Access and burnout challenges revealed in surgical workforce census report

30th January 2024

Over half of the UK surgical workforce face problems accessing theatres, which is contributing to long waiting times for hospital treatment and excessive workloads, according to a new census report.

The ‘Advancing the Surgical Workforce: 2023 UK Surgical Workforce Census Report’, revealed 56% of respondents found access to theatres was a major challenge, and this rose to 61% among all surgical trainees.

Some 47% of respondents said they believed that ‘system challenges’ had an impact on their ability to deliver their work, including balancing clinical and managerial responsibilities.

Access to theatre/operating lists, adequate support staff and admin support were listed as the top three responses to a question asking what would increase productivity.

The Royal College of Surgeons of England (RCS England) said the results show ‘too many staff are trying to navigate a system that often frustrates the delivery of surgical care, rather than enabling all members of the team to deliver services to patients in the most timely and efficient way’.

It added that the report ‘paints a stark picture of a surgical workforce working long hours and in stressful environments’.

Indeed, 61% of respondents cited that burnout and stress was the main challenge in surgery due to excessive workloads.

Some 67% of consultants reported always or frequently working beyond their contracted hours and 42% of respondents did not take their annual leave entitlements in the past year. 

The impact of these pressures is also revealed in the report as 50% of respondents across all career grades indicated that they considered leaving the workforce in the past year. 

And 64% of the 55-64 age group of consultant surgeons plan to retire in the next four years.  

Recommendations for improvement

The report was based on a survey of the whole surgical workforce that aimed to identify the key challenges facing surgical teams and inform workforce planning.

There were 6,348 responses to the census survey from different members of the surgical team, which is approximately 25% of the current workforce. Of the respondents, 54% were consultants, 25% were trainees, 10% were SAS surgeons, 5% were LEDs in surgery and 6% were part of the extended surgical team.

Led by the RCS England, it was supported by the Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh and the Federation of the Surgical Speciality Associations.

The report sets out three recommendations from the surgical Royal Colleges focusing on improving productivity, capacity and efficiency; ensuring sustainability within the workforce by focusing on wellbeing; and overhauling the surgical team structure with further integration of associate specialist and specialty (SAS) surgeons and locally employed doctors in surgery (LEDs).

It is hoped these recommendations will provide a basis for future comparative work to support the work of surgeons and the wider surgical team across the UK and help to reduce waiting lists.

‘Happy and fulfilled‘ surgical workforce

Tim Mitchell, president of the Royal College of Surgeons of England, said: ‘At a time when record waiting lists persist across the UK, it is deeply concerning that NHS productivity has decreased. The reasons for this are multifactorial, but access to operating theatres and staff wellbeing certainly play a major part. If surgical teams cannot get into operating theatres, patients will continue to endure unacceptably long waits for surgery.’

Commenting on the retirement data in particular, Mr Mitchell said: ‘This will create a significant loss of experienced surgeons who are key to helping bring NHS waiting times down and training our future surgeons.   

‘Tackling the challenges health services face hinges on having a happy and fulfilled workforce. We should not be losing any talented surgeons or surgeons in training because they do not feel valued, or they are denied the flexibility in their careers they require.  

‘There is an urgent need to increase theatre capacity and ensure existing theatre spaces are used to maximum capacity. There is also a lot of work to be done to retain staff at all levels by reducing burnout and improving morale.’

Mike McKirdy, president of the Royal College of Physicians and Surgeons of Glasgow, added: ‘The findings of this important report underline the intense challenges being felt by surgical teams across the UK.

‘In addition to increasing theatre spaces and staff to help drive down waiting lists, we must ensure that we protect training time for all members of the surgical team: without quality, ‘on-the-job’ training, we simply won’t have the surgical workforce we need for the future.

‘With alarming levels of burnout, it is also vital that we have a national focus on improving the wellbeing of our dedicated surgical teams.

‘The UK’s surgical Royal Colleges have a long history of working together to inform workforce planning. We are ready to work with the wider health system to drive positive change.’

Surgeons lose one working month a year due to outdated technology, study finds

26th July 2023

Surgeons in the UK lose an average of four working hours a week – equal to one working month a year – due to inefficient technology, according to a new survey by Censuswide on behalf of Medtronic.

The ‘State of Surgery in the UK’ survey explored surgeons’ attitudes towards the technologies they use in their role, the efficiency of them and the degree to which they enhance or hinder performance.

Some 79% of the 300 respondents said surgical care would be easier to deliver if technology was improved, and 58% agreed that technology in the operating room is inefficient and could impact the delivery of patient care.

In addition, 54% of surgeons reported spending time outside of hospital hours on administration that could be automated, and 56% of surgeons agreed time spent on administrative and logistical tasks could be reduced with better technology, which could free them up to focus on upskilling themselves and their team in other areas.

Commenting on the findings, Professor Sanjay Purkayastha, consultant upper GI and bariatric surgeon at Imperial College, NHS Healthcare Trust, and honorary professor at Brunel University, said: ‘The survey results reflect a challenge that many of us in the surgical community know all too well. For many surgeons, the lack of adequate technological support throughout the patient pathway leaves the surgical team perpetually short on time. Time that could be used on crucial analysis and training. An upgrade in the technologies available to surgeons is long overdue.

‘The enhanced efficiency and accuracy we gain from a more integrated and intelligent operating room are undeniable. In surgery, the benefits of being proactive, rather than reactive, are critical to maintaining a high quality of care. Digital technologies will be key to sustaining this. Unfortunately, these benefits remain out of reach for far too many in our field.’

Professor Naeem Soomro, consultant urological surgeon at Newcastle’s Freeman Hospital and Royal College of Surgeons Council member, added: ‘These findings validate and mirror our own research highlighting that the future of surgery lies in more forward-facing digital solutions. Robotics, data and artificial intelligence will allow the NHS to respond to current challenges around access, safety and sustainability of healthcare.’

The future of robotic assisted surgery

This comes as the Royal College of Surgeons of England published a new guide covering some of the challenges – such as accessibility, variable outcomes and possible patient harm – and benefits of robotic surgery, including greater precision, freeing up hospital beds and improving patient recovery.

The guide, ‘Robotic assisted surgery: A pathway to the future’, also looks at the potential future application of robotics and makes recommendations to encourage sound governance practices that can lead to the safe adoption and expansion of robotic surgery in UK hospitals.

It proposes a structured pathway for established surgeons who want to transition to robotic-assisted surgery and identifies the relevant roles and responsibilities of key stakeholders for ensuring and maintaining safe autonomous practice in robotic surgery.

Nuha Yassin, consultant colorectal surgeon, robotics and minimally invasive surgery and RCS England Council lead for the future of surgery, robotics and digital surgery, said: ‘This timely new guidance will support the safe and structured introduction of robotic assisted surgery – and the fruitful collaboration between hospitals, surgeons and industry. It’s important for the surgical profession, led by RCS England, in collaboration with the surgical speciality associations, to take charge of all processes, accredit training centres and pathways and facilitate equity in access and training.

‘To benefit from the potential advantages, any investment in purchasing robots needs to be accompanied by proper planning for its introduction into the service with a focus on training, quality assurance and efficiency. This also needs to acknowledge the variable learning curve which can be long for some surgeons and theatre teams before these efficiencies can be observed at a large scale.’