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Pressure on doctors and impact on patients laid bare in latest census

The latest census from the Federation of the Royal Colleges of the Physicians in the UK has revealed the pressures faced by doctors and the reported impacts on patient care. 

Almost one in five doctors (18%) almost never feel in control of their workload while a majority say widespread vacancies are significantly impacting patient care, a census from the three medical royal colleges representing UK physicians has revealed.

The Royal College of Physicians, Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow have today (21 June) released the findings of the 2022 annual consultant physician workforce census with senior doctors reporting widespread gaps in the medical workforce and an impact on patients.

The census reveals a staggering 58% of consultant physicians reporting consultant vacancies – the most senior in the medical workforce – in their departments last year. 69% of consultant physicians were also aware of gaps on trainee rotas either daily or weekly. Seven out of ten (73%) say gaps in working rotas are having an impact on patients, with access to outpatient care (25.8%), the length of hospital stays (23.4%) and out-of-hours inpatient care (23.3%) the most cited impacts.

As doctors usually working in hospitals, physicians are at the forefront of bringing down waiting lists, including for diagnostic tests, checks and scans. Widespread staff shortages make it increasingly challenging to meet rising demand. Despite over 2 million diagnostic checks and tests being delivered by NHS staff in April 2023, there were still over 1.5 million patients waiting for one of 15 key checks at the end of that month with 430,800 patients waiting six weeks or more for a test or scan from referral.

The census highlights the strain felt by UK doctors trying to keep pace with ever growing patient need. The majority of consultant physicians (84%) felt valued by their patients – but 44% reported having an excessive workload almost always or most of the time. Worryingly, almost one in five (18%) said they almost never feel in control of their workload and the census estimates that a similar proportion (19%) are at risk of burnout.

The three royal colleges of physicians representing over 50,000 physicians globally say that the findings underscore their repeated calls for the government to publish the delayed long-term workforce plan in full, with independently verified staffing projections for the next 5, 10, and 15 years, underpinned by the necessary funding.

Dr Sarah Clarke, president of the Royal College of Physicians in London, said: 

“It is alarming that so many of our dedicated doctors feel that their workload is out of control. Large-scale staff shortages see patients in need facing further delays to care, which in many cases negatively affects their treatment. Doctors are feeling intense strain and responsibility for making up for these shortcomings when they have been trained to do the best for their patients.

“The census data presents the stark reality that the medical workforce is under far too much strain to cope with the significant demands faced by our health service.

“The negative impact of delaying long-term workforce plan is growing by the day. It is only with effective, long-term planning that we can work to recruit more healthcare professionals and importantly ease the overwhelming pressure on the current medical workforce so we retain it. This will support doctors to provide the standard of care they know their patients deserve.

“It is imperative therefore that the government publishes the workforce plan, with full staffing projections underpinned by funding, without further delay.”

Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh said:

“Year on year, the census data demonstrate increasing risk to the safe provision of patient care, with an alarming and rising proportion of unfilled consultant posts and consultants approaching retirement. In order to address these challenges, an effective recruitment and retention strategy is required for doctors across each of the four nations of the UK.

“While increasing the number of medical school places and placements is welcome and vital, governments across the UK should also look to increase international recruitment as a means to boost the number of doctors working in our NHS. This should be a temporary solution however, while the NHS workforce strategy is implemented and we must also remember that medical students and postgraduate doctors in training need structured education, supported training and mentorship. That, in turn, requires a strong foundation of more experienced doctors capable of taking these roles on.”

Mike McKirdy, President of the Royal College of Physicians and Surgeons of Glasgow said:

“This year’s physician census once again demonstrates the challenge of delivering good medical care when there are so many consultant vacancies, and gaps in the rotas of doctors providing emergency care, right across the United Kingdom.

“We eagerly await the NHS Workforce Plan and hope that this will address not only issues of recruitment and retention but also the wellbeing of the medical workforce, which this report shows is currently very fragile.”

The 2022 census also revealed that:

  • 28% of consultant physicians are working less than full time. The census projects that by 2027, a third (31%) of consultants will be working less than full time.  
  • The proportion of in training higher specialty trainees working less than full time has increased from 18% in 2021 to 25% in 2022.
  • Women make up 41% of the consultant physician workforce. On current trends, they will make up 46% of the consultant physician workforce by 2027.
  • According to the 2022 UK census, the proportion of men and women working less than full time is similar until age 35 where they diverge. Over 49% of female consultants aged 35-44 are working less than full time compared to 10% of male consultants in that age bracket. 84% of consultant physicians reported feeling valued by patients.
  • 42% of consultant physicians did not take all their annual leave. The main reasons for not taking all of their leave were either being unable to find cover or being too busy to arrange cover.
  • 9.4% of consultant physicians are involved in delivering care on virtual wards where the patients are in the community.
  • Almost half (47%) said they had an additional leadership role (either clinically or in education). 72% said they enjoyed their job more due to a leadership role.