Gender, flexibility and workforce in the NHS: A qualitative study

Abstract

Data from the General Medical Council show that the number of female doctors registered to practise in the UK continues to grow at a faster rate than the number of male doctors. Our research critically discusses the impact of this gender‐based shift, considering how models of medical training are still ill‐suited to supporting equity and inclusivity within the workforce, with particular impacts for women despite this gender shift. Drawing on data from our research project Mapping underdoctored areas: the impact of medical training pathways on NHS workforce distribution and health inequalities, this paper explores the experiences of doctors working in the NHS, considering how policies around workforce and beyond have impacted people's willingness and ability to continue in their chosen career path. There is clear evidence that women are underrepresented in some specialties such as surgery, and at different career stages including in senior leadership roles, and our research focuses on the structural factors that contribute to reinforcing these under‐representations. Medical education and training are known to be formative points in doctors' lives, with long‐lasting impacts for NHS service provision. By understanding in detail how these pathways inadvertently shape where doctors live and work, we will be able to consider how best to change existing systems to provide patients with timely and appropriate access to healthcare. We take a cross‐disciplinary theoretical approach, bringing historical, spatiotemporal and sociological insights to healthcare problems. Here, we draw on our first 50 interviews with practising doctors employed in the NHS in areas that struggle to recruit and retain doctors, and explore the gendered nature of career biographies. We also pay attention to the ways in which doctors carve their own career pathways out of, or despite of, personal and professional disruptions.

The workforce crisis in healthcare: Moving the debate to bridge evidence and policy

“…Benefits of effective governance include inclusive work arrangements and investment in HCW training/education, such as 'interprofessional work' and 'communication', 42 'coaching programs', 44 'leadership competences', 43,45 and broader commitment to diversity, equality and inclusion. 30,40 The research presented in this Special Issue also illustrates the importance of global knowledge exchange. For instance, while acknowledging that CHWs are not 'quick fixes' for the HCWF crisis and come with their own unique challenges, 47 community-centred transformations can help countries, irrespective of their economic status, to prepare better for crises and to mitigate shortages of HCWs.…”

“…39 A case study of the English National Health Service adds examples of intersectional gender-based HCWF inequalities. 40 An assessment of German bilateral recruitment agreements with Colombia, Indonesia and Jordan highlights the need for equity-based approaches in global HCW migration policy. 41 Finally, the Special Issue investigates the capacity for HCWF recruitment and retention, accentuating organisational and professional levels.…”

“…46 Governance gaps and policy failures at macro-and meso-levels are especially visible when looking at the inequitable geographical distribution and mismatches between need, demand and supply of HCWs. [31][32][33] They are also responsible for poor attention to equity measures and persisting gender inequalities, 12,13,30,39,40 as well as for the missing support for new nursing roles 43 and mental health needs of HCWs. 30 On a positive note, identifying poor governance as major problem highlights that change is possible!…”