Census Shows Consultant Posts Going Unfilled

Peter Russell

October 14, 2019

A UK-wide census of senior doctors revealed continuing pressure on the medical workforce and the NHS.

The latest survey by the Medical Workforce Unit of the Royal College of Physicians (RCP) showed consultant posts going unfilled, ongoing problems with rota gaps, and high levels of sickness absence.

The problem was particularly severe in rural areas of England where hospitals were struggling to recruit senior doctors.

It said the large number of vacancies was impacting on patient care.

The RCP called for a significant expansion in the number of medical school places across the UK.

The Government said it had a strategy in place to boost training.

Unfilled Posts

The census, Focus on physicians 2018-19 , found that in England and Wales, 43% of advertised consultant posts with an advisory appointments committee went unfilled due to a lack of suitable applicants. Of those, 56% went unfilled because nobody applied.

Also, there had been a 33% fall in job advertisements for these roles, perhaps because NHS Trusts lacked confidence that they could attract enough qualified applicants.

The survey also noted a disparity in the number of successful appointments in different areas.

Only 13% of senior doctors' posts in England were made in rural parts of the country. In the East Midlands the problem was even more severe, with only 11% of advertised posts in rural areas being filled. In the North West, no appointments were made in rural areas at all.

Of the 8656 physicians who contributed to the latest census:

  • 40% of consultants and 63% of higher specialty trainees (HSTs) said that rota gaps occurred on a daily or weekly basis

  • 45% of consultants and 61% of HSTs reported that a trainee was absent due to sick leave during their last on-call shift

  • 55% of HSTs reported they had felt pressured to cover rota gaps

Medical Training Expansion

Prof Andrew Goddard, president of the RCP, said in a statement: "The results of our census are an incredibly alarming indication of the huge disparities in care across the country. Some rural areas are so severely under-doctored, that patient lives could potentially be at risk.

"The sheer dearth of senior doctors in rural communities goes to the heart of the crisis facing our NHS: there simply aren't enough doctors to treat the number of people in need.

"A major part of the problem stems from the fact that medical schools don't have enough places to offer those who are keen to study the subject."

The RCP said it wanted to see a doubling in the number of medical school places, and more effort to retain exiting staff.

It said it would continue work to identify ways of encouraging doctors in training to take up posts in specialties – and in locations – with the largest recruitment gaps.

Senior Doctors 'At Breaking Point'

The annual census is produced to give the RCP, the Royal College of Physicians of Edinburgh (RCPE) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) robust data on the state of the consultant and HST physician workforce in the UK.

Prof Jackie Taylor, president of the RCPSG, said: "This census provides the definitive picture of the state of the medical profession across the UK today. It makes clear that despite the commitment and professionalism of doctors up and down the country, the pressures that we face on a day-to-day basis are becoming more acute.

"These results show that we are now at breaking point. The wellbeing of doctors is suffering because of the increased workforce pressures that we face, and this situation now risks plunging our profession into a downward spiral which contributes to further workforce shortages and rota gaps."

Prof Derek Bell, president of the RCPE, said: "It is time to value our medical workforce and support their wellbeing to retain the experience, skills and knowledge of doctors at every level, from trainees to senior consultants.

"We need to ensure an increased number of medical school places, sufficient time for training, and maximise international training fellowships. Similarly, repurposing the current NHS spend on locum and agency staff into permanent posts would be a more effective use of this money."

A Department of Health and Social Care spokesperson said: "The NHS has more consultants now than at any time in its history, with over 17,300 more doctors working in the NHS since 2010 delivering excellent, safe care to patients.

"We also have record numbers of doctors in undergraduate training, recently adding 1500 extra training places by opening five new medical schools across England – the majority in rural areas.

"The upcoming People Plan will address how we can ensure all NHS services have access to the doctors they need, including a national programme to tackle geographic and specialty shortages in medicine."

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