Workforce planning in Ireland – what does the future hold?
In 2016, the National Doctors Training and Planning unit within the Irish Health Service
Executive (HSE) developed and published their methodology for medical workforce planning
in the Republic of Ireland [1]. The methodology is being used to predict the medical workforce
requirements for public and private care over a defined ten year projection period. The
approach consists of five phases: set the context, analyse the major drivers of change to the
workforce, develop a stakeholder informed set of future workforce scenarios, analyse the future
gap between the supply of and demand for staff, and, develop the workforce plan.
Methodology
The National Clinical Programme for Anaesthesia (NCPA)
[2] has facilitated the development of a Model of Care for
Anaesthesiology to assist planning the future workforce
requirements in the disciplines of anaesthesiology, intensive
care and pain medicine. This work was strongly supported by the
College of Anaesthesiologists of Ireland and the Irish Standing
Committee (ISC) of the Association of Anaesthetists.
The draft model of care, published in October 2018, sets the
context and outlines a model of care suitable for the next ten
years. It considers the standards required for the provision
of scheduled and unscheduled 24-hour care, the need for a
retrieval service, and the provision of pain medicine services
nationally. It recommends engagement in quality improvement,
postgraduate training and continual professional development
by all anaesthesiologists. All of these are consistent with the
national health care strategic plan (Slaintecare) [3].
The Model of Care for Anaesthesiology sets out the
requirements to deliver safe, internationally acceptable levels of
anaesthesiology care throughout Ireland, irrespective of whether
the patient is being cared for in a Model 2, 3 or 4 hospital setting
[4]. To provide this care, the anaesthesiology team needs to
collaborate with colleagues from other disciplines, who are
similarly planning for the future [5].
Evolving role of the anaesthesiologist
In the past decade the role of the anaesthesiologist has
evolved from being a theatre-based specialty to one involved
in critical care, resuscitation, pain medicine, the provision of
anaesthesiology for radiological, cardiac and other procedures
outside the theatre environment, transport of the critically ill,
and responding to critically ill or deteriorating patients on
wards or in the emergency department. This future orientated
workforce plan considers the continued evolving role of the
anaesthesiologist.
‘2 plus 2 model’ of anaesthesiology/critical care
cover for unscheduled care
A comprehensive anaesthesiology/critical care service requires
a team structure that enables the delivery of an elective service
and an emergency anaesthesiology/critical care service on a
24 hour basis. The emergency team must be able to provide
an immediate and sustained response to more than one
emergency. Second emergencies – such as a category-1
Caesarean section or a cardiac arrest in the emergency
department, intensive care unit (ICU), or on the wards, as well
as the transfer of critically ill patients to other hospitals – can
arise while the team is already involved with other operating
room cases. In the context of previously published safety
recommendations [6-8] the 24 hour provision of a clinically
appropriate safe anaesthesiology/critical care service for
unscheduled care is a major challenge. To provide such a
comprehensive service in Model 3 hospitals, which, along with a
critical care and anaesthesiology service may have a co-located
obstetric unit with a possible addition of a trauma service,
the Model of Care recommends the ‘2 plus 2 model’ of cover
(two consultant and two NCHDs) for unscheduled care as the
minimum acceptable cover for 24 hour unscheduled care.
In the area of particular subspecialties, such as cardiothoracic,
neuro-anaesthesiology, and transplant services, the longterm
national goal should be to create larger subspecialty
centres, geographically sited according to population need,
with clearly defined referral patterns. These centres should
be staffed with an adequate number of appropriately trained
subspecialty consultant anaesthesiologists, thereby providing a
comprehensive 24/7 service.
Additional posts
As a first step, providing the ‘2 plus 2’ cover in hospitals in all
maternity units would require an additional 74 consultant posts
and 43 NCHD posts. Significant reconfiguration of services
involving many of the smaller units would reduce this figure.
Consultant posts in the Irish health service must be attractive
and well-structured, with reasonable on-call commitments,
and provide the incumbents with the opportunity to use their
skills/training appropriately. The Model of Care espouses a 1
in 8 on call roster frequency and adequate non-clinical time for
administrative, teaching & research activities.
The College of Anaesthesiologists of Ireland will continue
to train sufficient numbers of consultants in the various
subspecialty areas in order to provide the numbers required to
implement the vision of this model of care.
Jeremy Smith
Clinical Lead, National Clinical Programme for Anaesthesia
Martin McCormack
Chief Executive, College of Anaesthesiologists of Ireland
References
- Medical Workforce Planning Ireland: A Stepwise Approach
(2016). https://www.hse.ie/eng/staff/leadership-educationdevelopment/met/plan/mwp-guide.pdf
- National Clinical Programme for Anaesthesia (2016)
https://www.hse.ie/eng/about/who/cspd/ncps/anaesthesia/
- Sláintecare Implementation Strategy (2018) https://
health.gov.ie/wp-content/uploads/2018/08/Sláintecare-Implementation-Strategy-FINAL.pdf
- Securing the Future of Smaller Hospitals (2016).
https://health.gov.ie/wp-content/uploads/2014/03/SecuringSmallerHospitals.pdf
- Health Service Executive https://www.hse.ie/eng/staff/resources/our-workforce
- Association of Anaesthetists of Great Britain & Ireland.
Recommendations for standards of monitoring during
anaesthesia and recovery 2015. Anaesthesia, 2016; 71(1):
85-93
- Association of Anaesthetists of Great Britain & Ireland and
Obstetric Anaesthetists’ Association (2013). OAA / AAGBI
Guidelines for Obstetric Anaesthetic Services 2013.
https://www.aagbi.org/sites/default/files/obstetric_
anaesthetic_services_2013.pdf
- Department of Health (2016). Creating a Better Future
Together: National Maternity Strategy 2016-2026.
https://health.gov.ie/wp-content/uploads/2016/01/Finalversion-
27.01.16.pdf