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AUG 29/2014

The rising demand for general expertise in the medical profession

As the NHS continues to expand its workforce and create new jobs for doctors, close attention will need to be paid to the specific expertise candidates will require in order to fulfil the changing needs of an evolving patient base.

Recent research carried out by the Royal College of Physicians (RCP) has suggested that a potentially significant shift away from specialist working and towards a more generalist-focused approach is currently taking place - one which will have an impact on future NHS recruitment strategies.

This change will have a number of implications for NHS staff and employers alike, and potentially reflects a wider change in patient demands and expectations that will require new approaches across the entire health service in the years to come.

The growing importance of acute medicine
The RCP highlighted this transition towards generalist roles treating acutely ill patients in its most recent census of the UK's consultant physicians, which measures the number of consultants in all medical specialties.

It was found that acute medicine has seen the largest increase, with a dramatic 33 per cent rise in numbers. Although this specialty remains relatively small in real terms with just 393 practising physicians, this figure stood at 295 the previous year, suggesting that demand for these doctors is shooting up rapidly.

Moreover, there has been a significant increase in the provision of acute care by other medical specialists. Between 2011 and 2012, the number of renal medicine specialists contributing to acute care rose from 48 per cent to 58 per cent, while the total amount of rheumatology specialists doing the same increased from 22 per cent to 44 per cent.

Meanwhile, other specialities with a traditional acute care focus continued to have a large proportion of consultants providing acute care, including 79 per cent of respiratory medicine staff, 82 per cent of endocrinologists and diabetes specialists, and 83 per cent of geriatric medicine practitioners.

Changing age demographics
The main reason why this change is occurring is because of the ageing nature of the UK population. As highlighted by the RCP's Future Hospital Commission report, 65 per cent of people admitted to hospital now are over the age of 65, with many having multiple complex conditions. These patients therefore require more generalist care.

This helps to explain why geriatrics remains the largest specialty overall, comprising ten per cent of the total workforce, and this is a trend that is likely to continue due to greater life expectancies.

It has been acknowledged by the government that the ageing population will require a number of changes to the way NHS care is organised, with an increased focus on community-focused preventative care, but acute medicine is always likely to play an essential role in looking after the needs of the elderly and infirm.

Rising demand for staff
Such factors create challenges for those in charge of managing services, but also opportunities for medical professionals with the generalist skills for which the sector is crying out.

Indeed, the RCP's report showed the huge increase in demand for these workers currently greatly exceeds the supply of trained acute medicine specialists. As a result, 41 per cent of acute medicine posts advertised at the time of the 2012 census could not be filled due to a lack of suitably trained applicants.

As such, increased investment in training and recruitment in this area may be essential in making sure the NHS properly adapts to the needs of British patients in the 21st century.

Dr Harriet Gordon, director of the RCP's medical workforce unit, said: "Hospital care must change to better meet the needs of the large numbers of older patients presenting with multiple conditions. Key to this will be a more generalist workforce willing and able to treat acutely ill patients with complex needs that span traditional specialty boundaries."

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