How Cumbria is now training future medics

Sustaining services that patients want, near to their homes, always centres on recruitment and retention.

But finally there is something positive happening that could potentially deliver the NHS staff of the future.

The University of Central Lancashire, and its Westlakes School of Medicine at Whitehaven, is behind these efforts.

Already medical students are receiving some or all of their training here in the county, and there are big plans to expand.

The vision is to turn Cumbria into a centre of excellence for remote and rural medicine, training up staff who have the skills a county like ours needs and, in many cases, also have local connections.

The idea is that home grown staff are more likely to stay here once qualified, while the focus of the new centre will start to attract students who want to practice in a county like Cumbria.

The Uclan medical school is based in Preston, but is gradually gravitating towards Cumbria. In just two years the number of students has grown considerably, with more starting next year.

The courses include a foundation programme, which started in January 2017 with nine students and that has now doubled.

This provides an introduction to medicine, with students then going on to train as doctors or into a different field.

Initially it was an international cohort, due to limits on the number of training places allowed by Government. This meant the students were all self-funding students from overseas.

Now it's an international and home cohort after agreeing funding, via the local NHS, to train 10 locally-funded students. From September, Uclan has secured Government backing for 15 places.

Cumbria is also leading the way in the training of physicians associates - a relatively new role for the UK but widespread in Americia.

These are people from a relevant background, such as scientific research, that want to work in a medical role.

They work in hospitals or other health settings on a level similar to a registrar, supported by senior staff, making them invaluable to areas where consultants are hard to recruit.

It was a post grad diploma but from January 2019 it will be a Masters, with about 15 places available each year.

Uclan has been training PAs for three years, two of those at Westlakes. But even those who trained at Preston have been coming to Cumbria, and the West Cumberland Hospital, for placements.

The other innovative course is in hospitalist medicine.

These are advanced practitioners - nurses or similar who have upskilled - who now want to take that a step further.

This is the first year it has run and there are five students in the current cohort. To get accepted, students need to have been working as an advanced practitioner for at least two years.

In two years the Westlakes campus has really taken off, with students coming from all over the world to Whitehaven, and others from the local area starting to see it as a place to expand their career.

Uclan has also invested in technology, so students have access to the same equipment as those at bigger centres, while senior doctors are starting to see it as an attractive place to come and teach.

Project manager Valerie Smart is very passionate about the medical school. She was taken on to get the Cumbrian campus up and running, supporting international students arriving in Whitehaven.

"I started two years ago in June with no students and no programmes. I'm very proud of what we have achieved here, and of all the staff who have helped get it off the ground. It's a real team effort," she said.

She believes in building strong links with the area, encouraging students to volunteer locally and become part of the community.

She also wants to recruit as many local students as possible, with a bursary scheme even available to one Cumbrian each year.

Valerie, who has lived in west Cumbria for many years, believes that having the medical school here is a real game changer.

"We are working really closely with the health trusts – primary care and the hospitals – to help recruit and sustain a local workforce. It's about bringing people into the area, and also growing our own.

"We are also recruiting qualified staff who come here to teach our students. We are bringing from all over the country, and the world, to Whitehaven. That will help recruitment in other areas – nuclear, teachers etc. If you've got a good working hospital it makes a big difference," she said.

VISION FOR EXCELLENCE

Professor Cathy Jackson has a real vision to turn the fortunes of Cumbria's NHS around.

She wants to make the area a centre of excellence for remote and rural medicine, and said it is already starting to become a reality.

Cathy is Executive Dean for Uclan's Faculty of Clinical and Biomedical Sciences and head of the medical school.

Although her initial focus was Preston, she was keen to expand into Cumbria as she has worked here before.

"I was a medical registrar and became a GP. The place where I retrained was west Cumbria, at Seascale, with Barry Walker who now works here. It was him that gave me a love of the area," she said.

She later moved to Scotland, where she moved into education - but stayed focused on remote and rural medicine.

Cathy said there is real appeal in working in this field, yet it has traditionally been undervalued.

"I'd been looking at how to improve recruitment in rural and remote areas. There's a lot of evidence that if you train students in those areas, they are more likely to stay and work in them.

"You need a different set of skills as a doctor and you have a lot more responsibility. You have to be really good," she said.

A twist of fate brought her to Uclan, to head the medical school and eventually expand into Cumbria, where the university had premises that were not being utilised. A couple of years in and she said her vision is starting to materialise.

"We had to drag the first lot of students up here, but the welcome they got was phenomenal. This time we have more medical students wanting to come than we have placements.

"We have started a National Centre for Remote and Rural Medicine. That's always been my ambition. What we want to do is make Whitehaven the place you think of first," she said.

"This is growing and growing. The more people see it's working, the more they want to come and work with us.

"Essentially we are making the West Cumberland Hospital into a teaching hospital. That can only be good for the area.

"We've shown already that it can work with our cohort of physicians associates. Four of them have returned to work at North Cumbria University Hospitals NHS Trust."

She said they have strong relationships with local health trusts and GPs, who are keen to find innovative ways to build their workforce, thinking outside the box to tackle long-standing issues.

She said one big plus is creating joint appointments, so senior doctors will come in to teach and also work in the local area.

One of the recent appointments is Dr Stuart Maitland Knibb who came in as director of the National Centre for Remote and Rural Medicine.

He said: "I think there's a huge opportunity to make a real difference to patient care in the UK and beyond. In fact I think we will be delivering better care for patients in remote and rural areas than they actually get in inner city conurbations.

"My vision is to go back in time if anything. As you grow up, the majority of your healthcare needs are delivered by a GP. What we've done over the past couple of decades is move general practice away from acute care and we've lost that ability to deal with acuity. We want to bring that back into general practice."

Stuart, a qualified GP who has also worked in acute medicine, as an air medic and served with the RAF, said embracing technology will be key, so doctors out in the field can access specialist advice.

"As a doctor, why wouldn't you want to work in remote and rural medicine? What's stopping you? It's that nervousness of what if I have a really poorly patient. It's the uncertainty.

"We want to frontload the system to bring technology to rural settings. That way they can make informed decisions and start immediate treatment before a patient leaves the area.

"At present we know that whilst living in remote and rural areas is great for your mindset, it can be detrimental to your health because we are not delivering that level of care in the community.

"We are saying you don't have to pay a price to live in a remote or rural area. We want more people to want to live in these areas, but young families want to feel safe. My vision is that there should never be a wrong place for the patient. It might not be the final destination, but every step of their journey should enhance their care."

Cathy said in future they will be looking to expand the courses, even looking at areas like paediatrics, where there is currently a shortage of consultants both locally and nationally.

"I think there's a very bright future. I think we've only touched the surface so far," she said.

DOCTORS TAKING ON TEACHING ROLES

Senior consultants and GPs, both from Cumbria nad further afield, are among the lecturers at the new medical school.

Professor Gershan Davis is a professor of cardiology who came here from Aintree to lecture in hospitalist medicine.

He also works at the North Cumbria hospital trust, based at the West Cumberland Hospital, treating local patients.

"I wanted to do more in education, in addition to cardilogy. The university was an attraction for me, so I could develop much more in terms of teaching," he said.

"Hospitalist medicine is one of the programmes we set up. The students have a nursing background and have done a Master's degree, then worked for a number of years after that.

"This programme takes them through an additional two years of medical and clinical training.

"It's a unique course, the first of its kind in the UK. This degree is a collaboration between the university and the trust. It's a new concept, building a different type of workforce.

"It's generating and creating skills with the right skills and qualities to serve the local population. It's innovative. These are local students with the support of their local trust. We are piloting it here, but will probably take it to other trusts," he said.

Dr Eric Bater, a retired GP who worked in Distington, is academic lead for the physicians' associate (PA) programme.

He too was attracted by the innovative approach.

"I think it's important because it's bringing in a new kind of person to the workforce, and it puts Whitehaven at the front of teaching.

"They are not doctors and not nurses, but they contribute to the medical care of patients. They can assess patients and look after patients on a ward. It's a fairly new role for this country, and I think it's going to evolve. In the US, PAs have been around for about 70 years.

"West Cumbria, and Cumbria as a whole, needs to find a different way of addressing its medical workforce. The opportunities are there, the need is there and because of the local situation, the enthusiasm for developing new ways of working is there."

Dawn Sawyer, was a physicians associate in America. She is now a lecturer at Uclan who also works in the hospital.

"I'm a PA. I've been one for 25 years. I spent the last 10 years in Alaska but I'm from the mid-west originally. They were telling me how remote it was here, but to me this is not remote," she said.

"We do a lot. We are trained like a physician, to diagnose and think like a doctor. We make decisions and work alongside physicians."

Dr Rick Tranter, is clinical senior lecturer in rural medicine and long-serving Whitehaven GP. He arranges the placements for Uclan students and said many of them are already coming back, leaving him optimistic for future recruitment in Cumbria's NHS.

"Quite a few students from the foundation programme have already come back during their first year because they liked it. And word has got back to Preston that it's a great place to come. They know that students are really wanted here," he said.

WHAT THE STUDENTS SAY

Uclan's Westlakes medical school is now attracting students from all over Cumbria, the UK and the world.

Rose Cleeton, 41, from Whitehaven, had a background in science but had been a stay at home mum for seven years, but decided to retrain as a physician's associate.

"The role hadn't been on my radar, but it seemed to tick all of my boxes. The big advantage for me, with having a family, is that I can do all of the training here in the local area," she said.

Training locally was also a big advantage for Joshua Keen, 24, from Millom, who, having already been away to university once, didn't want the financial burden to continue his studies. But training here, as a physician's associate, means he can live at home.

Although he came from a scientific background, he didn't want to work in a lab so started to look at medicine.

"I wanted to do something a bit more hands on. I was looking at a postgraduate medicine course, then I came across this. It said Whitehaven. I couldn't believe I could do it here," he said.

Both plan to work locally after qualifying.

The foundation medical students come from all corners of the world, but say they have been welcomed in Cumbria.

They include Tanmeet Chwla, 22, from the USA; Sohema Moosa, 19 from Malawi; Aaditya Sonah-ori, 19, from Mauritius; and Azeem Shafai, 20 from Bahrain. They all started in September, living and studying together in Whitehaven, and are nearly at the end of their course.

Aaditya said: "I felt this course would broaden my opportunities for getting into a medical field. I like the community here. I hope to stay in the UK. I'd maybe come back to Cumbria later."

Azeem added: "I did sixth form in the UK, then I wanted to study medicine here. Coming to a rural area has been really nice. I've always lived in a city so coming here is a change of perspective. It's been really nice here. Everyone has really looked after us."

The students have volunteered with Whitehaven's Harbour Youth Project, among other organisations, as part of their course and really appreciated have those community links.

Simon Pritchard, 25, from Chester, was one of the first physicians' associates who trained at Uclan, based in Preston.

Having carried out some placements in Cumbria, he has now returned to the West Cumberland Hospital to work as a PA.

"I think I wanted to come back because the consultants here were so friendly. They were very enthusiastic and approachable. You could ask them anything, everyone gave me their phone numbers and we even played table tennis and badminton together. You probably wouldn't find that anywhere else," he said.

"I'm enjoying it. There's more responsibility than I expected. I'm usually looking after my own bay, working closely with other doctors. There's always someone there to ask for an opinion."

NATIONAL NHS RECRUITMENT CAMPAIGN

The NHS has this week launched a major recruitment drive to coincide with the 70th birthday of the health service.

As well as attracting new recruits, it is also encouraging staff that have left to return and help to retain existing staff.

The long-running campaign will initially focus on nursing and but will highlight other roles, particularly those with the largest shortages, such as mental health and learning disability.

The campaign focuses on the great care being provided by NHS staff and the fantastic teams working across the service.

The #wearetheNHS campaign feature on TV, radio, posters, digital and social media, directing people to the Health Careers website.

This provides information on the different roles within the NHS and how to access them, including training requirements and funding.