BMA Health Survey

Findings from the Public Health Survey

Key Findings

State of the profession

  • Just over half of non-trainee respondents reported having considered leaving public health in the last three years, and just under half of trainees reported having considered leaving training. The five main reasons for this are not feeling professionally fulfilled, a poor work-life balance, the work environment not being sufficiently supportive, a fear of future deterioration of terms and conditions and disagreement with the overall direction in which the organisation is going. 
  • Overall, respondents are content with their remuneration and terms and conditions. They also report being confident in their role, and feel their skills are valued by their colleagues. There is however a perceived lack of understanding of their roles in the wider organisation, and a perceived lack of valuation for skills by senior management. Both problems are significantly worse among non-trainees working for local authorities.
  • Less than half of participants agree that they have the necessary professional independence to speak out on public health issues. The percentage is significantly lower in local authorities and Public Health England (PHE).
  • Respondents expressed a very strong concern about overall future workforce numbers. Only 12 per cent of participants thought that, in ten years time, there will be sufficient substantive consultant posts available to serve the needs of the population, and concerns were voiced that the workforce is being spread too thinly. 
  • Medical professionals are much less likely to want to work for local authorities and this trend is likely to increase in the future. There are two main reasons for this: doctors perceive a lack of support for their skill set in local authorities, and believe local authorities are likely to want to employ non-medical professionals for budgetary reasons. 

The reforms

There is still little support for the public health reforms in England. Those surveyed largely do not think the reforms have benefitted public health in England, or have made the system more supportive to staff. There is furthermore a consistent perception that, since the reforms, bureaucracy has increased and the workforce is increasingly fragmented. 

Local authorities

Respondents’ views of local authorities were mixed; this reflects a wide variety in performance across the different local authorities. However, universal findings are:

  • Whereas relationships with local CCGs are generally seen as good, the perceived ability to effectively influence commissioning decisions is lagging behind.
  • There is widespread concern over current and future funding levels.
  • There appears to be agreement that it is easier to collaborate with or influence other local services, but at a cost to collaboration with the NHS. 

Public Health England

  • There is a concern among those working for PHE (and the Health Select Committee) that PHE does not have the necessary political independence from the Department of Health. 
  • There is a perceived lack of national leadership, and the workforce is calling on PHE to fill this void. This national leadership is particularly important considering the above mentioned fragmentation of workforce and practice.

© British Medical Association, 2014

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