A survey of the specialist public health workforce in the UK in 2003

OBJECTIVES: To identify the number and distribution of public health specialists in the UK. STUDY DESIGN: Cross-sectional survey. METHODS: Postal survey of UK members and fellows of the Faculty of Public Health and primary care trust directors of public health in England in October 2003. RESULTS: Of 1993 individuals surveyed, 1566 (78%) responded, of whom 1331 reported working as consultants or specialists in public health in the UK. Of the 1331, 891 (67%) were on the General Medical Council Specialist Register, 53 (4%) were on the General Dental Council Register, and 92 (7%) were in the process of applying for the Voluntary Register; 295 (22%) did not appear to be on any professional register or in the process of applying to the Voluntary Register. This equated to a total UK rate of 14.1 per million 'service' public health. There was substantial variation by region from 9.3 per million population in Wales and the South West to 18.0 per million population in the West Midlands and 19.5 per million population in London. An increase of 218 (21%) additional consultants and specialists in public health across the UK would be required to bring other regions up to the level of the highest region. CONCLUSIONS: This survey, although limited, being based on a survey of members and fellows of the Faculty of Public Health, shows that specialist public health is under capacity, is resourced in a highly variable manner, and needs to be built up to meet the challenges we face. A comprehensive workforce plan for public health is urgently needed.     

Developing a speciality: regearing the specialist public health workforce

OBJECTIVES: To identify issues surrounding the future training needs of the specialist public health workforce following the most recent restructuring of the National Health Service (NHS) in England. METHODS: All directors of public health (DsPH) based in strategic health authorities and nine senior staff working in public health at the regional level were invited to participate in a semi-structured telephone interview. RESULTS: Twenty-six people were interviewed. Many interviewees expressed concern that because consultants and specialists in public health will be working in much smaller teams than hitherto, they will have to generalize their skills to cover a much wider range of functions (including board-level duties). This may result in a loss of specialist expertise. Successful public health practice in the new structures will require new ways of interorganizational working that will add an administrative burden to specialists in public health. Also, the creation of a board-level post in each primary care trust (PCT) has resulted in more time spent on corporate responsibilities and less on public health for DsPH, who are often the only fully trained specialist in public health in their PCT. Furthermore, interviewees expressed their anxiety about the lack of diversity in the posts available to specialists in public health and particularly to those newly completing their specialist training. Generally, interviewees felt that traditional public health roles and responsibilities were being eclipsed by corporate and managerial ones. Professional development activities were being carried out, but in a rather ad-hoc fashion. Interviewees were hopeful that public health networks would lead professional development initiatives once they were more established. CONCLUSIONS: It is important that excellence in public health is maintained through a set of accreditable standards, whilst corporate skills, essential to successful public health practice in the new UK NHS, are developed among specialists in public health.     

Mapping the public health workforce I: a tool for classifying the public health workforce

We aimed to develop a tool to identify members of the public health workforce and classify them using categories developed for the Chief Medical Officer's project to strengthen the public health function. The tool was developed to gain a picture of London's public health workforce, and needed to be reliable and easy to use in many settings inside and outside the health service. We needed to be able to classify posts from brief information without interrogation of postholders, so that the entire workforces of large organisations could be classified from information provided by only a few key informants. Key questions and decision rules were defined by presenting interviewees in public health with brief information on nine jobs and discussing with them the process by which they determined whether each post was in the public health workforce, and if so, in which category. The questions and decision rules were refined into a classification tool which was presented as a flow diagram and a questionnaire. Application of the tool revealed that it was understood by key informants and resulted in classifications which were accepted by the researchers. The tool has now been applied extensively in London and yielded useful results. Many other applications in public health workforce planning and development are anticipated.     

Specialist public health capacity in England: working in the new primary care organizations

OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.     

An evaluation of a public health nutrition workforce development intervention for the nutrition and dietetics workforce

Background: Workforce development is a key element for building the capacity to effectively address priority population nutrition issues. On‐the‐job learning and mentoring have been proposed as strategies for practice improvement in public health nutrition; however, there is limited evidence for their effectiveness. Methods: An evaluation of a mentoring circle workforce development intervention was undertaken. Thirty‐two novice public health nutritionists participated in one of three mentoring circles for 2 h, every 6 weeks, over a 7‐month period. Pre‐ and post‐intervention qualitative (questionnaire, interview, mentor diary) and quantitative (competence, time working in public health nutrition) data were collected. Results: The novice public health nutritionists explained the intervention facilitated sharing of ideas and strategies and promoted reflective practice. They articulated the important attributes of the mentor in the intervention as having experience in and a passion for public health, facilitating a trusting relationship and providing effective feedback. Participants reported a gain in competency and had an overall mean increase in self‐reported competence of 15% (range 3–48% change; P < 0.05) across a broad range of competency elements. Many participants described re‐orienting their practice towards population prevention, with quantifiable increases in work time allocated to preventive work post‐intervention. Conclusions: Mentoring supported service re‐orientation and competency development in public health nutrition. The nature of the group learning environment and the role and qualities of the mentor were important elements contributing to the interventions effects. Mentoring circles offer a potentially effective strategy for workforce development in nutrition and dietetics.