Psychiatry Recruitment and Retention Working Group: final report

Executive summary

This report shares the views, expertise and evidence shared by the members of the Psychiatry Recruitment and Retention Working Group (2023-25). The report sets out the challenges and issues within the training pathway for psychiatry and in the recruitment and retention of psychiatrists in NHS Scotland workforce.

In particular retention challenges were considered as being critical by the Working Group. These challenges were underpinned by increasing demands upon psychiatric services in NHS Scotland, cultural attitudes, high workforce vacancy rates and an increased reliance on locum psychiatrists, particularly under-qualified consultant locums, to fill vacant positions. The Working Group reflected on the consequences of these challenges not only for patients and the current workforce but also for future trainees to receive quality supervision and training provided by substantive Consultants who have the necessary skills and expertise to nurture them in their future careers.

This report sets out a series of recommendations in Annex A. The recommendations aim to address the current challenges and work towards helping support a profession that is attractive, sustainable and ultimately results in better access, care and outcomes for patients. The recommendations centre around the following themes:

Training pathways

• Perception, early exposure and training experiences
• Core and Higher Speciality training: attraction and flow-through
• Supervision of trainees

Recruitment and retention

• Job plans
• Realistic workloads
• The use of locums in psychiatry
• Role of psychiatrists in leadership and governance
• Flexible working and retention of psychiatrists in their careers
• Future actions from improvements already implemented during the lifespan of the working group

It is acknowledged that some of the proposed recommendations will take time to implement and will require oversight of an implementation group alongside strategic stakeholders including the Scottish Government, NHS Health Boards/ Integrated Joint Boards (IJBs), NHS Education Scotland (NES), the Centre for Workforce Supply (CWS) and the Royal College of Psychiatrists in Scotland (RCPSYCHIS).

It was agreed at the outset, this report and recommendations would go to Scottish Ministers, by Spring 2025.

Introduction

The Scottish Government’s Mental Health and Wellbeing Workforce Action Plan (November 2023) included a commitment to consider better support for the recruitment and retention of psychiatrists in Scotland via the Psychiatry Recruitment and Retention Working Group (“the Group”). It stated:

‘Through the newly established Psychiatry Recruitment and Retention Working Group, Scottish Government will consider how we can better support the recruitment and retention of psychiatrists in the NHS in Scotland. The initial phase of the group’s work will look at the recruitment and retention of trainee doctors at Core and Higher Specialty training level, followed by a second phase which will consider the wider workforce including consultant and specialty grade doctors’.

The Action Plan recognises that the Scottish Government’s Mental Health and Wellbeing Strategy (June 2023) and its associated actions can only be achieved with the right workforce, supported to have the right skills, in the right place at the right time.

Vision

The Group have invested and shared their time and expertise to produce a set of recommendations (Annex A) to ultimately support a skilled and sustainable psychiatry workforce in NHS Scotland. Group members want to ensure careers in psychiatry are attractive, rewarding, and with improved policies and practices both current and future psychiatrists are supported and valued in their roles. Recognising their clinical expertise and the unique set of responsibilities that they hold within the medical profession.

Role/Remit of the Group

The Group was established in May 2023 by the Scottish Government. It met on a quarterly basis and convened a total of eight times.

In addition to the formal meetings, sub-groups focussed on the following activity:

• Agreeing and implementing immediate improvements to the psychiatry webpages on NHS Education for Scotland (NES) website.
• Scottish Government funding and supporting a recruitment stand at the Royal College of Psychiatrists (RCPSYCH) international congress events 2023 and 2024.
• Group members attendance at the Medical Locum Engagement Task and Finish Group meeting to represent psychiatry interests.
• Considering potential recruitment (including international) options, and retention issues including job plans in psychiatry.

The Group adopted a phased approach to its work programme. Phase 1 focussed on recruitment and training issues and phase 2, considered retention issues affecting the existing workforce. Initially the Group was co-chaired by former Scottish Clinical Leadership Fellow Dr Nina McKenzie and Dr Alastair Cook, Principal Medical Officer in the Scottish Government, however due to a change in role, the Group was then chaired solely by Dr Cook from August 2024 onwards.

The Terms of Reference and full membership of the Group is provided in Annex B. Members included representation from NES, the Royal College of Psychiatrists in Scotland (RCPSYCHIS), the Senior Medical Managers in Psychiatry Group (SMMPG) and various NHS Scotland health board representatives including trainee doctors. The Scottish Government provided secretariat support to the Group. It was not within the Group’s remit to define the role of the psychiatrist. The Royal College of Psychiatrists ‘Choose Psychiatry’ pages can provide more detailed information on the variety of roles available to psychiatrists across different speciality areas.

Trade Union Engagement

Representatives from the British Medical Association (BMA) were invited to contribute to the formulation of the Group’s recommendations. Additional engagement has taken place between the Group’s Chair and BMA colleagues to discuss the draft report and its draft recommendations.

Trade union engagement was also in place via other health workforce working groups referenced in this report such as the Scottish Government’s Medical Locum Engagement Task and Finish Group as well as ongoing Terms and Conditions discussions taking place. The intention was to avoid replicating these existing discussions and negotiations.

In addition, the Group’s secretariat attended a meeting of the Scottish Workforce and Staff Governance (SWAG) Group (March 25) and shared a copy of the draft report and presented on the work of the Working Group.

Aim/Audience of the report

It was agreed at the outset, that the Group would report to Scottish Ministers, with recommendations and proposed next steps by Spring 2025.

This report aims to provide:

• A summary of positions held on the issues relating to the recruitment and retention of psychiatrists whilst also outlining the current position and policy in place by Scottish Government.
• Provide a factual and up-to-date context which sit alongside the recommendations being presented by the Group.
• Set out a summary of psychiatry training and trainee recruitment issues identified by Group members.
• Actions or improvements related to these that were explored or implemented by the Group or Scottish Government as part of this work, and
• The Group’s view on next steps in these areas.

The final recommendations made by the Group, as outlined later in this report, include recommendations for the Scottish Government as well as for significant stakeholders such as RCPSYCHIS, SMMPG and delivery partners such as NES and NHS Scotland Health Boards.

In producing this report and recommendations, the Group are asking lead delivery partners and organisations to prioritise implementation of the recommendations. It is their strong recommendation that these improvements are required to support the significant challenges facing the NHS workforce in psychiatry. The full list of recommendations is provided in Annex A.

The proposed next steps and the proposals for implementation are outlined in more detail later in this report.

Known Challenges and Limitations

In drafting this report, the Group’s members, recognise many of the issues raised, such as the use of locums in psychiatry, job plans and retention of skilled staff are also critical issues across the wider medical workforce as highlighted in improving medical retention advisory group report (2022). As such, the Group supported by the secretariat team, have linked in with other Scottish Government policy teams to consider the ongoing wider impact and where appropriate will be referred to later in this report.

The Group recognises that there are ongoing areas of work and negotiations that will support recruitment and retention of psychiatrists which sit outside of this report’s recommendations and that consideration of the recommendations on the wider workforce will also be important to the Scottish Government, NHS employers and other partners. This includes work to develop a Target Operating Model/Service Specification for general adult and older adult services and the ongoing tripartite negotiations between Scottish Government, BMA and NHS Employers. However, Group members are keen that their voices are heard in those discussions to ensure that some of the distinct and urgent challenges facing psychiatry are understood and prioritised.

Understanding Equalities

Throughout the development of this work and in writing this report, the Group considered the challenges and recommendations through an equality’s lens. The challenges and recommendations outlined in this report, in some instances, will be linked to wider work being progressed within Scottish Government or are the responsibility of employers. We would expect employers and other relevant policy areas to undertake their own impact assessments where necessary and in line with their public sector equality duties. Scottish Government have an influencing role in supporting employers to promote and support the conditions that enable the workforce to thrive.

The Group also recognise that actions within the Mental Health and Wellbeing Action Plan seek to address issues around equalities in relation to the workforce. The commitment to consider how we can better support the recruitment and retention of psychiatrists was included in the action plan which had its own Equality Impact Assessment (EQIA). The EQIA considered the equalities of the workforce as a whole but included targeted engagement with RCPSYCH to ensure this included psychiatrists and took into account the evidence contained within the RCPSYCH’ s own Equality Action Plan. The Scottish Government has also shared the RCPSYCH’ s new guidance and resources to NHS Boards in Scotland to help tackle racism in the workplace.

It is agreed that any new policy decisions agreed as a result of the recommendations made by this report, will need to undertake the relevant impact screening and assessments.