The NHS is at growing risk of losing critical senior staff unless the new Government urgently prioritises action on poor working conditions and retention of the consultant physician workforce, data from the UK’s three Royal Colleges of Physicians shows.
Results from the latest annual UK consultant physician survey conducted by the Royal College of Physicians (RCP) on behalf of the RCP, the Royal College of Physicians of Edinburgh (RCPE) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) reveal overwhelming workloads, poor IT equipment that erodes physicians’ time, widespread staff vacancies and plummeting job satisfaction.
The survey of 22,253 consultant and SAS physicians between November 2023 and January 2024 had a response rate of 16.6%. Almost half of UK consultant physicians (47%) reported that enjoyment in their job had decreased over the last year – with clinical workload, poorly functioning IT equipment and staff vacancies cited as the top three reasons, followed by a lack of administrative support and lack of capacity in social care to discharge patients in a timely manner.
Impact of staff shortages
Other key findings from the survey showed vacancies and rota gaps at consultant or trainee level were having a negative impact on patient care, and physicians’ abilities to supervise and train others.
Some 59% of UK consultant physicians reported that they have at least one consultant vacancy in their department, and 69% felt that consultant physician rota gaps were having a negative impact on patient care, with reduced access to outpatient care, increased length of stay, the care of inpatients out of hours and delays in diagnosis the most commonly cited issues.
A total of 62% of consultant physicians reported daily or weekly trainee rota gaps when on acute duty over the past year, with rota gaps also impacting consultant physicians’ ability to supervise and train others. When asked whether rota gaps at consultant or trainee level were having a negative impact on their ability to supervise and train others, 32% said a lot, 41% said to some extent, 16% said a little and 12% said no impact.
In addition, most UK consultant physicians said they take part in educational and clinical supervision but the time allocated is not always sufficient. Of the 85% who did so, 94% said they supervised doctors in training, 41% said they supervised doctors not in a training post and 41% said it was other health professionals under their remit. Some 61% said they had time in their job plan to undertake this supervision, and while 65% of those said the time was adequate, 35% said it was not.
Calling the medical workforce ‘the lifeblood of the NHS’, Dr Mumtaz Patel, vice president of education and training at the RCP, said: ‘While we must train more doctors to meet demand, retaining the staff we already have is critical to getting our health service back on firm footing and delivering many of the new Government’s promised commitments on the NHS.
‘Right now, we have dedicated staff working in a health service which simply doesn’t work for them. They are overworked, undervalued, job satisfaction is falling and many are clearly becoming disenfranchised. Unless we urgently improve working conditions, we face losing many of our brightest and most committed.’
Workload pressures
The stresses of significant workloads were also borne out by the survey results. Almost a fifth (18%) of consultant physicians said they almost never feel in control of their workload, and only 36% said they feel in control of their workload most of the time or almost always. Furthermore, 14% of respondents said they were very stressed at work, and 55% said they were somewhat stressed at work.
The data also show consultant physicians continue to work beyond their job plans, with over half of respondents (52%) saying that their job plan does not adequately reflect all of the work that they do, compared to 48% who said that it did. On average, full-time consultant physicians are contracted to work 11 programmed activities but actually work 12, while those who work less than full time are contracted to work eight programmed activities but work 8.5.
As a result, respondents said the top three things that were squeezed out of a week when things get too busy were continuing professional development, quality improvement activity and education, training and supervision of doctors of all grades, including appraisals.
When asked what top three things would improve work satisfaction, improved IT systems, reduced clinical workload and increased workforce/fewer gaps were most cited as measures that would most improve work satisfaction.
In addition, less-than-full-time and flexible working continues to grow, with just under a third (32%) of UK consultant physicians saying they work either flexibly or less than full time. This breaks down into 46% of female consultants and 21% of male consultants.
Priorities for the new Government
The three Royal Colleges, representing over 60,000 physicians, said the census makes clear that retention – including efforts to improve working conditions for staff – must be a key priority for the new Labour Government.
‘The findings of our latest census show the new government must prioritise retention,’ said Dr Patel. ‘From improving NHS IT systems and affordable childcare to embracing flexibility and getting the basics right, there is much that would make a difference. We need to urgently alleviate pressure – boost doctor numbers to close rota gaps and reduce the clinical workload to manageable levels.’
Noting that the NHS relies on the doctors working today and those who will join the health service in the near future ‘to turn the tide on long waiting lists and backlogs’, Mike McKirdy, president of the RCPG said: ‘It is important that our new Government reflects their value and recognises their contributions and sacrifices through workforce planning that has wellbeing at its core.
‘That 59% of consultant physicians reported at least one consultant vacancy shows the pressure on our ability to deliver care and prepare our next generation of doctors to move to consultant level positions. We strongly urge as a first action that the new Government seriously address the ongoing crisis in the NHS workforce, which any reform in our health system will depend upon.’
Professor Andrew Elder, president of the RCPE, added that while focus on the recruitment and retention of the consultant physician workforce is ‘vital’, it ‘means little without serious investment in public health’ and a ‘strategy for health-promotion activity and the avoidance of ill-health and health inequalities’.
As such, he highlighted that the RCPE has been calling on the new Government to introduce a range of measures around restricting advertising of unhealthy food, extending the sugar tax and introducing a sugar and salt reformulation tax, and introducing minimum unit pricing on alcohol to better support healthy diets. Professor Elder also encouraged the new Government to ‘follow through on proposed new legislation making it an offence for anyone born on or after 1 January 2009 to be sold tobacco products’. Indeed a number of these were referenced as priorities for the Government in this week’s King’s Speech.
Earlier this year, a census carried out by the three Royal Colleges of Physicians in the UK warned of a rise in patients with poor health due to their socio-economic circumstances.
