Focus on physicians: 2018–19 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 2019 retirements survey — the census data help us plan for the future.

This is particularly important in 2019 as the NHS starts to implement the Long Term Plan and develops the associated People Plan.

Key points

• Close to half of advertised consultant posts with an advisory appointments committee (AAC) went unfilled due to a lack of suitable applicants. However, this year the number of consultant posts advertised with an AAC also fell by 33%.
• 40% of consultants and 63% of higher specialist trainees (HST) said that rota gaps occurred on a daily or weekly basis. Only 7% and 12% respectively said such gaps did not lead to significant patient safety issues.
• 45% of consultants and 61% of HSTs reported that a trainee was absent due to sick leave during their last on call shift, particularly Foundation Year 2 (FY2) and Core Medical Trainee (CMT) doctors.
• 55% of HSTs reported they had felt pressured to cover rota gaps and 26% said they were encouraged to take on the work of more than one doctor almost always or most of the time when covering a gap. 
• 59% of consultants and 46% of HSTs reported that as a consequence of rota gaps, adequate work/life balance was most commonly affected.
• Consultant and HSTs continue to find their General Internal Medicine (GIM) work much less satisfying than their specialty work.
• Over half (52%) of trainees reported that work in the past year had affected their relationship with their partner and their relationship with their children.
• 32% of HSTs reported that their morale was worse compared with a year ago and only 20% that it was better, with 69% reporting that working conditions affected their morale. However, 38% of HSTs felt they had achieved more over the past year, with only 20% reporting they had achieved less.
• 36% of consultants will reach their planned retirement age in the next 10 years.

The pressure all physicians are under appears to be the main factor behind the negative experiences documented by the 8,656 doctors who contributed to this year’s census. Reducing rota gaps, filling vacant consultant posts and improving consultant and trainee experiences of GIM are crucial if we are to improve the working lives of physicians in the UK and care better for the population we serve.

Next steps

We will use the census data in our discussions with government about the current pressures on the NHS. They will also inform our work with the NHS in England to develop the People Plan that supports its Long Term Plan.

The primary focus must be managing and reducing demand. We need more investment in public health initiatives, including the public health workforce. Indeed, prevention should be the very basis of our health and care system.

If we are to improve population health, we must recognise and accept the link between poverty and ill health. Government must act to tackle the significant and growing health inequalities that exist in our society. 

• We continue to call for the number of medical school places to be doubled to 15,000 per year across the UK, with the aim of a small surplus of supply. We will estimate the costs of such an expansion and explore how it could help regions with lower numbers of doctors.
• We will continue work to identify ways of encouraging doctors in training to take up posts in specialties and locations with the largest recruitment gaps. Our chief registrar scheme and portfolio careers project are examples of how we can meet the needs of doctors and their employers, while improving patient safety.
• With the UK set to leave the EU in October, more than ever we need the UK to be more accessible to doctors and other professionals from other countries. We continue to call for an increase in the size of the Medical Training Initiative to 2,000 places, but more importantly we need to make sure we are a welcome prospect for doctors looking to work in another country. The recent recommendation by the Migration Advisory Committee to add ‘medical practitioner’ to the shortage occupation list is the first of many steps that will support international recruitment.
• The NHS is slowly becoming more flexible in terms of working patterns, regulation, moving between training programmes, moving between specialties, and meeting the aspirations of current and future professionals. This year’s report on the experiences of doctors one year after gaining their Certificate of Completion of Training (CCT) shows it is possible for people who want that flexibility to pursue a medical career.
• We are pleased that Health Education England is developing the single, robust source of data that we need to plan for the long term. We will work with these data to make sure our assumptions and recommendations are based as much as possible in the real world, taking into account the demographic changes the UK will undergo in the next 15 years. We will also work with Health Education and Improvement Wales to ensure that the implementation of its new health and social care workforce strategy is informed by RCP census data.

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.