Innovation in Medicine 2018: Focus on physicians census shows doctors ‘fear that understaffing is compromising patient safety’

Mounting concerns for patient safety have been expressed by consultant physicians responding to the profession’s annual census, Focus on Physicians 2017–18 census (UK consultants and higher specialty trainees), published today. 

Focus on Physicians 2017-18 is the Royal College of Physicians, Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow’s most recent temperature check on the consultant physician and higher specialty trainee workforce in the UK. It captures the views of 8,579 consultants and trainees and shows a modest increase in the number of female consultant physicians, taking the gender split to 36 per cent female and 64 per cent male across the whole profession.

Highlights

The findings highlight the rising pressure understaffing is having on doctors in all four nations and the dangerously long hours some are having to work. Issues with junior doctors are also evidenced, with trainees reporting a colleague calling in sick for up to half of all on-call shifts.

Issues with junior doctors are also evidenced, with trainees reporting a colleague calling in sick for up to half of all on-call shifts.

Focus on Physicians 2017-18

For the first time more than one in four trainees say that if they could turn back time, they would choose a medical job outside of the NHS. One in three queried whether they would choose medicine as a career at all. More than half of all consultants and two thirds of trainees reported frequent gaps in trainees’ rotas, with 20% saying they are causing significant problems for patient safety in hospitals and 75% highlighting the workaround solutions they are regularly having to find.

Other high-level findings in the census include:

  • almost half of advertised consultant posts remain unfilled because of a lack of suitable applicants
  • consultants and trainees are working around 10% more than their contracted hours, which equates to trainees working an extra 6 weeks and consultants an extra month unpaid a year
  • thirty-three per cent of the current consultant workforce are predicted to reach their intended retirement age in the next decade. Medical student places need doubling now to fill this and the gap left generally by doctors leaving the profession
  • the number of consultants working less-than-full-time increased again, with the proportion now totalling 23 per cent.

Commenting on the census RCP president Professor Dame Jane Dacre said: 

Sadly the census confirms our fears that the demands on doctors are increasingly untenable. Unfilled vacancies and rota gaps, alongside rising numbers of patients, are impacting patient safety and badly affecting doctors’ morale.

Unfilled vacancies and rota gaps, alongside rising numbers of patients, are impacting patient safety and badly affecting doctors’ morale.

Professor Dame Jane Dacre, RCP president

With increasing numbers of consultants looking to retire in the next 10 years and our trainees expressing concerns about their wellbeing, we are facing the perfect storm. Both short- and long-term action needs to be taken if we want to protect patient safety and make medicine the rewarding career it should be. This includes Health Education England reflecting our findings in their new health and care workforce strategy, and action being taken now to expand medical school places and the Medical Training Initiative. 

It is remarkable and credit to doctors’ stoicism that over 80 per cent in the census still mainly report satisfaction with working within their specialty. We are pleased that the government has now pledged increased funding for the NHS, but as the 70th birthday approaches and we reflect on the many achievements of the past, more investment in the workforce needs to be at the heart of any new plans so that we can ensure this positive legacy lasts into the future.

Professor David Galloway, president of the Royal College of Physicians and Surgeons of Glasgow added:

I’m glad that the three Royal Colleges have once again joined together to produce this important piece of work. It’s vital that everyone involved in the NHS now reflects on these findings and takes all the action necessary to replicate best practice and address the challenges that this document has highlighted. Government, patients and the medical profession must work hand in hand if we’re to deliver the best possible NHS for all.

The RCP will use the census alongside findings from its safer medical staffing working party to publish a major review and recommendations in July.