‘Medical associate’ scheme proposed for non-training NCHDs

A “medical associate” programme is being considered by the HSE as a means of reducing over-reliance on non-training NCHDs.

The proposal is included in a report by a HSE National Doctors Training and Planning (NDTP) working group, which states that a “more robust clinical governance framework” should be developed for NCHDs in non-training posts, with the involvement of the postgraduate training bodies.

A HSE spokesperson told the Medical Independent it is considering “the development of a medical associate programme for non-training scheme doctors”.

The NDTP report said the existing clinical governance, oversight and education/training opportunities for non-training NCHDs in hospitals “appears insufficient and means that clinical ability may be unverified”.

According to statistics from May 2018, included in the report, there were 9,178 doctors working in the health service, comprising 2,942 consultants and 6,242 NCHDs. Excluding interns, the remaining 5,503 NCHDs were split almost equally between training and non-training NCHDs.

The three hospitals with the highest ratios of non-training NCHDs were Ennis General Hospital, South Tipperary General Hospital, and Cavan General Hospital. There was an over-reliance “across the system” and some specialties, such as surgery and emergency medicine, had twice the numbers of non-training NCHDs as trainees.

Doctors of “uncertain professional ability and limited previous clinical work experience” were working in the acute hospital system.

Among the report’s other proposals to “rebalance” the medical workforce was increasing consultant numbers and trainee places, optimised recruitment for non-training posts, and expansion of the International Medical Graduate Training Initiative.

The HSE’s National Service Plan 2020 stated the number of NCHDs in training would be increased by over 100 for the current training year, primarily through the conversion of non-training posts.

According to the HSE, training posts have increased by 106 in 2019/2020, mainly through small increases across the majority of medical and surgical specialties. Most of the posts were converted from non-training posts.

An NDTP assessment of NCHD posts for 2018/19 found an 18 per cent increase in trainees (including interns) occupying clinical posts in the Irish healthcare system since 2011 (3,412 to 4,018). However, there had also been “a disproportionate increase” in non-trainee numbers, which rose by 63 per cent (1,524 to 2,482).