The Public Health Workforce
Overview
Public health is a ‘multi-disciplinary medical specialty’ with a five-year training programme, and this is the standard route to becoming a public health specialist / consultant. Being multi-disciplinary allows the public health training programme to accept applicants with a medical background and applicants from a background other than medicine, but with extensive experience in public health. This duality adds greatly to the richness and skill mix of the specialty, provides a fascinating and wide-ranging career for specialists and ensures the UK has the readiness and capacity to tackle the enormous health challenges of the twenty first century.
Public health knowledge and expertise is critical at all levels: international, national, regional and local. Public health specialists provide crucial leadership across the three main domains (health protection, health improvement and healthcare public health) and training sufficient numbers of specialists for the future is critical for the health of the nation. The UK training programme has provided a supply of consistently high standard public health specialists deployed flexibly between the home nations, between local, regional and national roles and between service and academic public health. This was critical while public health specialists were at the epicentre of the UK’s response to the COVID-19 pandemic and will be critical in response to future pandemics and all the other public health challenges faced in the UK.
The public health workforce in the UK
There is wide national variation in the number of public health specialists working in the UK, and a significant gap in what is required. Public health registrars (trainees) are increasingly Less Than Full Time (LTFT), but with a fixed number of placements in the training scheme this has led to a supply shortfall. Alternative portfolio routes (GMC and UKPHR) are not being fully utilised and remain an undeveloped solution to the issue. The age structure of the specialist public health workforce is older than average and, although there has been stability, there have tended to be increased rates of retirement in the wake of the type of structural change we have recently seen (establishment of OHID and UKHSA). Increased recognition of the value of individuals with specialist public health skills by other employers (notably the NHS in England to support Integrated Care Systems) is good for penetration of skills across systems but reduces the candidates available for more traditional roles.
FPH position on workforce
Public health is a small speciality punching above its weight. The annual intake of new trainees on the training scheme is around 85 per year, with about 550 trainees on the scheme at any one time. Applications for the training scheme are heavily over-subscribed with over ten applications for each available training post.
Given the experience of the pandemic and the likelihood of similar events in the UK, FPH believes a safe number of public health specialists with surge capacity would be 30 specialists per one million of the population: just over 2000 consultants across the UK. Currently the UK has around 18.6 per million population, a shortfall of 750 consultants. We should aim to reach this level over the next 10 years, delivering an expansion of the specialist workforce of just over a third compared to current numbers, and this will require a trainee expansion of about 25 trainees a year. There is capacity in the training programme for such an increase.
FPH recommendations
- The UK gets to a position where there are 30 qualified public health specialists per 1 million of the population.
- There is a modest (20-30) increase in the annual intake of public health trainees on to the speciality training scheme.
