ASSOCIATION OF PALLIATIVE MEDICINE

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1 ASSOCIATION OF PALLIATIVE MEDICINE Palliative Medicine Wrkfrce Reprt Executive Summary 1.1 Key messages 2.APM Wrkfrce Cmmentary by Cuntry 2.1 England 2.2 Sctland 2.3 Wales 2.4 Nrthern Ireland 2.5 Ireland 3. Cmmentary by medical grade 3.1 UK and ROI Cnsultants 3.2 UK and ROI SSAS Drs 3.3 UK and ROI Higher Specialist Trainees 4. APM Wrkfrce Survey UK & ROI 2016 Analysis 4.1 Cnsultants 4.2 SSAS Drs 4.3 Trainee Drs 5. OOH On Call APM Survey UK Cnsultants 5.2 ROI Cnsultants 5.3 UK SSAS Dctrs 5.4 ROI SSAS Drs 5.5 UK Trainee Dctrs 5.6 ROI Trainees 1

2 6. UK Cnsultants 7-Day Palliative Care Services APM 2016 Survey 6.1 Hspice IP Units 6.2 Hspital Supprt Teams 6.3 Cmmunity Palliative Care Teams 6.4 Day care Services Appendix Table 1. APM Wrkfrce Survey 2016: UK cnsultant prvisin seven-day services Table 2. Estimates by ppulatin need fr Cnsultant wrkfrce in each cuntry fr UK and Ireland APM wrkfrce cmmittee Chair f APM Wrkfrce Cmmittee Stephanie Gmm Representatives fr: England Sctland Wales Nrthern Ireland Republic f Ireland Registrars SSAS SAC Junir Members Cmmittee Benit Ritzenthaler/Plly Edmnds Vacant Carline Usbrne Jan Regan Feargal Twmey Felicity Dewhurst Nicla Gss Plly Edmnds /Alisn Cackley Laura Grdge 2

3 ASSOCIATION OF PALLIATIVE MEDICINE Palliative Medicine Wrkfrce Reprt The 2016 APM wrkfrce cmmentary presents a summary f the analysis f the APM 2016 wrkfrce survey. Wrkfrce data frm the RCP Census f Cnsultant physicians and higher medical specialty trainees (HST) , and the 2016 wrkfrce data prvided by the SAC Palliative Medicine are included in this reprt. 1.Executive Summary 1.1 Key messages: There has been n expansin f UK Cnsultants in palliative medicine with headcunts f 609 and 603 in 2015 and 2016 respectively that nly represent 471 and 459 FTEs, (Table 1. SAC data 2015 & 2016), as the % f less than full-time wrking (LTFT) increased frm 61% t 66%. Overall the participatin ratis (FTE/Headcunt) are reduced t 77% and 76%, partly explained by 74% f the cnsultant wrkfrce is female (RCP Census ). The average annual number f 40 CCTs is inadequate t meet the existing and anticipated demand fr Cnsultant psts, as the UK Cnsultant vacancy rate has increased t 10 % (61 psts) in 2016 cmpared t 7.5 % in 2015, alng with the expected develpment f 30 new psts ver the next 5 years, and an anticipated increase in the average retirement rate f 11/year between (SAC data September 2016). Fr HST n recruitment prblems in 2016 as all ST3 psts filled and a 5% NTN vacancy rate. Impact f lss f LATs in 2016 fr hspices re funding f LAS psts fr maternity leave and OOP experience and the effect f reductins in tariff make the ptential withdrawal f training psts if hspices are disadvantaged. Majr risk f nt meeting the current curriculum if hspices financially becme less willing t train. Majr gegraphical variatin in Cnsultant psts as demnstrated by RCP data fr 2015/16 fr East Midlands and East f England fllwed clsely by Wessex LETBs in having the lwest number f FTE cnsultants i.e. 1 FTE fr > 165,000 ppulatin. Cnsideratin needs t be given t recruiting additinal funded NTNs in these gegraphical areas, and specifically in LETB areas where Cnsultant recruitment is difficult requiring a greater increase in bth training numbers and capacity. It remains challenging t interface with deaneries and LETBs re palliative medicine wrkfrce needs but vitally imprtant we d s fr 2017/18 e.g. submissin f infrmatin t HEE n wrkfrce numbers and planning. Impact f implementatin f Shape f Medical Training n wrkfrce requirements fr the specialty: the SAC and APM have fed back the implicatins fr the specialty fr delivering service requirements and training in all settings alngside internal medicine training 3

4 requirements. There must be a clear recgnitin f maintaining and expanding bth training and service delivery in nn-hspital settings t fit with the natinal agenda f mre care delivered in the cmmunity. The full implicatins n training and service, including n call prvisin, are currently being wrked thrugh. Shape f Medical Training has the ptential t change the distributin f bth the junir dctr and cnsultant palliative medicine wrkfrce, particularly if cnsultants are appinted in future that are dual accredited in palliative and internal medicine. The junir dctrs cntract in England significantly changes the pay fr nn-resident n call structure. This cmbined with the changes t pay prgressin may affect the chices junir dctrs make abut entering the specialty, and the chices made abut taking time ut f prgramme fr research etc. In all cuntries, the cnsequences f financial restraints and envisaged changes t educatin, training and wrkfrce planning are a majr cncern. This will require the recgnitin that a review f the skill-mix f the specialist palliative care wrkfrce bth medical and nursing is undertaken t meet demand and access t 7 day, 24 hurs palliative care. 2. APM Wrkfrce Cmmentary by Cuntry 2.1 England: As a specialty there has been n reductin in training numbers in 2015 and Despite detailed data frm the APM and SAC, HEE and LETBs use Infrmatin frm NHS Trusts that underestimates bth the headcunt and FTEs fr palliative medicine trainee/cnsultant and their required expansin e.g. 272 FTE Cnsultants fr England but SAC 2016 data reprt 376 FTE. Acrss England engagement with LETBs has been difficult, in many places there is lack f understanding abut NHS and vluntary sectr wrkfrce. It remains challenging t interface with LETBs re palliative medicine wrkfrce needs but vitally imprtant we d s fr 2017/18,and submit infrmatin t HEE n wrkfrce numbers and planning. The Assciatin fr Palliative Medicine apprached Health Educatin England, explaining that we will nt be able t meet the demand and the existing Cnsultant vacancy rate unless a significant increase f natinal training numbers is prvided fr the specialty and specifically in the LETBs where there is a higher need fr cnsultant psts per ppulatin because mst trainees d nt mve given the availability f cnsultant psts acrss the cuntry. The lw participatin rate f 77% means we require mre dctrs trained in the specialty t meet the existing and future need.. SAC data 2016 indicated a ttal f 505 cnsultants (34% FT) cmpared t 34% in the UK.49% (157/320) f Cnsultant respnders in England wrk full-time (48% in the UK; APM 2016). 63% (138/219) f Registrars (SAC 2016) are in full-time psts cmpared with UK-wide, 65% (SAC 2016) and 65% (APM 2016) respectively. 56/521 respndents (10.7%) f respndents, held academic psitins vs. 66/629 (10.5%) acrss the UK. (APM 2016). Fr lead emplyer, 73% f cnsultants respndents hld NHS cntracts, 23% a vluntary hspice cntract and 3.8% with an academic institutin (APM 2015). 4

5 207/261 (79%) f cnsultant respndents receive funding frm the NHS, 28 (11%) frm a charity, 92 (35%) frm a vluntary hspice and 31 (12%) frm an academic institutin. (APM 2015). 2.2 Sctland: Fllwing the decisin apprved by the Reshaping Medical Wrkfrce Prject Bard that NES shuld wrk with whle time equivalent (wte) numbers rather than trainee establishment numbers, the Scttish training Prgramme was given ne additinal trainee in 2016, The number f trainees n the Prgramme is 14. SAC data 2016 reprted 14/46 cnsultants (30% FT).43% (9/21) f Cnsultant respndents wrk full-time (49% in the UK; APM 2016). 54% (7/13) f Registrars (SAC 2016) are in full-time psts cmpared with UK-wide, 65% (SAC) and 66% (APM 2015). 3/66 (4.5%) f respndents hld academic psitins vs. 10.5% in the UK. (APM 2016). 53% f respndents emplyed by the NHS and 47% by vluntary hspices (APM 2015). 8/17 (47%) f cnsultant respndents receive funding frm the statutry sectr, 12 frm a charity, and 5 frm a vluntary hspice and 3 frm an academic institutin. (APM 2015). 2.3 Wales: It is nt anticipated that there will be a significant further expansin in medical wrkfrce in Wales. These calculatins are based n the existing mdels f service delivery and wrkfrce. There remains uncertainty, depending n the utcme n the current cnsultatin n the Shape f Medical Training in making future prjectins difficult fr the medical wrkfrce. SAC data 2016 reprted 34 cnsultants (41% FT).46% (13/28) f Cnsultant respndents wrk full-time (49% in the UK; APM 2016). 54% (7/13) f Registrars (SAC 2016) are in full-time psts cmpared with UK-wide, 65% (SAC) and 66% respectively (APM 2015). 5 f 66 respndents (20%) held academic psitins vs. 11% in the UK. (APM 2015). 84% f respndents hld an NHS cntract and 16% by a vluntary hspice (APM 2015). 17/19 f cnsultant respndents indicated that funding was received frm the statutry sectr, 5 psts frm a vluntary hspice, and 9 frm a charity and 3 frm an academic institutin. APM 2015). 2.4 Nrthern Ireland: The Palliative Care Prgramme Bard has develped a Clinical Engagement Grup, whse first task is undertaking a wrkfrce planning review f the specialist palliative care wrkfrce and will include specialist medical, nursing and AHP staff. This unique multidisciplinary review is being lead by Dr Gillian Rankin f the Public Health Agency, and is using the 2012 UK Cmmissining Guidance t benchmark current staffing and activity levels. This review is well underway, with the final reprt due in Autumn There are n plans t expand trainee numbers prir t the utcme f the reprt. 16 cnsultants respnded t APM survey 2016 (7 full-time, 44% and 9 < full-time) and 5 registrars. SAC data 2016 reprted 18 cnsultants (55% FT) and 7 registrars (57% FT) cmpared with FT UK-wide, 65% (SAC 2016) and 66% (APM 2016). 5

6 Fr 8/9 Cnsultant respndents receive NHS funding,1 receives funding frm a charity,2 frm an university and 5 frm vluntary sectr hspices. (APM 2015) Mst Cnsultants participate in n-call fr Hspice units, including thse wh wrk primarily in hspitals. In ne Specialist Palliative Care Unit, Cnsultants participate in a first n-call Rta. There is currently n cmmissined ut-f-hurs cver fr hspitals in Nrthern Ireland. There is variable ut-f-hurs Cnsultant cver fr Cmmunity Teams. 2.5 Ireland: The HSE s Natinal Clinical Prgramme fr Palliative Care has priritised the develpment f a palliative care mdel f care fr Wrkfrce planning acrss disciplines is a cre cmpnent f this wrk stream. The Palliative Medicine Wrkfrce reprt has been submitted t the HSE s Natinal Dctrs Training and Planning Directrate. It is hped that the HSE will endrse and publish this as a specialty benchmark reprt t guide wrkfrce develpment and expansin. 94% (17/19) (APM 2016) f Cnsultant respndents wrk full-time (34% in the UK) and 35/38 (92%) RCPI data % f ROI Specialist Registrars are in full-time psts (APM 2016) and 14/15 (93%)RCPI data 2017 cmpared with 65% UK-wide. 12/28 (43%) respndents, in the ROI held academic psitins vs. 10.5% in the UK. 80% f respndents indicated that 10 psts received funding frm the statutry sectr, 1 had academic and ne received charitable funding. (APM 2015). 95 % prvide OOH n call, with 48% prvided secnd n call nly and 52% undertk first and secnd n call. 3. Cmmentary by medical grade: 3.1 Cnsultant Wrkfrce data 2016 There has been n expansin f UK Cnsultants in palliative medicine with headcunts f 609 and 603 in 2015 and 2016 respectively, and nly represent 471 and 459 FTEs, (Table 2. SAC data 2015 and 2016} as 61% and 66% are wrking less than full-time (LTFT). Overall the participatin ratis are reduced t 77% and 76% and is partly explained by 74% f the cnsultant wrkfrce is female (RCP Census ). Fr Ireland Cnsultant headcunt is 38 (36.6 FTE) with 3 (5.3 %) LTFT. RCPI expansin rate f 8.5% frm 35 Cnsultant psts (33.6 FTE). There is ne new fulltime cnsultant pst expected in HST numbers are 14 (13.5 FTE) at present with n immediate plans t expand the number f higher specialist training psts. The UK palliative medicine cnsultant vacancies are 61 psts (53.8 FTE) using SAC data September 2016, with apprximately 30 new psts in develpment. Hence the current average annual number f 40 CCTs is inadequate t fill the existing and anticipated annual cnsultant vacancy rates. 6

7 The RCP census (2014) f Cnsultant physicians identified 586 (519) palliative medicine cnsultants wrking in the UK, with 484 (427) in England, 33 (26) in Wales, 51 (51) in Sctland and 18 (15) in Nrthern Ireland. The self-reprted planned average retirement rate is 4-5 cnsultants per year in increasing t annually fr (RCP census ) and 58 anticipated retirements ver the next 5 years, an average f 11/yr (SAC data 2016). A significant decline in the number f AACs fr Cnsultants held in 2015 (RCP data 2016) decreased by 30% frm 70 t 49 with 34 appinted (69%). With the extensin f palliative care activity t nn-malignant disease, end f life and supprting patients during active treatment and in survivrship, this is likely t increase the verall wrkfrce need. There is reginal variatin in the number f Cnsultant FTEs per ppulatin; t address this cnsideratin needs t be given t the recruitment f additinal funded NTNs in thse gegraphical areas with the lwest FTE per ppulatin. The majrity f UK Cnsultants (>90%) prvide telephne advice n call t hspices cmmunity palliative care teams (75%) and fr hspital palliative care teams. (70%). 76% undertake emergency face-t-face assessments with 70% fr hspices but nly 32% fr hspitals and 23% fr cmmunity palliative care team reviews. (APM Wrkfrce survey 2016). See Appendix Table 1. Table 1. UK Cnsultants by Cuntry. (SAC and RCP data ). UK Cnsultants England N Ireland Sctland Wales SAC 2015 N = FTE = SAC 2016 N = FTE =

8 RCP N = FTE = Overall significant cumulative cnsultant expansin ccurred in the last decade but has declined ver the last 5 years. Nting that there has been an increase in the prprtin f Cnsultants wrking less than FT i.e. frm 30% t >60%, and hence using 2.5 FTE/250,000 ppulatins wuld represent 651 FTE needed fr UK (Appendix Table 2). A significant shrtfall exists in England with 385 FTE Cnsultants in 2015 cmpared with an estimated need f 548 FTE. The mst imprtant variables in the current financial climate remain the creatin and funding f new cnsultant psts and the cntinued funding f existing cnsultant vacancies. Currently there is n risk f a mismatch f CCT hlders in regard t available cnsultant psts with the cnsistent Cnsultant vacancy rate ver the last 5 years. Recruitment f trainees and cnsultants t regins that are currently under supplied shuld be facilitated. 3.2 SSAS Drs Wrkfrce data 2016 SSAS and nn-training dctrs make a significant cntributin t the medical wrkfrce yet their cntributin tends t be are under-reprted. The APM Survey 2016 included SSAS grades and ther nn-training grades. Fr the UK 96 SSAS dctrs respnded, 88% f wh are female. 79% f 81 respndents prvide n call fr telephne advice mstly cvering hspices and cmmunity services, 71% undertake emergency face-t-face reviews with the majrity at a hspice unit(s) SAC 2016 data hwever indicated there are 482 (293 FTE) SSAS and nn-training dctrs f whm 78% wrk LTFT. Medical grades belw Cnsultant will need expansin t supprt service mdels, which require these dctrs t be available n Saturdays, Sundays and Bank Hlidays. 3.3 Higher Specialty Trainees (HST) Wrkfrce data

9 In the UK, RCP HST Census reprted 218 trainees (161 FTE), 177 female (81.2%) and 41 male (18.8%); England 189 (140 FTE), Wales 9 (7 FTE), Sctland 14 (10 FTE) and Nrthern Ireland 6 (4 FTE). See Table 2. In September 2016, the SAC reprted 240 (202 FTE) palliative medicine registrars in the UK. Overall, 35% f registrars were wrking < FT. The breakdwn fr these psts was: 209 (175.2 FTE) in England, 13 (11 FTE) in Sctland, 11 (9.7 FTE) in Wales and 7 (6.0 FTE) in Nrthern Ireland. See Table 1.The number f Out f Prgramme (OOP) UK trainees was 19 (18.4 WTE) (8% f trainees). 43 (37.6 WTE) are n maternity leave (ML). A ttal f 26% trainees OOP r n ML that required backfill, nting the natinal variatin as t funding f LAS psts and ability t mrtgage NTNS. In England there were 5 academic fellws and 5 academic clinical lecturer psts ccupied. Fr the Republic f Ireland there are 15 (14.5 FTE) registrars. Over the last 5 years as a specialty we have the highest average % f female trainees at 87% (JRCPTB data) and taking int accunt maternity leave, LTFT in bth male and female trainees, and ut f prgramme experience the average length f training increases frm 4 t 5 years. 40 higher specialty trainees annually achieve their certificate f cmpletin f specialist Training (CCT). 43 and 30 CCTs were achieved in 2015 and 2016 with 37 anticipated fr The prjected average number f CCTs per year ver next 3 years is The annual average utput f 40 CCTs is nt sufficient t cver the demand f filling > 60 vacant cnsultant psts each year. The estimated need is fr 60 StRs t undertake HST annually t increase the number f CCTs required each year t fill the current 50 FTE cnsultant vacancies, the 30 anticipated new psts ver the next 5 years and t supprt the increasing wrklad f existing pst-hlders. Hwever, n increase in training numbers is expected in the current financial climate. 89% f trainees wh respnded undertake n-call telephne advice with 94% prviding face-t-face emergency reviews in hspices, 30% in hspital and 19% in the cmmunity. (APM Wrkfrce survey 2016). Shape f Training may result in a shrter length f time in specialty training that may influence vluntary sectr hspices funding speciality dctrs rather than HST that culd ptentially reduce the annual utput f the numbers f cnsultants. Table 2. Cmparisns f UK Higher Specialty Trainee Numbers (RCP and SAC data). Registrars RCP SAC 2015 SAC

10 UK 218 (161 FTE) 236 (204 FTE) 240 (201.9FTE) England 189 (140 FTE) 202 (175 FTE) 209 (175.2 FTE) Nrthern Ireland 6 (4 FTE) 7 (6.4 FTE) 7 (6 FTE) Sctland 14 (10 FTE) 14 (12.5 FTE) 13 (11 FTE) Wales 9 (7 FTE) 13 (10.4 FTE) 11 (9.7 FTE) Challenges Main issues cnfrnting the wrkfrce are extending the current patterns f 7 day wrking and the ptential added cmmitment t acute medicine, in the cntext f delivering ut f hurs crss-site wrking in cmmunity, hspice and hspital settings and securing the recgnitin that the current prpsed changes t UK medical training wuld shrten the length f specialty training in that mre medical specialties will have greater invlvement in acute medical intake. These changes are being cnsidered by the specialties and Clleges but will ultimately be determined by the GMC and the respective Departments f Health. The effect f Shape f training review and the anticipated changes in service prvisin will influence the traditinal rles f hspices, the future mdels f cmmunity and hspital palliative care teams and their medical wrkfrce requirements. These prpsals will impact n the frmat f the delivery f 7-day access t palliative medicine, cntinuity f care, ur relatinship t the wider hspital and cmmunity services, in meeting the needs f the frail elderly and the rising tide f acute medical admissins. There remains uncertainty in making future prjectins fr the medical wrkfrce at this juncture. In all cuntries, the cnsequences f financial restraints and the envisaged changes t educatin, training and wrkfrce planning are a majr cncern. This will require the recgnitin that a review f the skill-mix f the specialist palliative care wrkfrce bth medical and nursing is undertaken t meet demand and imprve access t 7-day, 24 hur palliative care. 4. APM Wrkfrce Survey 2016 Analysis A ttal f 1213 questinnaires were issued between July 1st t 30th September % issued t APM Members and 4% t nn-members understd t be wrking in palliative medicine in the UK and the Republic f Ireland. In ttal 717 questinnaires were cmpleted a respnse rate f 59%. 4.1 Medical Grade Cnsultants in UK and ROI 405 Cnsultants frm UK and 19 frm Ireland APM 2016 Survey. See Table 3. Grade f Dr by cuntry fr UK and Ireland 10

11 ANSWER OPTIONS ENGLAND NORTHERN IRELAND SCOTLAND WALES UK TOTAL REPUBLIC OF IRELAND Cnsultant SSAS Dctr Training Pst Other nn-training Grades Ttal Table 3 Type f wrking: In the UK % f less than full time Cnsultants was 52%; in England 51%, N Ireland 56%, Sctland 57% and Wales 54%. Academic psts: Ttal f 138 psts in UK and 19 psts in Ireland. Gender by cuntry: Highest % was female in bth UK and Ireland fr all grades. See Table 4. CLINICAL POSTS UK REPUBLIC OF IRELAND FEMALE MALE TOTAL FEMALE MALE TOTAL Cnsultant (75%) (25%) (62%) (38%) Specialty, Staff Grade r Assciate Specialist (SSAS) Dctr 84 (88%) 12 (12%) 96 1 (50%) 1 (50%) 2 Training Pst (83%) (17%) (83%) (17%) Ttal Clinical Psts (78%) (22%) (78%) (22%) Ttal Clinical Psts by Cuntry UK = 617 Republic f Ireland = 27 11

12 Table 4 Cntracts: majrity held by NHS Emplyer in UK and Ireland. Fr UK, 72% f cntracts held by NHS and 22% by a hspice. Appraisals: In last 12 mnths > 95% f UK Cnsultants and >75% f Ireland Cnsultants. Retirements: In the UK between a ttal f 29, an average f 5/yr and fr a ttal f 30, an average f 6/yr; majrity at age f 60 years reflecting high % f female. Cnsultants in ROI a ttal f 4 Cnsultants expect t retire between 2020 and 2024, majrity at age f 65 years. 4.2 SSAS Drs APM Survey 2016 APM survey 2016 reprted: - 96 UK and 2 ROI SSAS dctrs cmpleted the survey representing 15% f the ttal respndents. Tables 3 & 4. 69% f SSAS Drs wrk less than full time, a similar trend fr the specialty. In the UK 88% are female and 50 % in the ROI. 67% are emplyed/cntracted t hspices. 96% (UK) and 100% (ROI) had an appraisal in the last 12 mnths Trainee Drs APM Survey 2016 A ttal f 114 UK palliative medicine trainees cmpleted the survey, cmprising f 95 frm England, 5 frm Nrthern Ireland, 5 frm Sctland and 9 frm Wales and 6 trainees frm the Republic f Ireland. Ttal respnses f 120 trainees, 83% were female and 17% were male. See Tables 3 & 4. Accrding t the APM data there is nly 1 UK Academic Clinical Lecturer and 2 in the ROI. This is a very small number in cmparisn t ther specialties. There are 6 Academic Clinical Fellws in the UK and 1 in the ROI. Trainees cmpleting the survey cmprised the fllwing: 1 (1%) F1, 1 (1%) ST1/ST2, 5 (4%) Academic Clinical Fellws, 1 (1%) Academic Clinical Lecturer, 108 (90%) specialty registrars, and 4 (3%) in ther types f training psts. With regard t yearly appraisal in the UK; nly 91/114 trainees cmpleted this sectin f the survey, 73 had received an appraisal in the last 12 mnths, 5 had nt and 13 deemed this t be nn applicable. All 6 ROI trainees cmpleted, 4 had received an appraisal in the last 12 mnths, 1 had nt and 1 deemed it nt applicable. 5. ON CALL APM SURVEY

13 5.1 UK Cnsultants OOH On call Ttal number f UK Cnsultants prviding n-call was 342/380 representing 90% f respndents. The majrity f cnsultants 181 (53%) prvide nly secnd n-call duties but a large number 136 (40%) include first n-call duties with their secnd n-call wrk. 24 cnsultants (7%) are first n call. 91% f n-call Cnsultants cvers ut f hur s telephne advice. 85% fr hspices, 75% fr cmmunity palliative care teams and 70 % fr hspital palliative care teams. Majrity f Cnsultants cver OOH ne hspice site, 1 in 3 prvide n hspital cver and majrity cver 2 r mre cver cmmunity teams. 76% undertake emergency face-t-face assessments with 70% fr hspices but nly 32% fr hspitals and 23% fr cmmunity palliative care team reviews. (APM Wrkfrce survey 2016). 1 in 3 Cnsultants cver OOH 2 r mre hspice sites; >40% cver 2 r mre hspital teams and >50% 2 r mre cmmunity teams. On-call frequency: High frequency 87/266: - 1 in 1 t 1 in 4 = 33% O Medium frequency 150/266: - 1 in 5 t 1 in 8 = 56% O Lw frequency 29/266: -1 in 9 r less = 11% O O On Call Supplement fr UK Cnsultants 79% f 266/335 cnsultants receive paid supplement and 69 (21%) declared n n-call supplement. Cntracted PAs fr OOH n call UK cnsultants 168/322 (52%) receive n PAs fr cmbined telephne advice and facet-face cntact. 154 /322 (48%) receive PAs f whm nly 54 (35%) receive 1 PA r >. 5.2 ROI Cnsultants OOH On call OOH Telephne advice Undertaken fr hspices by 91% f cnsultants, fr cmmunity and hspital palliative care teams by 56% and 64% respectively. Cnsultants cver 2 r mre services acrss all types f rgabisatins. Emergency Palliative Medicine OOH n call: OOH Palliative Medicine Emergency admissins n call: Undertaken fr hspices by 93%, 56% fr hspital and 64% fr cmmunity palliative care teams. 36% - 44% f cnsultant respndents reprted as nt prviding emergency cver. Majrity cvers 2 r mre sites fr hspitals and cmmunity teams/. 5.3 UK SSAS Dctrs 2016 OOH On call Telephne advice OOH 81/96 participating SSAS dctrs (84%) answered this questin. 13

14 64/81 (79% f respndents) prvided telephne advice.92% fr hspices, 27% fr hspital and 87% fr cmmunity palliative teams. Majrity cver ne site fr each sectr f care. Emergency OOH reviews 71% undertake emergency face-t-face reviews with the majrity 88% cvering hspice units and cmmunity services. There is variatin in hspital cver, which may reflect the hspice arrangements with lcal hspitals and cmmunity teams. Type f n call Prvisin: 74% 1st n call, 11% nly 2nd and 14% a mixture f 1st and 2nd n call Fr 1st n call - 90% cver hspice, 23% hspital, 50% cmmunity and 17% patient telephne advice. Numbers t small t interpret secnd n call sites. On call frequency: 65% prvide either 1:4 r 1:5 fr first n call. On call payments: The majrity f SSAS dctrs d nt receive PAs fr OOH telephne advice, althugh 51% did get payment fr telephne advice t hspices. Only 14% and 4% f respndent SSAS Drs receive payment fr hspital and cmmunity face-t-face cntacts and 63% fr hspice review. Fr hspices 24% f SSAS Drs received < 1 PA and 38% 1PA r >, thse prviding hspital r cmmunity cver were small in number. 5.4 ROI SSAS Drs OOH On call OOH Telephne advice In the nn-training grade, 26/28 (93%) undertake telephne advice. Emergency Palliative Medicine OOH n call. The very small numbers f SSAS Drs and nn-training psts made it difficult t cmment. 5.5 UK Trainees OOH On call A range f grades f junir dctrs cmpleted the survey under the umbrella term f "trainee" hwever the majrity f respndents were higher specialist trainees. 14

15 Levels f service prvided by trainees is highly variable with regard t the different sites cvered, Service prvided by trainees regarding the frequency f n calls, the types f n calls and the number f sites cvered when n-call is als highly variable making it difficult t ascertain hw they will cntribute t the effective prvisin f a 7 day service. The majrity f face t face n calls are prvided t hspices whilst ther palliative care services are prvided with telephne service and less frequently a face-t-face service. Palliative Medicine OOH n call. The majrity f UK Trainees 101/112 (90%) prvides palliative medicine OOH n call. Telephne advice OOH 86/97 89% f trainees wh respnded undertake n-call telephne advice Emergency admissins OOH Palliative Medicine undertaken by 97/112 87% trainees. 94% prvided face-t-face emergency reviews in hspices, 30% in hspital and 19% in the cmmunity. 78% f Trainees cvered 1 hspice unit nly.51% f trainees cvers 2 r fewer hspitals. The majrity f trainees (56%) cvered 1 cmmunity team. The majrity f trainees did nt prvide cver fr hspitals withut n call teams. Type f n call 60/65 trainees (92%) wrking first n-call are in hspices and nly 18 (28%) cver hspital, 20 (31%) cmmunity services and 12 (18%) patient/carer advice lines. Mst will d ward runds at weekend in hspices but n data as t the level f face t face review is prvided in hspital at weekends. Frequency f n-call duties fr UK trainees 38 trainees (63%) d between 1:5 and 1:6 first n call duties cvering Hspices but a few (4 trainees 7%) d a mre frequent rta (1:1 t 1:4) and the remaining 18 (30%) d 1:7 r less frequently in hspices. Fr secnd n-call duties the data is t small t be meaningful but fllws the pattern fund with cnsultants On call payments: OOH face t face cntacts were cntracted/remunerated, 30%, 87%, 18%, and 47% f UK trainees 40%, 97%, 4%, and 90% f ROI trainees felt this was the case fr hspital, hspice, cmmunity and "in ttal" respectively. 15

16 5.6 ROI Trainees OOH n call Trainees all undertk OOH n call (6/6). OOH Palliative Medicine Emergency admissins undertaken by 83%. 6. UK 7-DAY PALLIATIVE CARE SERVICES APM 2016 SURVEY 6.1 Hspice IP units Ttal respndents = 315 UK Cnsultants Number f cnsultants available by number f units: O Mnday t Friday 9am -5pm fr 1 unit number f cnsultants ranged frm 1 t 7, median f 2. OOH median number f cnsultants = 1 Admissin access t hspice in patient units: Mnday t Friday 9am t 5pm Mnday t Friday access = 20% f cnsultant respndents Mnday t Sunday 9am t 5pm access = 31% f cnsultant respndents IP admissins Mnday t Sunday 24-hur access = 41% f cnsultant respndents. 6.2 Hspital supprt teams UK Cnsultants 74 % f cnsultants, wh respnded, undertake 7/7 cver fr a hspital supprt team. Majrity cver nly ne unit (78%; n=139). Hwever in a small number cver prvided t 2 r 3 hspitals (n=24 and n=16 respectively). 16

17 O CNS number high range 1 t 17, median 5. O The majrity f hspital teams appear t have access t at least ne cnsultant Mnday t Friday 9am-5pm fr ward runds and patient review. O OOH there is less cver usually nly by ne cnsultant. Where there is cnsultant cver, n the whle nly fr ne unit thugh there are sme exceptins. Number f cnsultants available by number f hspital palliative care teams O Mnday t Friday 9am t 5 pm fr ne unit number cnsultants 1 t 5 median 1; O Sat t Sun 9am t 5pm ttal number Cnsultants 1 per unit, median 1 fr 86 respndents with 75% wrking in ne unit. O 5pm -9am OOH fr 84 respndents with 71% wrking in ne unit CNS Face-T-Face Cver fr 7-Day Hspital Supprt Teams CNS cver apprximately 50% f hspital supprt teams nly had access t CNSs Mnday t Friday, 9am t 5pm (althugh in Wales this is in all teams 7/7). Fr 1/2/3 units the % trends seem fairly cnsistent independent f the number f services cvered. 116/223 respndents indicated CNS cver fr ne team: O 7 day CNS service 9am t 5pm = 52%; O Mn t Sun 9am t 5pm = 25% O Mn t Sun 24 hurs = 1% CNS Telephne Advice Cver Bank hliday, Saturday t Sunday 9am t 5pm Nearly 50% cvered by just telephne cntact nly with 50% presumably prviding direct assessment. OOH the prprtin n these days cvered by telephne advice nly was slightly greater at between 65 59%. 6.3 Cmmunity Specialist Palliative Care Teams: Fr dctrs wrking in the cmmunity with palliative care teams, 57% f respndents prvided face-t-face 9-5pm reviews. Hwever, the majrity (>71%) prvided in-hurs and ut f hurs telephne supprt t the cmmunity teams. UK Cnsultants The majrity f cnsultants (79%) wrked in 1 cmmunity team site r hspice at hme site (25% f respndents). 277 cnsultants respnded t the questin f wrking with cmmunity teams (68%). Of these respndents, tw thirds (66%) wrked with a single team; 19% wrked with 2 sites/services, while 10% wrked with >2 sites/services. O CNS numbers per single team range 1-25, median 7. CNS Face-T-Face Cver 7-Day Cmmunity Specialist Palliative Care Teams CNS cver apprximately 49% f cnsultants in cmmunity teams nly had access t CNSs Mnday t Friday, 9am t 5pm. Fr 2/3 units the % trend ranged frm 31 t 39% f services cvered. 17

18 110/226 respndents indicated CNS cver fr ne team: O CNS service cver Mnday t Friday 9am t 5pm = 49%; O Mn t Sun 9am t 5pm = 40% O Mn t Sun 24 hurs = 1% CNS Telephne Advice Cver Bank hliday, Saturday t Sunday 9am t 5pm,nearly 37% cvered by just telephne cntact nly with 63% presumably prviding direct assessment. OOH the prprtin cvered by telephne advice nly was greater at between 54 68%. 6.4 Day Care Services 236 UK cnsultants respnded f whm 64% cntributed t a day care service and the majrity f cnsultants 80% wrk at a single site units, 13% n 2 sites and 7% n 3 sites. Units ffer 5 t 30 day places per day median = 15/day Days pen 1 t 7 days, median 4 days/week Single site cver Cnsultants range frm 1 t 4, median f 1 SSAS Drs range frm 1 t 5, and median f 1 Trainees range frm 1 t 3, median f 1. APM Wrkfrce Cmmittee March 31st 2017 Chair f APM Wrkfrce Cmmittee Stephanie Gmm 18

19 Appendix Table 1. APM Wrkfrce Survey 2016: UK cnsultant prvisin seven-day services UK Cnsultant prvisin seven day services Hspice Hspital with Palliative Care Team Hspital with N Palliative Care Team Cmmunity with Palliative Care Team Cmmunity with N Palliative Care Team Nt applicable Ttal Where d yu prvide Cnsultant 9am- 5pm reviews? 228 (67%) 227 (67%) 12 (4%) 193 (57%) 9 (3%) 10 (3%) 340 Where d yu prvide Cnsultant facet-face planned OOH review? 130 (43%) 35 (11%) 8 (3%) 26 (9%) 5 (2%) 165 (54%) 305 Where d yu prvide emergency cnsultant facet-face n call? 228 (70%) 104 (32%) 28 (9%) 76 (23%) 13 (4%) 78 (24%) 328 Where d yu prvide 9am 5pm telephne advice? 235 (71%) 242 (73%) 44 (13%) 236 (71%) 32 (10%) 15 (5%) 332 Where d yu prvide n call telephne advice? 287 (85%) 234 (70%) 107 (32%) 251 (75%) 60 (18%) 27 (8%)

20 Table 2 shws estimated Cnsultant wrkfrce numbers and FTE fr 2015 fr each cuntry n the basis f 2.5 FTE/250,000 in UK cmpared t current prvisin (SAC data 2015). With participatin rati f ( ) fr FTE and head cunt in each cuntry. Table 2. Estimates fr each cuntry in UK and Ireland UK <40% full time Cuntry Ppulatin Est.ONS Millins (2015) RCP estimate 1 SAC 2015 data Participatin Headcunt FTE Headcunt FTE Rati Wales N Ireland Sctland England UK Ireland

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