Future Medical Workforce Project Annex B: Workforce engagement – methodology and thematic analysis framework

Annex B: Workforce engagement – methodology and thematic analysis
framework

The Future Medical Workforce in Scotland project was developed with the aim to seek to understand the needs of the future medical workforce^[1] and to ensure that we can deliver a workforce with the right skills and expertise to provide for the healthcare needs of the future Scottish population (15-20 years’ time). It was identified that a key requirement to inform future planning would be to seek the perspectives of the current – and future – medical workforce but also to create the opportunity for direct dialogue between SG representatives and the medical workforce to support a collective approach and ultimately support a cultural shift to enable change and reform.

The project has been split into two phases:

Phase 1 (May – November 2025): Discovery - Dialogue and Data

• Workstream 1 - Workforce dialogue to build understanding of workforce views on current issues and future opportunities. Taken forward through focus groups and survey
• Workstream 2 - Supply pipeline scenario modelling – understanding the possible shape and size of the future medical workforce. Modelling provided by NHS Education for Scotland.

Phase 2 will begin in January 2026 and will focus on working in partnership to design solutions to the issues identified within this report.

The methodology to inform workstream 1 (workforce engagement) of Phase 1 is described here.

Recognising a wealth of data already exists to reflect workforce experiences, an initial literature review, focusing on search topics of 1. Health workforce planning, 2. Medical staff experiences and 3. Medical education and training, was undertaken to inform the development of research questions for ongoing workforce engagement. This review was shared with a research advisory group formed by representatives of key representative bodies including the GMC, Scottish Academy of Royal Colleges, NHS Education for Scotland, NHS Board Medical Directors and Directors of Medical Education and Scottish Government policy and social research officials to support discussion of the project design and focus. Following extensive discussion, 4 Research questions were agreed:

• What is the role of a doctor?
• How will the role of a doctor need to evolve to meet population needs in 15 years’ time?
• What does a modern medical workforce need to sustain fulfilling careers?
• How do we improve workforce planning to best serve the public and delivery of high quality care?

Study Design and Data Collection

In order to ensure a diverse range of voices, a series of focus groups combined with a sense-making survey were planned. Focus groups were chosen to facilitate interactive discussion and capture diverse viewpoints within a shared context, while the online survey was recognised to increase reach and ensure all doctors were offered the opportunity to participate.

Focus groups

Recruitment

All territorial boards were approached to offer both online and in person focus groups at a time and location convenient to the board. Arrangements were facilitated through the Executive Medical Directors Offices. Invitations to sign up to participate were shared by email or posters through Medical Directors, Directors of medical education and NHS Education for Scotland to try and maximise reach across both primary and secondary care. Additional focus groups were offered for national boards, clinical academics, medical school programme leads, Resident doctors, representative bodies and medical students. Where boards expressed a preference for online only, this was facilitated. Expression of interest to participate was received from doctors across all boards in Scotland. Limited sign up in some rural areas resulted in participants being offered or allocated to online sessions within other regions to optimise capacity and participation. As was expected for busy clinicians, there was significant attrition noted with 135 expected participants unable to attend.

The distribution of focus groups and are participants is outlined in table 1. 207 doctors attended across all focus groups. While 42 groups are listed, 2 groups were unable to go ahead as planned due to lack of attendees on the day, therefore 40 transcripts were analysed. The demographics of attendees are presented on page 9 of the main report.

Each focus group lasted approximately 90 minutes and was facilitated by Scottish government officials using a semi-structured script to explore the 4 research questions. The qualitative design allowed facilitators to evolve the questions in the context of the discussion and experiences shared by attendees. Participants were challenged to explore or develop perspectives expressed.

Analytical Approach

Focus groups were chosen to facilitate interactive discussion and capture diverse viewpoints within a shared context. Sessions were audio-recorded and transcribed verbatim to ensure accuracy and completeness of the data. It was recognised that the core remit of this process was to hear the voice, perspectives and opinions of doctors, informed by their own experiences. Data were analysed using b flexible method for identifying, analysing, and reporting patterns of meaning within qualitative data. TA was selected for its adaptability and suitability for exploring both explicit and underlying meanings in participants’ narratives.

Coding and Theme Development

An inductive approach to coding was employed, allowing themes to be developed from the data rather than being driven by pre-existing theoretical constructs. Coding was conducted iteratively, combining semantic codes (capturing explicit content) and latent codes (interpreting underlying assumptions and conceptual meanings). This dual-level coding supported a nuanced understanding of participants’ perspectives.

Initial codes were generated through detailed reading of transcripts and organised into potential themes through collaborative discussion among the project team. Themes were refined through an iterative process of reviewing coded extracts, and exploration of patterns across themes and research questions to allow the final themes to be defined and integrated into the narrative report to capture the insights gained.

Reflexivity

Throughout the analysis, the project team, including colleagues from clinical and non clinical backgrounds engaged in reflexive discussions to acknowledge and manage potential biases. A strength and potential weakness was the multidisciplinary nature of the project team allowing internal challenge of potential bias alongside experience to support in-depth exploration of concerns or issues identified.

Survey

During initial theming and iterative review of codes and data, early themes were used to develop an online survey to be shared with all doctors in Scotland to sense-check the themes emerging within the focus group discussions.

A Microsoft forms survey was designed to incorporate a mixture of ranked, scaled or choice questions alongside a series of free text responses aligned to the 4 research questions but developed in line with the focus group discussions. The survey was shared by email through Medical Director/RO networks, Directors of medical Education, HR Director networks and NHS Education for Scotland and remained open for responses over a 4 week period. The 1817 responses, including >3400 free text comments were then analysed allowing a combination of quantitative and qualitative data to further inform the final themes for the narrative report while also providing further detail regarding trends from defined groups/roles.

Final themes and underlying subthemes/codes are outlined below and have been used to inform the narrative report.

RQ1: What is the Role of the Doctor?

Patients

• Caring
• Diagnosis
• Treatment plans
• Specialised Care
• Managing Complexity
• Problem solving
• Clinical Intuition
• Advocacy
• Relationships & continuity
• Communication
• Practicing Realistic Medicine
• Preventative care
• Supporting self-management
• Population/Public Health

Public expectations

• Trust
• Respect
• Be able to help
• Social media influences
• Erosion of respect
• Move away from paternalistic exchange of information

Working with others

• Other disciplines/specialisms
• Other professions
• Working in local and national contexts
• Clinical networks
• Management and supervision of wider MDT

Leadership

• Clinical Governance
• Decision making
• Accountability
• Managing risk and complexity

Guardians of the NHS

• Gatekeepers
• Service design

Professional standards

• Resilience
• Elevated status
• Held to a higher standard
• Role model for the profession
• Regulation
• Vocation

Defined by training

• Broad-based
• Pattern recognition
• Prepared doctors for their role
• Under threat

Variety/Portfolio Careers

• Education/mentors
• Research & Innovation

RQ2: How will the role of the doctor evolve?

NHS Service Reform

• Regional Services
• Community delivered Services
• Interface models
• Risk appetite and management
• Public attitudes
• Waiting times
• Primary Care referrals
• Societal Attitudes

Population changes

• Greater complexity and burnout
• Patient expectations
• Public responsibility
• Prevention
• Generalism and holistic care
• Realistic Medicine

Service capacity and design

• Consultant led model
• Use of MDT
• Technology and AI
• Patient access/self-supported care
• Training requirements
• Exposure
• Undergraduate recruitment
• Modular training
• Remote and rural pathway
• Workforce transition
• Clarity of roles
• Feeling valued
• Workforce planning
• Career pathways

RQ3 What does a modern medical workforce need to sustain fulfilling careers?

Feeling valued

• Autonomy
• Job security
• Respect
• Working conditions
• Remuneration
• Work to skillset/training

Job fulfilment

• Making a difference
• Patient centred
• General practices challenges
• Continuity of care
• Service Capacity

Belonging

• Team
• Culture
• Role Modelling
• Rotations
• Support
• Inclusion

Competence & Confidence

• Leadership
• Training
• Duration
• Support
• Rotations
• Continuing Professional Development

Attraction & Retention

• Flexibility
• LTFT
• Travel & return to workforce
• Complexity
• Incentivisation/dis-incentivisation
• Attractiveness of role
• Job certainty
• Respect
• Remuneration
• Hard to recruit areas
• Infrastructure
• Incentivisation
• Return of service
• Sense of contribution
• Flexible rotations contracts
• Evolving Roles

RQ4 How do we improve workforce planning to best serve the public and deliver higher quality care to patients?

Attractive medical careers

• Profession/role model influences
• Training bottlenecks
• Prioritise UK medical graduates
• Working conditions

National provision of services

• Compulsory/ market forces to determine deployment
• Flexible deployment
• Incentives approaches
• Exposure
• Management of training
• Social contract
• Attractive careers
• Renumeration & T&Cs
• Resources
• Training and employment
• Return of service
• Patient Care
• Societal/public respect

Ensuring value for money

• Efficient use of doctors time
• Use of MDT
• Invest in primacy care
• Bottlenecks in and after training

Planning

• Improve data
• Management of training
• Increase training places
• Training capacity
• Remote and Rural planning
• Reduce siloed funding
• Reduce number of health boards
• Collaboration

Role of government

• National conversation on the NHS
• Authenticity, Trust & transparency
• Listen
• Seek political consensus/ depoliticisation
• Long term planning
• Shift funding to prevention
• Wider policy interactions/failures

Summary of Engagement episodes: table 3

Over the course of the project, over 2000 individuals engaged with the project team alongside the 30 submissions to the Call for Evidence. There was representation from all grades, from primary secondary care, Higher Education Institutions and third sector organisations. It was noted that, when considering the current medical workforce in Scotland, there was a relatively low participation from locally employed doctors. This may reflect inadequate routes of communication, distribution of invitation to participate or a degree of disengagement. However, those locally employed doctors who did participate provided a valuable insight into current concerns, which were strongly echoed by other resident doctors and more senior grades. A key consideration for phase 2 will be to consider how we ensure the actions proposed are impactful for all.

A final note: a clear theme identified was a sense of lack of voice and influence, and doctors of all grades voiced cynicism that this project would be meaningful or effective.

“I won't lie I just feel this survey is someone in an office asking questions where it doesn't really do anywhere and you'll make your own decisions anyway.

Come work 12.5 hour shifts, 60 hour weeks with us and you'll realise why doctors are so burnt out and tired. “

“Speak to the doctors at the coal face (not those that have gone into management away from regular clinical practice). Every department will be able to tell SG what the staffing requirement is now and what it will be in 10 years time. Additionally they will be able to tell you how that changes with different service delivery models”

But what also came across from some participants was an appreciation of an opportunity to have a voice and to be heard:

“ I guess this was part of the reason why I signed up for this because actually it’s an opportunity to try to have those discussions…”

“I am not sure, thank you for this survey and taking the time to read the responses I hope it generates discussions that will improve the situation.”

“ Thank you for providing this opportunity.”

“More working programmes like the Focus group... The one I attended was one of the most useful sessions I have been to on workforce planning and it is no surprise that this has gone on to produce this really excellent consultation which really seems like the team were actually listening to us. This whole exercise has filled me with hope for the future. Please keep conducting it in such a constructive manner, I hope it gives you useful information please continue this.”

In reviewing this work, there will be elements which with more time, capacity, resource, the design or methodology might be improved, but it is hoped that comments such as those above and the degree of thoughtful, considered responses received from busy clinicians across our services reflect that the opportunity to contribute was valued and the wealth of insights outlined in this report can support an informed and impactful response.