Consultant census 2019/20: the College's view

Consultant Census 2019/20

Everyone who works in NHS is all too aware of the strain that our healthcare system is under, particularly as we prepare for another winter with the extra pressures relating to COVID-19. The consultant census report 2019/20 – which is a joint endeavour by the Royal College of Physicians of Edinburgh, the Royal College of Physicians of London, and the Royal College of Physicians and Surgeons of Glasgow - will help inform policy-makers as we move into winter. Although the data were collected before COVID-19, the findings are stark. Too often, data may feel unrepresentative of the reality on the ground. However, the 2019-20 census reveals what working conditions have been like for consultants right across the UK.

In sifting through the data, we were struck by how many consultants said that they did not usually receive a lunchbreak at work. In Scotland, the figure was 35% and it rose to 43% in England. 27% of consultants in Northern Ireland and 31% of consultants in Wales also failed to receive regular lunchbreaks. Anecdotally, our Fellows and Members tell us that COVID-19 may have made this situation worse – although the data are not yet available.

Fundamentally – at a basic human level – it is troubling that so many of our consultants are unable to get a regular lunch break. And according to the data, this is a problem experienced by consultants in all parts of the UK. How can we expect consultants to maintain their own health and wellbeing when they do not have time to eat, keep hydrated and recuperate during their shift? Would this be expected in other professions? In light of the data, we urge cross-government action to ensure that all our healthcare workers get the rest breaks they need.

But why is this happening? One of the core reasons could be the frequency of rota gaps. Daily, weekly and monthly rota gaps were reported in each UK nation in the 2019-20 census. Daily rota gaps being reported daily are fairly low across the board (England: 7%; Scotland: 6%; Northern Ireland: 5%; Wales: 9%) – although still too high for comfort. Daily rota gaps are highly disruptive, can make planning more challenging, and can negatively impact patient safety. Higher numbers of weekly rota gaps were reported (England: 27%; Scotland: 25%; Northern Ireland: 25%; Wales: 31%), as was the case for monthly rota gaps (England: 19%; Scotland: 20%; Northern Ireland: 27%; Wales: 19%). This ultimately reflects that there are too few NHS consultants to fill the rota gaps, due to a range of factors including retirement, trainee attrition (drop out), the need for more medical school places and the availability of more trainee jobs (dispersed fairly across health areas and regions). Therefore, a clear medical workforce strategy is required in the UK – we cannot simply rely on locum doctors which can be more costly. It is significant that 56% of respondents to the census reported that external locums were provided as the solution to rota gaps.

Furthermore, the 2019/20 census reveals the significant negative impact of rota gaps on UK consultants. It is extremely concerning – although unsurprising - that 73.5% of consultants reported that rota gaps had a negative impact on their work-life balance. Inadequate work-life balance is of course unenviable in any profession and can affect mental health. COVID-19 has added another significant burden and the situation has not improved, with consultants regularly working more than their contracted hours. Perhaps, most surprising of all, is that 57% of consultants received no compensation for covering rota gaps across the UK – rising to 67.5% in Scotland. While we accept that consultants are sometimes asked to cover gaps, we do not accept that they are often not paid for it. This is something we urge action on.

In addition, we note that the proportion of consultants who will reach their mean intended retirement age in the next decade is 35%. This is deeply concerning. According to the census data, doctors still intend to retire below statutory age in the UK, with an average intended retirement age of 61.7. Furthermore, across the UK, 41% of consultants will reach 60 in the next 10 years, and in Scotland the figure is 43%. We highlighted this issue last year along with our sister Colleges, in a pensions snapshot survey. We found that almost half (45%) of the 2800 doctors who responded had decided to retire at a younger age than previously planned, with 86% of them citing pension concerns as reason for this decision. It is more vital than ever that within workforce strategies, there is a clear plan to recruit and retain doctors. As part of that, long-term pension issues must be addressed, to help doctors prepare for their future in a fair and flexible way.

Another worrying factor in the census is bullying. According to the data, 20% of consultants have felt bullied or harassed “in the past year”, with 5.6% saying that this has been the case on a monthly basis (daily: 0.4%; weekly: 3.6%). The College is adamant that there should be zero tolerance on bullying and harassment in the NHS. Broken down by nation, the figures were as follows: England: 20.3%; Scotland: 21.8%; Northern Ireland: 19.3%; Wales: 13.1%. A similar proportion (20.8%) of respondents said that they had witnessed the bullying or harassment of a colleague. In Scotland, we are encouraged that an Independent National Whistleblowing Officer (INWO) has been established to act as an independent watchdog on bullying and harassment within the NHS in Scotland. The INWO is designed to “…set the standards for complaints about the application of the local NHS whistleblowing processes, including examination of the decision-making and outcomes of the whistleblowing complaint”. It is hoped that the INWO will build on the findings and recommendations of the Sturrock Review, as nobody should come to work and be subjected to bullying or harassment in any form, whether physical or emotional. This should be extended to all groups in society – including ethnic minority groups. We are concerned that according to the census, consultants from an ethnic minority background were twice as likely as their white colleagues to experience discrimination. Equality, diversity and inclusivity is vital in the NHS – as we stated in a recent Black Lives Matter statement. There should be zero tolerance on bullying or harassment based on race, colour, religion, gender, sexuality or disability.

In more positive news, and despite all of the problems this blog has highlighted, the census reveals that job satisfaction remains high among consultants. Across the UK, 56% of consultants said that they were often satisfied with their job, while 27% said that they were always satisfied – 83% combined. Looking at the combined figures across the different nations of the UK, this represented: England: 86%; Scotland: 87%; Northern Ireland: 88%; Wales: 90%. While this is positive news, it should not be assumed that the medical workforce is universally content with their working conditions and arrangements. However, the fact that so many consultants are satisfied with their jobs is a strong basis to build for the future. In the most recent edition of the GMC’s National Training Surveys of trainees and trainers, findings suggest that urgent reform is needed on doctors’ rotas, workload, time for training and improving the working environment. We agree with that assessment. Measures such as more humane rota design, and steps to improve workplace culture can help improve the morale of the workforce and make the job easier. It is time to truly value the workforce.