Description
One of the main strengths of the UK public health system and its delivery is its multidisciplinary workforce. Until recently only one structured training programme was available exclusively to medical graduates and in line with other medical specialities. The Faculty of Public Health Medicine (Public Health since June 2003) of the Royal Colleges of Physicians of the United Kingdom, as the UK main body for setting standards and monitoring training, have taken a courageous and welcomed step to lead on the training of other graduates. A step which many of us felt was long due to ensure that Britain has the public health workforce to meet the changing needs in a rapidly changing society. However, the new programme is based on one channel of training for people from any background, moulding them through a four-year structured training based on the ten public health competencies. Many of the non-medical trainees (called Associates to separate them from the Specialist Registrars) enrolled were without any biological sciences training background. Yet they are required to do at least three months training in communicable disease control and join the public health out of hours on-call rota dealing with a range of problems from infection to chemical and biological incidents! The question many of us are asking after more than two years of the introduction of such a single channel of training is, whether, this is multidisciplinary training. The obvious answer is certainly not. But, what are the alternatives?
The Wanless Report1 and the consultation on the Public Health White Paper2 provide great opportunities for public health leaders to re-define the workforce needed, the skill mix and thus the training pathways for a truly multidisciplinary public health practitioners meeting the challenges of the 21st century. We always believed that the single channel training arrangement was rushed under pressure without considering the long-term consequences. Some of these consequences were highlighted in warnings by public health leaders in Public Health Medicine.3,4 It is certainly not the solution for the shortage in the public health workforce and it will not diminish the so-called medical domination of the speciality. With a new set of leadership at the UK Faculty, it is the time to reflect. Many colleagues have suggested that the best way forward is to have many channels of training with different categories of membership ie medical, science, dental etc. Those with no biological sciences background for example will need a different type of training, perhaps longer than those from medical and other clinical backgrounds. Furthermore, to widen the scope of public health physicians, for example, some of them could be encouraged to combine their training with some clinical elements, for example child health, mental health, preventive cardiology, substance misuse, infectious diseases etc; a proposal which was endorsed by the Faculty’s Board sometime ago, but not as yet fully activated.
Preparing a multidisciplinary public health workforce requires multiple approaches. We need some fresh ideas fortified with courage and determination to re-shape the future. A strong and effective public health function is a necessity for modern society in order to improve, promote and protect people’s health. We should capture such a good opportunity to improve the public health.
References:
1. Wanless D. Securing the health of the whole population. The final report. London: HMSO, 2004.
2. Department of Health. Choosing Health? A Consultation on action to improve people’s health. London: Department of Health Publications, 2004. www.dh.org.uk
3. Bophal R. Without Sound biological and medical science foundations the existing curriculum and standards of public health are not suitable for non-medical health practitioners. Public Health medicine 1999; 1:2
4. Watson. J. The speciality of public health medicine. Has it lost its way? Public Health medicine 2002; 4:1
