom: Two Decades of Growth and Development

Building the Genetic Counsellor Profession in the United Kingdom: Two Decades of Growth and Development

Health care and adult safeguarding: an audit informing the relationship of the UK vetting and barring scheme with the NHS

Purpose – The paper seeks to report on an audit undertaken in 2010 to support implementation of the Independent Safeguarding Authority (ISA) processes by National Health Service (NHS) Trusts. The ISA was set up under the Safeguarding Vulnerable Groups Act (SVGA) 2006. Concern has been expressed that some NHS employers are not familiar with their new obligations to consider making referrals to the ISA.Design/methodology/approach – This audit was designed to provide an estimate of possible NHS referrals to the enhanced vetting and barring scheme run by the ISA in England and Wales; and to explore two NHS Trusts' potential decision‐making and referrals to the ISA following disciplinary action or adverse events. The two NHS Trusts that participated engaged in a detailed review of incidents and their relationship to harm as defined in the SVGA 2006.Findings – The simple number of how many incidents have been reported to the ISA by an NHS Trust will not equate to the same number of cases of individual patients ...

Supporting trainees in difficulty: a new approach for Scotland

National Health Service (NHS) Education for Scotland (NES) works with NHS and University employers, through the four Postgraduate Deaneries to provide education and training for medical trainees from graduation to completion of specialist and general practice training. Most trainees make good progress through the relevant curriculum supported by a managed system of supervision with regular appraisal and feedback. Similarly most trainees demonstrate their progression to Certificate of Completion of Training through the assessment process that is defined in each specialty curriculum. However a small number of trainees each year will experience difficulties sufficient to impact on their progress and when this occurs, a clear plan of investigation, support and management is required. These activities now have to be robust, and are subject to quality management locally and also external scrutiny by Postgraduate Medical Education and Training Board. Therefore, there is a need for the management process to be clear and consistent, and easily accessible to both trainees and their consultant supervisors. NES has introduced a new infrastructure for Scotland which is described in this paper. The paper also discusses training of educational supervisors, best use of national training and remediation resources and how a national advisory group might contribute.

After picture archiving and communication systems: information technology in radiology

This is my perspective of information technology (IT) developments in radiology, based mainly on my experiences of the current situation in the English national health service (NHS) and some knowledge of the other countries of the UK. The views expressed here represent my personal opinions, and are not necessarily those of my NHS employers. I have confined my comments purely to IT matters. I shall not, therefore, be discussing developments in computer aided diagnostics, in reformatting or other image manipulation techniques, nor in imaging, such as the use of terahertz radiation. Despite being given the title “After picture archiving and communication systems…”, the story of picture archiving and communication systems (PACS) in the NHS is far from over. PACSs are used throughout England and Scotland, but Wales and Northern Ireland still have some catching up to do. Even in England, there is still room for development in the PACS arena, in particular in regard to image and report sharing (this is less problematic in Scotland, given that they have a single PACS entity that spans the whole nation). For completion, I would also like to consider the question in reverse: “After radiology, what next for PACS?”

Why do speech and language therapists stay in, leave and (sometimes) return to the National Health Service (NHS)?

Research into recruitment, retention and return of speech and language therapists in the National Health Service (NHS) is relatively limited, particularly in respect of understanding the factors that drive employment choice decisions. To identify what factors influence speech and language therapists working in the NHS to stay, and consider leaving, but not do so. To identify what features of the NHS and alternative employers influence speech and language therapists to leave the NHS. To identify why some speech and language therapists return to the NHS after working elsewhere. A total of 516 male and female speech and language therapists, in three distinct groups (NHS stayers, leavers and returners) completed a questionnaire and gave responses to open-ended questions regarding their perceptions of the NHS and other employers. Qualitative data analysis identified reasons why individuals stayed in, left or returned to the NHS employment, and what actions could be taken by management to facilitate retention and return. Stayers value job and pension security; professional development opportunities; the work itself; and professional support. Leavers not involved in childcare left because of workload/pressure/stress; poor pay; and not being able to give good patient care. Returners returned because of flexible hours; work location; professional development; and pension provision. Stayers and returners primarily wish to see more staff in the NHS, whereas leavers would return if there were more flexibility in work arrangements. Returners were particularly hostile towards Agenda for Change. Whilst some preferences appear to require increased resources, others such as reducing bureaucracy and valuing professionals do not. The full impact of Agenda for Change has yet to be established. Predicted excess labour supply of allied health professionals and future structural changes present pressures but also possible opportunities for speech and language therapists.

Does a code make a difference – assessing the English code of practice on international recruitment

BackgroundThis paper draws from research completed in 2007 to assess the effect of the Department of Health, England, Code of Practice for the international recruitment of health professionals.The Department of Health in England introduced a Code of Practice for international recruitment for National Health Service employers in 2001. The Code required National Health Service employers not to actively recruit from low-income countries, unless there was government-to-government agreement. The Code was updated in 2004.MethodsThe paper examines trends in inflow of health professionals to the United Kingdom from other countries, using professional registration data and data on applications for work permits. The paper also provides more detailed information from two country case studies in Ghana and Kenya.ResultsAvailable data show a considerable reduction in inflow of health professionals, from the peak years up to 2002 (for nurses) and 2004 (for doctors). There are multiple causes for this decline, including declining demand in the United Kingdom.In Ghana and Kenya it was found that active recruitment was perceived to have reduced significantly from the United Kingdom, but it is not clear the extent to which the Code was influential in this, or whether other factors such as a lack of vacancies in the United Kingdom explains it.ConclusionActive international recruitment of health professionals was an explicit policy intervention by the Department of Health in England, as one key element in achieving rapid staffing growth, particularly in the period 2000 to 2005, but the level of international recruitment has dropped significantly since early 2006. Regulatory and education changes in the United Kingdom in recent years have also made international entry more difficult.The potential to assess the effect of the Code in England is constrained by the limitations in available databases. This is a crucial lesson for those considering a global code: without a clear link between explicit objectives of a code, and relevant monitoring capacity, it is not possible to judge the actual impact of a code.A second message for policy-makers is that attempts to use a single country code in other countries where there are a multiplicity of independent, private-sector health care employers, or where there is a federated political and regulatory structure, will be a much more challenging and complex issue than in England, which has one major public sector health care employer and one national point of entry for regulated health professionals.Finally, there is a message about the importance of the "visibility" of any recruitment code – for policy-makers, employers and potential recruits. The Department of Health Code has a good level of recognition in the National Health Service, but would benefit from better dissemination in low-income countries, particularly in Africa, together with further consultation on the appropriateness of its provisions in specific countries. To achieve high visibility and recognition of any global code will be a much bigger challenge.

Commentary on Eley R, Hegney D, Buikstra E, Fallon T, Plank A & Parker V (2007) Aged care nursing in Queensland – the nurses’ view. Journal of Clinical Nursing, 16, 860–872

Commentary on Eley R, Hegney D, Buikstra E, Fallon T, Plank A &amp; Parker V (2007) Aged care nursing in Queensland – the nurses’ view. <i>Journal of Clinical Nursing</i>, 16, 860–872

Manual handling risk controls in hospitals (MARCH): a cross-sectional survey of UK hospitals.

Injury and ill health among healthcare staff associated with handling patients is an important area of risk for UK National Health Service (NHS) employers. Since the introduction of a specific legal duty to control this risk in 1992, many Trusts have developed manual handling risk management strategies. Anecdotally, however, practice varies between Trusts and there is no published description of common practice among NHS employers. The latter would be useful as a benchmark for risk managers. Therefore, we undertook a cross-sectional survey of 158 UK trusts (81% of those invited) using a structured interviewer-administered questionnaire to collect information about manual handling risk controls. Most Trusts had basic systems for risk management, including defined management accountability, written policies, provision of handling equipment, training, expert advice about manual handling and access to occupational health services and physiotherapy for injured employees. However, there was wide variation in important aspects, including the extent of expert manpower and criteria for referral to occupational health. Arrangements for monitoring risk controls were generally poor, and the variation in practice was a cause for concern. These data will help NHS employers by providing a benchmark against which to measure and develop risk management systems for manual handling. Future research should aim to develop standards through consensus opinion and ultimately evidence of effectiveness of risk controls.

Healthy Workplace Indicators: Costing Reasons for Sickness Absence within the UK National Health Service

Sandwell Healthcare NHS Trust has been developing a tool for monitoring the reasons and costs of long-term sick leave (> 7 days). The data obtained from this process has been used to modify the type of occupational health and safety services provided for the Trust. Adoption of more standardized tools of this nature throughout the National Health Service (NHS) would help trusts to compare, and where appropriate enhance, the services provided by occupational health. Musculo-skeletal and mental health problems, account for the greatest costs arising from long-term sickness absence. It may therefore be prudent for NHS employers and their occupational health services to target their efforts on these particular problems.

A service in crisis? Reflections on the shortage of nurses in the British National Health Service

A service in crisis? Reflections on the shortage of nurses in the British National Health Service

Further Flexing? Issues of Employment Contract Flexibility in the UK Nursing Workforce

This paper, based on research commissioned by the Royal College of Nursing (Buchan, 1995), reports on the changing working patterns and flexibility in the employment of nursing staff in the National Health Service (NHS) in the UK. It reviews relevant literature, examines official data and draws information from 12 case study NHS trusts. Flexibility is invariably portrayed as a good thing, and as a means to a positive end, yet is rarely defined in detail, if at all. The aim of this paper is to consider flexibility not as a slogan or panacea, but in terms of the rationales for, and likely effects of, changing patterns of nursing work. It examines the reasons why NHS employers have been attempting to increase the flexibility of their nursing workforce.

Planning flexible learning to match the needs of consumers: a national survey.

The injection of market forces into the National Health Service (NHS) has led to nurse education being viewed as a commodity which educational institutions supply and NHS employers purchase. Conscious of the costs of paying for courses within this new consumer culture, NHS trusts and other health service employers are increasingly looking for cost-effective flexible training to educate their workforce quickly and efficiently. Parallel to this is the accelerated demand for continuing professional development (CPD) brought about by the inception of the UKCC's Post-Registration Education and Practice Project (PREPP). Both registered and enrolled nurses are finding they need professional updating and skills and thus increased access to courses. The increased demand for education and training brought about by these changes cannot be met through traditional methods alone, requiring educational institutions to re-appraise their methods of delivery and introduce more flexible approaches to learning. There is every evidence that this is now the case with open learning, distance learning and flexible approaches to learning ever growing in popularity as providers of nurse education recognize the benefits such approaches offer. The emphasis is on meeting the diverse needs of the health care employers and individuals by providing education that is flexible, learner-centred and customer focused. This paper presents the findings of a national survey to ascertain how providers of flexible education plan educational programmes to meet the needs of their customers. Based on data collected from 120 educational institutions within the higher education, health and social care and private sectors, it highlights: the ways in which flexible learning programmes and courses are delivered; what aspects of flexibility are considered important when designing programmes to meet the needs of prospective customers; and what approaches are used to assess demand for flexible education. The study stresses the need for providers of flexible education to take into account the dual perspectives of those who have a stake in the flexibility of nurse education; NHS employers as funders of students and individual healthcare professionals themselves.