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RECENT figures revealed Wales is short of almost 400 hospital doctors.

These figures came as no surprise to the BMA - we have been monitoring the situation for some time, frequently raising the issue with the Welsh Assembly Government, warning it of the implications if inadequate staffing levels in the NHS were not addressed.

Now, we are fast approaching breaking point.

Already we have seen hospitals being downgraded, wards closed, and inappropriate workloads being forced upon employees.

It is inevitable this situation will worsen unless immediate action is taken to plug the gaps. But this requires a long-term solution, not a temporary quick fix.

For some time there has been lack of enthusiasm from doctors to come to live and work in Wales - this problem is more acute in rural and deprived areas.

To a large extent this results from a poor perception of living, transport links, or working conditions in Wales, particularly in the west and north. For junior doctors, this is combined with a lack of choice about placements. Furthermore, many junior doctors have reported poor training experiences as a result of having to step in to fill rota gaps and inappropriate management pressure to fulfil internal locums.

While the UK government's decision to change the immigration laws was unforeseeable, it has placed a significant strain upon the recruitment and retention of medical profession-als. Wales' situation is made worse by its historical over-reliance on overseas doctors in comparison to other parts of the UK.

The new rules have considerably reduced the numbers of overseas doctors coming to Wales, and indeed many medics have had to leave the UK. In addition, the European Working Time Directive (EWTD), which limits junior doctors to working 48 hours a week has placed a notable strain upon the profession. The former NHS trusts and LHBs were ill-prepared to implement this change effectively and safely - despite knowing for 11 years that it was coming.

Initial reviews of EWTD suggest junior doctors are missing out on training opportunities following the change in working hours.

The risks currently posed to patient safety - and to medical training, are unacceptable and out of touch with the commitment set out in the One Wales agreement, which aspired to "a world-class health service".

A focused expansion in the number of doctors across the NHS is the best way of ensuring that we achieve the ambition of high quality care for all.

The Assembly Government has, to a degree, demonstrated its commitment to value the role of doctors in the NHS, with initiatives such as free hospital accommodation for junior doctors in their first year after qualifying, although the quality of the accommodation is often unacceptable. In previous years, "golden hello" and "golden thanks" schemes were successful in persuading GPs to come, and to stay, in Wales.

But the government needs to do more.

This is why BMA Wales has proposed a junior doctors retention initiative, modelled on a New Zealand scheme.

This is an incentive payment scheme which rewards doctors who agree to work in hard-tostaff areas or specialties by making payments against a graduate's student loan (or directly to the graduate if there is no student loan) which are sufficient to allow the doctor to repay the loan within five years.

This is just one idea to address the issue, but we believe it would go some way towards creating a culture in which we attract the best medical talent to Wales, to work in those hard to fill posts for the long term.

Meanwhile contingency plans are being put in place, including a recent recruitment drive in India.

But, in a competitive market for the best doctors across the UK, Wales needs long-term, intelligent workforce planning for the future, to ensure high-quality patient care is delivered and maintained. Carla Mahoney is public affairs officer for BMA Wales
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Title Annotation:Sport
Publication:Western Mail (Cardiff, Wales)
Date:Jun 14, 2010
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