Today the Royal College of Physicians launched Physicians on the front line, a major new report on the medical workforce in Wales which calls for a long-term vision for the Welsh NHS that shows real ambition on service change.
As almost 300 hospital doctors gather in Cardiff for the RCP Wales-Society of Physicians in Wales joint annual conference, the RCP has published the results of its 2015-16 census of consultants and trainees in Wales, with some alarming findings:
- 43% of consultant physicians in Wales say trainee rota gaps frequently cause significant problems to patient safety.
- In 2015, 40% of consultant physician vacancies in Wales could not be filled.
- 12% of trainee physicians in Wales say they rarely enjoy their job.
- Only two in every five trainee physicians in Wales would recommend medicine to a school-leaver.
- Almost half of consultant physicians in Wales say that there are times when they feel as though they are working under excessive pressure.
There are major gaps in both trainee and consultant-grade rotas in every hospital in Wales. One doctor told us that 'recruitment problems are threatening the existence of many hospitals in Wales', while 92% of consultants say they find themselves doing jobs that would normally be done by a junior doctor, because the rota gaps are so severe. There are not enough Welsh-domiciled students applying to medical school, and the numbers are declining every year. Without a homegrown workforce, the NHS of the future will be unable to cope with the needs of an ageing population and a rise in clinical demand, especially in rural and remote areas.
43% of consultant physicians in Wales say trainee rota gaps frequently cause significant problems to patient safety
“The trainee recruitment crisis feels like an oncoming train”
Written in collaboration with trainees and patients, this report examines how we could persuade junior doctors to come to Wales, and how we could keep them working here. The RCP has found that:
- Two thirds of trainees are working under excessive pressure, with a substantial majority saying this is down to insufficient trainee numbers.
- A third of specialty trainees have acted down to cover junior doctor rota gaps in the last year.
- Two thirds of junior doctors say their job gets them down.
- 69% of trainees say that the work-life balance of medical registrars is poor.
- Almost 2 in 5 specialty trainees say their workload is unmanageable.
With 30 overarching recommendations, the report highlights case studies from around Wales, including:
- Solving the unscheduled care challenge at Morriston Hospital in Swansea
- A new way of working at the front-door of the Royal Glamorgan Hospital as the hospital reforms its emergency care
- How Cardiff university is preparing its medical students for the NHS front line with real-life work placements
- Trainee leadership opportunities for one chief registrar in Cardiff & the Vale
- Partnership working between the Royal Gwent Hospital, the local authority and the third sector to keep older people at home for longer
- Delivering specialist diabetes care in the community, improving patient care and supporting GP colleagues
- Reducing emergency department poisons admissions by working as part of a multidisciplinary team of physicians, psychiatric nurses and toxicologists
This new report follows last year’s RCP’s action plan for the Welsh Government, Focus on the future, and our 2014 policy report, Rising to the challenge.
Dr Alan Rees, outgoing RCP vice president for Wales said:
The NHS recruitment crisis in Wales is getting worse, and is not confined to primary care. Last year, we were unable to fill 40% of consultant physician vacancies in Wales – in most cases, this was because there were literally no applicants – and there are major trainee rota gaps in every hospital in Wales. Across the UK, 95% of RCP trainee doctors tell us that poor staff morale is having a negative impact on patient safety in their hospital. This simply cannot continue.
It’s really important that future investment into the health service does not go towards propping up the old, broken system. We’re asking the Welsh Government to develop a really ambitious long-term vision for how the NHS will work in the future. For example, hospital specialists should be able to hold more of their clinics in the community as part of the wider primary care team. This is important because we desperately need to break down the barriers between hospitals and the community.
There also aren’t enough trainees to go around, so we need to focus on recruiting more Welsh-domiciled students to train and work in Wales, and then persuading them to stay afterwards. We need more clinical leadership and better engagement, and more joined-up thinking between the NHS and the Wales Deanery.
All of this will need a drastic change in mind-set, yet the 30 recommendations in this RCP report show that our doctors want to work with the Welsh Government and the NHS to improve patient care and solve this workforce crisis.
