A report by the BMA1 and eight of the country’s most well-respected medical bodies, reveals a significant shortage of consultants in hospitals across England, and that senior doctors are leaving the NHS at an earlier stage than anticipated including before their expected retirement age.
The report, published today, is a result of a collaboration between seven medical Royal Colleges, the Faculty of Intensive Medicine together with the BMA. It sets out to understand why hospital consultants are leaving the NHS earlier than expected and describes detailed practical solutions to Government, which require early adoption if we are to avoid today’s shortage becoming a crisis.
The key findings suggest that spiralling levels of demand, longstanding issues with excessive taxation of pensions and growing workloads are major contributing factors to the exodus. Inadequate staffing then leads to burnout, low morale and poor wellbeing, with doctors feeling as though they have no choice but to reduce their hours or in some cases, leave altogether.
A BMA survey from January 2019 found that six out of 10 consultants intend to retire before or at the age of 60, with health and wellbeing and pensions listed as important factors in their decision-making.
While the overall number of full-time equivalent consultants continues to grow, the demand for consultant-based work is growing at a much faster rate – compounded by our growing and ageing population needing even more care. At the end of June 2020, there were also at least 8,278 secondary care full-time equivalent medical vacancies.
The NHS must prioritise the retention of consultants to start to stem this tide. According to the report at least an extra 7,500 medical school places would also be required to grow the consultant workforce, taking the annual cohort to around 14,000-15,0000 medical students per year.
Since the Covid-19 outbreak, it is more important than ever that the existing NHS consultant workforce is both retained and subsequently increased in number. The report makes both short-term recommendations in this report to be implemented urgently to help allay additional pressures as a result of the virus, as well as an extensive suite of medium and longer-term proposals.
- Prioritising health and wellbeing of staff. It is vital that existing staff are properly cared for, including ensuring comprehensive risk assessments are rolled out and staff need to have adequate access to appropriate PPE. Staff who are more at risk of Covid-19, including BAME staff need to be well protected and feel comfortable that they are appropriately protected. Employers must ensure that staff know where they can access support for their mental or physical health.
- Making the most effective use of retired consultants who volunteered to return to medical practice during the Covid pandemic. More work needs to be done to harness the expertise of retired doctors coming back onto the medical register is used, ensuring employers are provided with adequate funds to use this vital resource. It is also crucial that this cohort receives adequate support.
- Developing and employing active workforce retention policies. Many consultants are worn down by the pressures of NHS working, and active policies are needed to encourage them to remain at work even longer. This includes allowing consultants to work more flexibly and encouraging conversations between employers and doctors nearing retirement about any adjustments they may need.
- Making the profession more attractive to women, including addressing the gender pay gap. A primary cause of the gender pay gap in medicine is because of the gender imbalance across the highest paid positions, grades and specialties. As increasing numbers of women enter the consultant workforce it is essential that career pathways and workplace environments are designed to retain them, while barriers that make women less likely to apply for higher paid roles must be removed. The failure to support doctors going through the menopause must also be tackled to prevent senior doctors stepping down from positions or leaving medicine earlier than intended.
- Increase medical school, Foundation Programme and specialty trainee numbers alongside increased resources and educators, including consultants and academics, who are also required to deliver the increased education and training workload.
Dr Rob Harwood, BMA consultants committee chair, said:
“The NHS was facing a huge workforce crisis long before Covid-19. Consultants feel progressively more ground down by an ever-increasing workload and progressively less appreciative employers so they choose to retire at an earlier stage than otherwise they might. In addition, a significant proportion of the consultant workforce is now approaching retirement age, and there is a growing trend of younger doctors already deciding they’ve had enough.
“We’ve reached a position where every consultant is more precious than ever, and in the face of an unwavering global pandemic, everything must be done to retain and recruit more doctors as a matter of urgency, not only to help in the fight against Covid-19, but also the immense backlog created as a result of the virus.
“It’s not solely the BMA who has highlighted these problems, but a group of some of the country’s most respected medical bodies and the Government must listen. It is crucial that our recommendations are thoroughly considered, and detailed plans are drawn up to address this crisis both for now and in the future.
“Without that, we risk creating an NHS that no one wants to work in, the consequences of which are potentially catastrophic.”
Professor Andrew Goddard, president of the Royal College of Physicians said:
“The size of the medical workforce is the key issue for the NHS, which is why we called for a doubling of medical school places in 2018, and will soon issue a report on the costs and feasibility. The Covid-19 pandemic has shown this in stark reality.
“If we had more doctors, nurses and other clinicians, we would have been much better prepared to deal with the pandemic and more able to reduce health inequality across the country.”
Dr Trudi Seneviratne, Registrar at the Royal College of Psychiatrists, said:
"Growing and retaining the consultant workforce is crucial for delivering high-quality patient care. The government must take these workforce challenges seriously and act now.
"Mental health services have been identified as a priority for improvement and expansion but more needs to be done to ensure a sustainable supply of consultant psychiatrists to work in them.
"As highlighted in the report, we must look after doctors' wellbeing, support more flexible careers, and ultimately, make the NHS a better, more attractive place to work."
Dr Alison Pittard OBE, Dean, Faculty of Intensive Care Medicine, said:
“These issues are ever more pressing with an ageing general population and staff. At all times, but especially during Covid-19, the health and wellbeing of staff must be a high priority for the NHS.”
Dr Jeanette Dickson, President of The Royal College of Radiologists, said:
“The BMA report outlines key themes we have seen raised repeatedly across the consultant workforce in imaging and cancer care, both before and during the coronavirus pandemic.
“It clearly highlights the need for greater flexibility at work and for a committed NHS culture of inclusivity, trust and shared leadership, as well as protected time for professional development and training the future workforce. NHS leaders are taking steps to acknowledge and improve on these issues, but as well as measures to boost ongoing support, we must see real increases the consultant workforce in order to be able safeguard the future of patient care.”
Dr Chris Carey, Chair of the Royal College of Anaesthetists’ Education, Training, and Examinations Board, said:
“The consultant workforce provides vital clinical leadership for NHS services. With anaesthetists involved in the care of two-thirds of all hospital patients, it is essential that we look at solutions to address current shortages in this workforce and consider strategies to ensure that the NHS can meet its longer term challenges, in particular caring for an increasing number of elderly and frail patients in the future.”
Notes to editors
The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.