Priorities for Health: Consultants
November 2006
Introduction
BMA Scotland believes that improved quality of care is very much dependent on a full complement of a well trained and well regulated workforce. Doctors are at the heart of the NHS, treating patients, improving care, educating future professionals, transferring new knowledge into service improvements and redesigning care in a more patient centred way.
Scotland has first class doctors, but supply does not match demand. In August 2006, BMA Scotland conducted a survey of members to obtain their views on their priorities for health for the next Scottish Parliament. More than half of respondents agreed that there was a shortage of doctors in the medical workforce and a quarter (26%) reported medical vacancies in their GP practice or hospital department. These vacancies cover a range of specialties but those where many vacancies are reported include anaesthetics, psychiatry, radiology and paediatrics. Doctors reported that more than half (54%) of these vacancies have existed for six months or longer.
More than 90% of doctors in the survey said there was a need for more detailed medical workforce planning in Scotland.
Scotland’s consultant workforce: setting the scene
Using September 2002 as a baseline and the most recent medical workforce statistics to establish the current position it is clear that the consultant establishment (number of consultant posts in all medical specialties) has increased by 377 wte (whole time equivalent) [reference 1]. Most recent figures show, however, that consultant vacancies are at an all time high (7.8% of establishment, a total of 288.5 wte posts) almost half of these having been vacant for more than six months [reference 2].
There is an increasing demand for flexible working, reflecting the trend in wider society. Much of this is influenced by the increasingly female medical workforce - currently women make up 42% of the consultant workforce. 14% of the consultant workforce works part time, two thirds (65.6%) of these are female. Almost one fifth (18%) of the medical workforce is aged 55 or older.
The new consultant contract should enable the Scottish Executive to identify the number of contracted hours worked by consultants by counting the number of programmed activities undertaken per week. Currently official statistics indicate that consultants are contracted to work on average 11.2 programmed activities per week (around 45 hours). However a recent survey of consultants undertaken by Audit Scotland found that the number of hours actually worked by consultants averaged 51 hours [reference 3]. Consultants should not be working these unpaid hours and should not be working more than 48 hours per week in line with European Working Time Directive (EWTD) limits (unless they sign an EWTD waiver which allows them to opt out of the requirements of the Directive). Worryingly, the Audit Scotland survey found that 93% of consultants who were working over and above 48 hours had not signed a waiver.
A Scottish Executive target, established in 2003 to increase the number of consultant posts by 600 by September 2006, was dropped in spring 2006. At that time, the NHS was still around 240 posts short of the target and it was clear that it would not be met by the deadline.
Meanwhile, since 2003, consultant vacancies have continued to increase and in order to fill this gap consultants are working longer hours or locums are being employed (which is an expensive way to staff a service). To add to this pressure, a significant proportion of the consultant workforce is nearing retirement.
The BMA therefore calls on the Political Parties to:
Develop and deliver plans to expand consultant numbers in the short and long term
Nine out of ten doctors who responded to a BMA Scotland survey on Priorities for Health said that it was important for the Scottish Executive to undertake more detailed workforce planning in Scotland.
Scotland’s medical Royal Colleges estimate that 70% more consultant posts will be needed within five years as a result of the reduction in junior doctors’ working hours and because of changes to the demography of the medical workforce. More women are entering medicine and there is an increasing demand for part time posts which means for each present consultant, 1.7 will be needed in future.
It is imperative that action is taken to increase the number of consultants in Scotland. To date, several documents have served to illustrate the shortage of consultants in our hospitals, yet no clear strategy has been developed or implemented.
Introduce improved succession planning for consultants leaving posts to prevent gaps in service delivery caused by delays in filling vacancies
Currently when a consultant is retiring the employer will have at least three to six months notice to recruit a replacement. However, because of bureaucratic and administrative barriers that slow down the process, there is often a gap between the doctor retiring and the post being filled. This is often because of delays in advertising the post, along with the three month notice period required for the incoming consultant, which leads to a gap in service. This is an unnecessary delay to the recruitment process, particularly for planned retirals, which is relatively simple to address and would ensure that services can continue to work seamlessly and at full capacity. Ideally, the replacement consultant would be in place before the existing consultant retires. The BMA would welcome the establishment of standards to be set in terms of advertising and filling vacancies within a certain timescale.
Create step down arrangements for consultants nearing retirement to encourage older doctors to continue to contribute to patient care rather than retiring early
It is acknowledged that there will be a higher than average number of consultant retirals in April 2007 when many consultants will have gained the maximum financial benefits from the increased salary under the new consultant contract. A flexible career scheme should be developed to create step-down options which allow these doctors to continue working, perhaps on a part-time basis and without onerous on call commitments.
Allowing consultants to continue to provide direct clinical care to patients, particularly if their original post is filled, creates a period of handover/mentoring for the new post holder as well as ensuring an element of continuity for patients of the retiring doctor. Providing this career option for older doctors will allow them to continue to contribute to the NHS rather than retire early.
More than 95% of doctors who took part in the BMA Scotland survey supported such a move. The BMA therefore believes that such a scheme would be popular with doctors, but it would require substantial funding. In Professor Sir John Temple’s 2004 review of the medical workforce, he emphasises that such a career option should be implemented quickly [reference 4]. The BMA echoes this view and considers that it may provide a short term reprieve to the workforce shortage, as well as enhancing patient care on an on-going basis.
Implement family friendly policies and flexible working patterns to reflect the needs of the changing medical workforce
Introducing family friendly policies, particularly for consultants with young families, will help to retain doctors in the service who would otherwise leave the service. This is particularly important as the workforce becomes predominantly female – currently more than 60% of medical students are female.
92% of respondents to the BMA Scotland survey said it was important to develop return to work schemes to encourage doctors who have taken a career break back into medicine – without detriment to their career.
A BMA study of medical graduates highlights the fact that the key reason that almost three quarters of doctors either work less than full time or would like to do so is a desire for improved work-life balance [reference 5]. Furthermore, the most common reason for changing career was hours of work and working conditions.
A study in 2003 concluded that the NHS is not yet a fully flexible and family friendly employer because of its long established organisational culture, structure and processes [reference 6]. The increased use of flexible working and family friendly policies has much to offer the NHS in terms of improved staff retention among both male and female doctors [reference 7].
References
1. ISD NHS Scotland Workforce Statistics (June 2006) Accessed on 23 October 2006.
2. ISD NHS Scotland Workforce Statistics (September 2005). Accessed on 23 October 2006
3. Audit Scotland Implementing the NHS consultant contract in Scotland: results of a national survey of consultants Edinburgh, March 2006
4. Temple J, Securing future practice: shaping the new medical workforce for Scotland, Edinburgh; Scottish Executive Health Department 2004.
5. BMA (2005) BMA cohort study of 1995 medical graduates, tenth report – June 2005. London: BMA.
6. Allen I (1994) Doctors and their careers. London: Policy Studies Institute.
7. Equal Opportunities Commission (2003) Women and flexible working in the NHS. Manchester: Equal Opportunities Commission.
For more information contact:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk