Medical Workforce Census Report 2015

There are 7,422 consultants in England, Wales, Scotland and Northern Ireland (7,439 including those from Crown dependencies such the Isle of Man and the Channel Isles).  Overall, throughout the UK there was an 8.4% increase in consultant numbers between 2010 and 2015 (and a 10% increase between 2007 and 2010) and this equates to an increase of around 2.3% per year between 2007 and 2015.

A total of 68% of the anaesthetic consultant workforce is male and 32% is female.  The percentage of female consultants has risen in each of the devolved nations over the period 2007 to 2015.  Nearly three-quarters (74%) of consultants currently work more than ten Programmed Activities (PAs) and of these 75% are male and 25% are female.  8.5% of consultants work nine or fewer PAs, and there are more female consultants than male in this group (5.4% versus 3.1%).

There has been an 8% expansion in the total number of consultants between 2010 and 2015 and a 28% increase over the same period in the number of consultants aged between 50 and 59 years, indicating an ageing consultant population.  Around 40% of departments have consultants doing both elective and emergency CEPOD sessions (separate from on-call duties) on weekday evenings.  Almost a third of departments have consultants doing elective work at weekends.  Over half of departments have consultants doing emergency CEPOD sessions (separate from on-call duties) at weekends.

There are 2,033 SAS and trust-grade doctors in England, Wales, Scotland and Northern Ireland (2,047 when those from the Crown dependencies are included).  There has been an increase of 14.7% since the 2010 Census, equating to an increase of 2.9% per year.  They make up 21.6% of the trained anaesthetic workforce (2,047 SAS doctors versus 7,439 consultants).  Overall, 61% are male and 39% female and, except in Scotland, there have been increases in the proportion of female SAS and trust-grade doctors between 2010 and 2015 in all of the UK nations.  SAS doctors have similar work patterns to consultants, with nearly three-quarters (74%) currently working more than ten PAs.  10% of SAS doctors work nine or fewer PAs, and there are more female SAS doctors than male in this group (7% versus 3.1%).  The age distribution of SAS doctors is similar in 2015 to what it was in 2010 – in both censuses just over a quarter (27%) are aged between 50 and 59 years.

In England just over a quarter of respondents (26%) stated that a gap in the consultant rota occurred approximately once a week.  In Scotland this figure is higher at 30%, in Northern Ireland it is 50%, and in Wales the number approaches 60%.  This adds to the workload of an already stretched workforce and generates additional expenditure.

This Census identified 250 doctors, of whom 202 (81%) were consultants, and 48 (19%) SAS doctors who had returned to work after retirement.  Although only an approximation, of the total number of trained anaesthetists (consultants and SAS doctors) currently working, about 2.5% in England have retired and returned.  The equivalent figures for Northern Ireland, Scotland and Wales are 1.49%, 1.66% and 3.88% respectively.  Males are nearly twice as likely to retire and return than females (3.1% versus 1.7%).

Over 50% of the 217 respondents expected to require 0–5 posts and over 30% 5–10 posts in the next two years.  A further 10% suggested they would require 10–20 posts.  In a separate question, of those trusts and boards that at the time of the Census had advertised posts, 55% were advertising replacement posts and 27% were advertising new posts (giving a ratio of 2:1 replacements to new appointments).

In the UK 4.4% of consultant posts and 11% of SAS and trust-grade doctor posts are empty.  A breakdown by devolved nation can be found in the body of the report.  The majority of respondents use internal locums – that is they cover vacancies from the existing complement of staff.  Only a relatively small proportion use external locums cover.

We were unable to collect accurate robust data for the total number of LETB/deanery funded full-time or less-than-full-time trainees working in each department, but College data suggests that there are in the region of 4,500 training grade anaesthetists across the UK.  However, we asked about the number of empty posts in each department and, although there were some non-responders to parts of the question, we identified a total of 424 empty LETB/deanery funded training posts throughout the UK.  An additional 248 trainees were absent because of maternity, paternity or long-term sick leave, or because of Out-of-Programme Experience.  Taken together, 15% of all LETB/deanery funded training posts were unfilled at the time of the Census.

Overall, nearly 70% of departments have to cover gaps in the trainee/SAS rotas more frequently than once a week, with 19% needing to do so every day.  When this is broken down by UK nation, 35% of departments in Scotland have to cover gaps in the trainee or SAS rotas once a week or more.  The figures for England, Wales and Northern Ireland are 89%, 92% and 100% respectively.  Just over half (55%) of respondents stated that the number of trainee/SAS rota gaps have increased over the last 12 months although 30% stating that they had remained the same.  98% of respondents said they use internal locums, almost three-quarters (74%) use external locums and nearly half (48%) use consultants ‘acting down’.

When responses are categorised by either deanery or LETB it is evident that most regions have empty or unoccupied posts at ACCS, core, or Specialist Training level.  England and Wales (but not Scotland or Northern Ireland) appear to be affected by decommissioning with 22% of respondents answering in the affirmative (although it is not clear at what level).  College data indicates that the UK-wide ST3 fill-rate for August 2015 was 94%.  The fill-rate at core level was 100%, but variable attrition rates may contribute to recruitment difficulties at ST level.  There continues to be an argument for improving the ST3 fill-rate by expanding the current core training numbers.

The relatively high proportion of specialty training (ST3–7) vacancies identified in this Census may be due to gaps created when an ST7 obtains CCT.  There is good evidence that the period of grace is not fully utilised.  Trainees are moving into consultant posts in the UK (nearly 70%) or obtaining fellowship posts (19%).  Because of the biannual national recruitment process there is an inevitable delay in their replacement.