By Bernard Place
FOR years, Jersey’s health service has been locked in the same cycle: too few permanent staff, too many agency contracts, and a growing sense of frustration that we are paying more but getting less. We talk about recruitment drives and overseas campaigns, but the real solution lies closer to home. We need to grow our own clinicians – and give them reasons to stay.
When I speak with nurses, therapists, or junior doctors, the same theme emerges: people leave not because they dislike their work or the Island, but because they can’t see a future here. With no next step, limited training, and few clear career ladders, the message is implicit – your development happens somewhere else. For many once they leave for that opportunity, they rarely return.
The paradox is that Jersey has many of the ingredients needed to become a remarkable place for clinical education. We have a single main hospital, a close-knit network of GP practices, and community teams where every patient’s story can be followed from start to finish. In larger systems, fragmentation hides the links between hospital, primary care, and social care. Here, those links are visible. That’s an advantage we’ve never fully used.
From dependency to capability
We have become dependent on imported expertise, as though skilled professionals can simply be flown in like medical supplies. It is an expensive habit that erodes morale and continuity. Temporary staff do their best, but they can’t build lasting relationships with patients or colleagues. And when they earn more than those who carry the permanent burden, resentment can grow.
The alternative is to shift from dependency to capability – by building a system where learning, supervision, and role development happen in Jersey as part of daily work. That means investing not just in pay, but in purpose.
Other small jurisdictions have already shown how. Local clinical education hubs can link universities to community and hospital placements. Jersey can do the same, using digital technology and blended teaching to overcome small cohort sizes. It’s not the number of students that matters, but the quality of their experience and the clarity of the pathway ahead.
Local Integrated Clerkships –a new kind of placement
One promising approach is the Local Integrated Clerkship (LIC) model. Instead of short rotations, students from different disciplines spend a full year embedded in a community, following patients across settings and learning from the continuity of care.
Imagine a student attached to a group of GP practices, community nurses, and hospital consultants, seeing how a person with diabetes or heart failure is supported over time. They would learn not just medicine, but humanity – and they would do so within the social fabric of Jersey itself.
This model has transformed medical education in parts of Australia, Canada, and Scotland. It encourages retention because it builds belonging: people trained in a place tend to stay in that place. For Jersey, it could be a game-changer. It would also strengthen relationships between education and service delivery, bringing teaching, supervision, and care closer together.
Learning through integrated teams
If we are serious about retaining skilled staff, we also need to rethink how we organise care. The Dutch Buurtzorg model – which literally means “neighbourhood care” – offers a useful blueprint. It builds small, self-managed teams of nurses and therapists who plan their work around the person, not the bureaucracy. These teams are trusted to organise their schedules, manage caseloads, and deliver integrated care within their communities.
The results in the Netherlands have been remarkable: higher patient satisfaction, lower overheads, and far lower staff turnover. People stay because they feel ownership and autonomy.
A Jersey adaptation could combine these principles with our Island’s intimacy. Teams based around parishes or neighbourhoods could bring together doctors, nurses, therapists, social workers, and volunteers, supported by digital tools but guided by human relationships. These teams would also make ideal educational platforms for students in Local Integrated Clerkships – enabling learners to experience multidisciplinary working as the norm rather than the exception. Education would no longer be something that happens to one profession at a time, but a shared process of service delivery and improvement.
Working at the top of our licence
Education and training are only half the story. We must also allow staff to work at the top of their licence – using all the skills they have trained for. Many nurses and allied health professionals could safely extend their scope of practice, managing long-term conditions, prescribing, or leading clinics. What they lack is not ability, but opportunity.
When people feel trusted and supported to use their full competence, morale rises and retention follows. The logic is simple: if we expect clinicians to commit to Jersey, Jersey must commit to their professional growth.
Extending roles doesn’t mean blurring boundaries irresponsibly. It means aligning training, supervision, and governance so that people can progress with confidence. And it means recognising mentorship and teaching as valued and funded parts of the job – not unpaid extras squeezed into breaks.
The Health Minister plans to establish a Health and Care Jersey Partnership Board. Championing and embedding integrated education and training within its work should be one of its first priorities.
Small Island, big opportunity
Critics will say that Jersey is too small to sustain its own education system. But that is precisely why we should try. We have the agility to innovate in ways that larger systems cannot. Small cohort sizes make it easier to test new models, learn quickly, and adapt.
The economics can be managed through partnerships with universities, shared modules, and virtual classrooms. The real challenge is not financial but cultural: are we ready to trust ourselves?
For decades we have assumed that expertise comes from elsewhere. Yet the clinicians who stay longest, and give most, are those rooted here – people for whom Jersey is not a posting, but a home. If we build a culture of education and progression that recognises that commitment, the rewards will ripple through every part of our health service.
A message of confidence
In the end, retention is not about contracts or bonuses; it is about confidence. Confidence that Jersey’s health service will invest in its people. Confidence that a clinician who starts here can build a whole career here. Confidence that we can deliver great care from our own soil.
Growing our own clinicians is not just an HR strategy. It is a statement of faith in the Island’s future – that we can make our systems work better and differently by starting with the people who already serve within them.
A registered nurse for nearly 40 years, Bernard Place has been a clinician, teacher and researcher in intensive care units. From 2012 he managed departments in Jersey’s healthcare system and from 2015 to 2019 was the clinical project director for Jersey’s new hospital.
