New survey of physicians shows workforce crisis in NHS

The Royal College of Physicians of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow, and the Royal College of Physicians of London have today [Monday 14 October 2019] released the results of the latest annual census of physicians in the United Kingdom.

The census reveals the continuing pressures on the medical workforce and NHS systems. These pressures are demonstrated by ongoing problems with rota gaps, unfilled posts and high levels of reported sickness absence. Once again, the census shows that the number of posts needed across the system significantly outnumbers the supply of physicians.

Key findings of this year’s census include:

• The ratio of consultant physicians to population served varies widely across the UK and regions with fewer consultants also have the highest rates of unfilled advertised posts.
• 40% of consultants and 63% of HSTs said that rota gaps occurred on a daily or weekly basis. Only 7% and 12% respectively said such gaps did not lead to significant patient safety issues.
• 45% of consultants and 61% of HSTs reported that a trainee was absent due to sick leave during their last on-call shift, particularly foundation year 2 (FY2) and core medical trainee (CMT) doctors.
• 55% of HSTs reported they had felt pressured to cover rota gaps and 26% said they were encouraged to take on the work of more than one doctor almost always or most of the time when covering a gap.
• 59% of consultants and 46% of HSTs reported that as a consequence of rota gaps, adequate work–life balance was most commonly affected.
• Consultants and HSTs continue to find their general internal medicine (GIM) work much less satisfying than their specialty work.
• Over half (52%) of trainees with partners and/or children reported that work had affected their relationship with them during the past year.
• 32% of HSTs reported that their morale was worse compared with a year ago and only 20% reported that it was better, with 69% reporting that working conditions affected their morale. However, 38% of HSTs felt they had achieved more over the past year, with only 20% reporting they had achieved less.
• 36% of consultants will reach their planned retirement age in the next 10 years.
• Close to half (43%) of advertised consultant posts with an advisory appointments committee (AAC) in England went unfilled due to a lack of suitable applicants. However, this year the number of consultant posts advertised with an AAC also fell by 33%.

In Scotland, the census found:

• 34% of consultants reported that a gap in the trainee rota occurred daily or weekly
• 16% of consultants reported that such gaps cause “significant patient safety problems”
• 70% of consultants reported preventing problems by trainee/SAS redistribution from ward work
• 19% of consultants reported being asked to cover a gap or vacancy in the last year
• 73% of consultants reported gaps or vacancies most negatively affected work-life balance. 
• 6% reported that rota gaps had no impact on patient safety
• 78% reported that rota gaps potentially cause patient safety problems but solutions are in place

Speaking about the results, Professor Derek Bell OBE, President of the Royal College of Physicians of Edinburgh, said:

“The Census - once again – highlights the immense pressures that exist in the NHS across the UK with rota gaps, unfilled posts and high levels of sickness absence all having a significant impact on our medical workforce and, ultimately, patient safety.

“Physicians work hard to mitigate the impact of rota gaps but these pressures contribute to increased need for consultant presence, poor morale, and insufficient time for service development. Put simply, the supply of physicians is not keeping up with demand and this needs to be addressed urgently if we are to continue to recruit and retain a world class workforce to deliver the best possible patient care.

“It is vital that now, more than ever, that we have effective workforce plans and policies in place to cope with demand on the NHS using data from this census to inform future plans. 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 staff would be a more effective use of this money.”

Professor Jackie Taylor, the President of the Royal College of Physicians and Surgeons of Glasgow, 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. That’s why we urgently need a comprehensive plan to address the serious issues that this census raises, so we can reduce the stress that doctors are under and take steps to retain practitioners within the NHS.

“I look forward to using these results to continue our work to stand up for the medical profession, and ensure that politicians and policy makers act now on the issues we’ve raised.”

Professor Andrew Goddard, President of the Royal College of Physicians of London, said:

“These results reflect the heart of the NHS crisis – there simply aren’t enough doctors to treat the number of patients in need.

“We’re calling on the next government to double the number of medical students, and better support efforts to retain current staff. Only then will we be able to provide sustainable and effective healthcare for our population.”

Each year the Medical Workforce Unit (MWU) of the Royal College of Physicians of London (RCPL) conducts the census on behalf of RCP London, the Royal College of Physicians of Edinburgh (RCPE) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG). The aim of the census is to provide the three colleges, their partners and others with robust data on the state of the consultant and higher specialty trainee (HST) physician workforce in the UK.

The three colleges also conduct a number of shorter surveys of our memberships which cover a range of topics. Alongside the census, these data help us plan for the future and ensure decision-makers across the UK are fully informed about the physician workforce.