Focus on physicians: 2017–18 census (UK consultants and higher specialty trainees)

Every year the Royal College of Physicians of London (RCP) conducts a consultant and higher specialty trainee (HST) census on behalf of the Federation of the Royal Colleges of Physicians with the aim of providing robust data on the state of the physician workforce in the UK. In conjunction with other data – such as our 2018 wellbeing survey – the census data help us plan for the future.

This is particularly important in 2018 as Health Education England (HEE) and its partners develop a 10-year health and care workforce strategy for England.

• The interactive data tool and the PDF of Focus on Physicians is available to download at the bottom of the page.  

Key points

The census revealed continuing pressure on the medical workforce and the systems in which we work. This pressure is demonstrated by ongoing problems with rota gaps, unfilled posts and high levels of reported sickness absence:

• 45% of advertised consultant posts went unfilled due to a lack of suitable applicants
• 53% of consultants and 68% of trainees said rota gaps occurred frequently or often, with significant patient safety issues in 20% of cases
• Trainees reported that a fellow junior doctor was absent due to sick leave in 46% of their on-call shifts
• Both consultants and trainees estimated that they worked on average 10% more than they were contracted to work
• The number of consultants working less than full time (LTFT) has risen to 23%. This was particularly noted among older consultants who have moved to LTFT, supplementing those working this way on a longer term basis. The number of trainees working LTFT rose to 15%.

The data demonstrate a mixed picture in terms of the consultant and trainee experience of general internal medicine (GIM). Satisfaction among consultants and trainees with working or training in GIM remains significantly lower than satisfaction with their specialty, but there have been modest improvements in job satisfaction in GIM for trainees since last year:

• 88% of consultants always or often enjoyed working in their specialty, but only 55% always or often enjoyed working in GIM, although that has risen from 49% last year.
• 86% of HSTs always or often enjoyed working in their specialty, but only 40% in GIM, although that has risen from 25% last year.

However, 59% of trainees would not train in GIM if they had their training period again, compared to 58% last year. A worrying 27% of trainees reported that if they could turn back time, they would take a medical job outside the NHS and 31% a job outside medicine. The reason for the dissatisfaction was made clear when we asked trainees what would improve the quality of their GIM training. 87% said no rota gaps, 82% a better balance between service and training, and 72% protected time for professional development.

The pressure all physicians are under, as demonstrated by these findings and in the RCP NHS reality check reports, appears to be the main factor behind these negative experiences documented by the 8,579 doctors who contributed to this year’s census. Reducing rota gaps and filling vacant posts is vital if we are to realise the Shape of Training’s vision of more doctors with general medical skills.

Next steps

We will use the data in our discussions with government about the current pressures on the NHS. In particular, the data support our response to the workforce strategy consultation in which we called for:

• the number of medical school places to be doubled to 15,000 per year, with the aim of a small surplus of supply
• doctors in training to be encouraged to take up posts in specialties and locations with the largest recruitment gaps, by providing them with incentives such as protected time for leadership, education, training, research and quality improvement
• the UK to be made more accessible to doctors and other professionals from other countries, with an immediate increase in the size of the Medical Training Initiative to 2,000 places
• more flexibility in terms of working patterns, regulation, moving between training programmes, moving between specialties, and meeting the aspirations of current and future professionals
• a single, robust source of data that brings together the various datasets that tell us about how many people are in the system, how they move within it, and when and why they leave, to enable us to plan well for the long term
• more investment in public health initiatives, including the public health workforce, that reduce demand.

Further information

• To view the data and learn more please download Focus on physicians. If you require a bespoke analysis of data by region or other factor, please contact us via policy@rcplondon.ac.uk.
• The RCP Medical Workforce Unit independently verified consultant headcount by nation, specialty and demographics by checking with specialty representatives, the GMC and with consultants’ work locations. Data for the full HST workforce were obtained from the Joint Royal Colleges of Physicians Training Board (JRCPTB), and from an electronic census sent to all trainee physicians.