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On-call should be opt-in for senior doctors aged over 60, Royal Colleges advise

Senior doctors should get flexible or part-time working options and from the age of 60 should opt into on‐call only if they wish to, according to joint guidance from the Royal College of Physicians (RCP), the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow.

The new ‘Later Careers 2023’ guidance aims to support senior doctors aged 50 and over – some 47% of the physician workforce – to continue working sustainably and help to mitigate the current NHS workforce crisis.

Supporting the retention of senior doctors in this way ‘brings benefits to patients, the individual doctor, the hospital, and the wider medical community‘, the RCP said.

The document is an update of similar guidance from 2018 and is based on findings from a survey of doctors aged 50 and over conducted in 2022 by the three Royal Colleges.

The guidance also advises that the appraisal of senior doctors should be ‘sensitive and proportionate to their working arrangements‘, and that clinical leads ‘should begin discussions about doctors’ intentions for the next 10 years as early as felt necessary’, and certainly by the time a doctor turns 55.

Recommendations set out in the guidance include:

  • Making flexible or part‐time working options available to senior doctors
  • Consultants opting into on‐call only if they wish to after the age of 60
  • Employers embedding time for teaching for senior doctors’ job plans
  • Employers considering whether doctors need a full licence to practise to keep working in a teaching or examining role
  • Job planning as a department to ensure roles are complementary
  • Making appraisal of senior doctors sensitive and proportionate to their working arrangements
  • Employers remaining in contact with recently retired physicians or those not currently working.

The survey underpinning the guidance found that one in three consultants who are not yet retired express they wish to retire early.

But over half of respondents (58%) said they would delay retirement and continue to work if they could reduce hours and/or work flexibly.

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RCP censor and consultant gastroenterologist Dr Harriet Gordon said: ‘Senior doctors are incredibly valuable to the NHS and have much to contribute clinically, but also in teaching and mentoring the next generation of physicians. 

‘Our survey showed that a large proportion of senior consultants have a strong interest in continuing working if it was possible to work more flexibly.

‘Considering the significant demands facing health services due to workforce shortages, this finding is encouraging. The guidance offers key recommendations that would support experienced hospital doctors to continue working sustainably in the NHS.‘

The Royal Colleges said they ‘will continue to promote this approach to governments and employers‘.

Senior doctors ‘at risk of burnout‘

Earlier this year, data showed that one in five (19%) of consultant physicians are at risk of burnout, and an NHS consultant missing three days of work for mental health reasons is 58% more likely to leave three months later.

In June, NHS England published its own guidance for retaining doctors in late stage career within the NHS and supporting them to stay well.

After the publication of NHS England’s long-term workforce plan in July, Amanda Pritchard admitted that there were no ‘specific costs’ associated with retention elements of the plan.

The senior doctor workforce is a major concern for the NHS and last month the UK Government offered a 4.95% investment in pay for this financial year, on top of the 6% uplift, in order to avert further strike action.

But a 2023 survey showed that pay increases alone will only have ‘a modest impact’ on NHS staff retention because the main problems are stress and high workload.

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