Change, humanity, and the nature of exile: workforce planning and the future of the health service

There have been many changes in the practice of medicine in the UK in the recent past, including major changes in training and trainees' hours, treatment options and patient expectations. These, in combination with a need for better accountability and improved continuing medical education, have increased the demands on senior doctors, and made apparent the need for increased medical resource. There would seem to be four areas through which this is being addressed - increased production of doctors; changes in medical training; changes in medical practice, and retention of seniors in post. This paper examines some of the perceived advantages and potential disadvantages of these approaches. It concludes that if the health service is to have a viable long-term future, its survival in the short term depends on maintaining within the service the skills of those seniors who have borne the brunt of recent change.