Concerns over lack of applications for vacant consultant posts in Scotland

College raises concerns over lack of applications for vacant consultant posts

Backed by the latest data, the Royal College of Physicians of Edinburgh (“the College") is encouraging the Scottish Government to “ramp up” its efforts to attract new NHS consultants, particularly in remote and rural areas. Our call is supported by the Academy of Medical Royal Colleges and Faculties in Scotland (“the Scottish Academy”).

The recruitment and retention of senior medical staff across the NHS in Scotland is one of the biggest challenges facing our health service. Every vacant position increases the pressure on overstretched colleagues and erodes the ability of the NHS to provide the level of care that Scotland’s population requires.

Appointment panels play a vital part in the consultant appointment process in Scotland, as governed by The National Health Service (Appointment of Consultants) (Scotland) Regulations 2009. If for any reason the Chair of an appointment panel is unable to appoint a candidate to the consultant post, the recruitment process will cease and reasons must be provided in writing to the NHS Board by the Chair.

According to new data from the Scottish Academy External Advisers - who sit on panels and provide input and advice throughout the appointment process - there were 733 appointment panels for consultant jobs in 2022, 306 (42%) of which were cancelled. That is 102 more than in 2018. Of those 306 cancellations, 271 (88%) were related to applicant reasons including no applications (194), no suitable applicants (53) and candidate withdrawal (24). This is concerning because a significant number of vacant consultant posts had no suitable applicants, or saw no applications whatsoever.

The data show that the recruitment challenge is greatest in remote and rural areas. NHS Boards with the highest number of cancelled appointment panels include:

• NHS Western Isles – 6 cancellations out of 6 (100%)
• NHS Shetland – 4 cancellations out of 6 (67%)
• NHS Highland – 36 cancellations out of 57 (63%)
• NHS Borders – 12 cancellations out of 19 (63%)

By comparison, in NHS Greater Glasgow and Clyde, there were 44 appointment panel cancellations out of 151 (29%) in 2022. In NHS Lothian, there were 35 cancellations out of 101 (35%) in 2022.

Remote and rural NHS Boards also tend to already have more consultant vacancies per 100,000 people, according to data from BMA Scotland, with the exception of the Borders (3 vacancies per 100,000 people):

• NHS Western Isles – 41 vacancies per 100,000 people
• NHS Shetland – 37 vacancies per 100,000 people
• NHS Highland – 30 vacancies per 100,000 people

Furthermore, according to estimations in the physicians’ census published in June 2023, the north of Scotland (including the Highlands and Islands) has one consultant per 4,094 people versus, for example, one consultant per 3,104 people in the East of Scotland.

Therefore, the latest data clearly highlights that remote and rural areas are struggling to recruit consultants the most, which is a major concern for people living in those areas. However, there are vacancies in every part of Scotland and this has been exacerbated by appointment panel cancellations across the country.

The College and Scottish Academy say that the consultant recruitment challenge must be addressed collaboratively by the Scottish Government and NHS Boards, in order to maintain standards of patient care.

Commenting, Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh said:

These figures will be of serious concern to people living in remote and rural areas particularly, especially the Highlands and Islands. The recruitment of doctors in these areas has been more difficult for some years. But given the already high existing number of vacancies, the lack of suitably qualified professionals applying to fill them now creates significant challenges.

While the challenges in remote and rural areas are greatest, it should be noted that there is a shortage of consultants - across many different medical specialties - throughout the country, including in the central belt.

The College is urging the Scottish Government and NHS Boards to work timeously and collaboratively to address the current recruitment challenges. While we welcome the recent expansion of medical school places, it takes many years for a doctor to become qualified – and many more before they can qualify as a consultant.

It is therefore vital that short term and medium term options are fully explored. We must consider how Scotland can attract more fully trained doctors by, for example, ethical international recruitment. This means examining the workplace environment, including the support and job planning process for consultants across all specialties. We must establish why some consultant posts consistently attract no applicants at all, and work to rectify local issues that contribute to this trend.

Professor Steve Turner, Chair of the Academy of Medical Royal Colleges and Faculties added:

The number of consultant appointment panels continues to rise, and in 2022, the Scottish Academy External Adviser team were involved in 733 panels across 56 different medical specialties – equaling 13 per week. Our External Advisers provide an important independent opinion throughout the recruitment process, from commenting on job descriptions before advertising to sitting on appointment panels.

Unfortunately, almost half of all appointment panels do not actually convene and this is mostly due to the lack of applicants; 26% do not receive any applicants and a further 10% are cancelled because the applicant is either felt unsuitable or withdraws altogether. Historically, more than a third of appointment panels do not actually take place, so it’s clear that a large number of panels are convened and then are not needed. At the Scottish Academy we looking at ways to make the consultant appointment system more efficient for all parties involved.