Census of consultant physicians and higher specialty trainees in the UK Palliative medicine

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1 Census of consultant physicians and higher specialty trainees in the UK

2 Census of consultant physicians in the UK The Federation of the Royal Colleges of Physicians of the UK s census of consultant physicians identified 502 palliative medicine consultants working in the UK: 414 in England, 25 in Wales, 48 in Scotland and 15 in Northern Ireland. There was no overall expansion of UK consultant posts compared to 3.9 for all specialties. The average rate of retirement (due to consultants reaching 65 years of age) is anticipated at 4.5 per year during the period , and 11 per year over the following 5 years. However, intended retirement ages reported in the census range from 59.8 years (Northern Ireland) to 61.7 years (Scotland). Women comprise a higher proportion of the consultant workforce (73.3) than most other medical specialties, with 63.6 of women working fewer than 10 per week. Overall 52.3 of consultants in palliative medicine work less than full time. The charitable sector employs 18.1 of palliative consultants and a further 32.2 are employed on joint charity-nhs contracts; 8.3 are employed on combined NHS and academic contracts, and 40.6 are totally funded by the NHS. Data for advisory appointments committees in England, Wales and Northern Ireland from January December 2013 show that 43 out of 59 (or 73) were successful, six were not made and 10 were cancelled. The average number of consultant appointments during was 30 per year. The UK consultant vacancy rate is 7.2 (or 39 posts). 1 The projected average number of CCTs per year over the next 3 years is The geographical distribution of UK consultant posts presented in the map shows that the East Midlands, East of England and Wessex local eductaion and training boards (LETBs) have the lowest number of full-time equivalent (FTE) consultants (ie 1 FTE:greater than 215,000 population). The RCP has previously published a workforce requirement of a minimum of 2 FTEs for a population of 250,000 across the UK. 3 However, the Association for Palliatve Medicine (APM) has estimated that this needs further modification on the basis that LTFT consultants comprise approximately 50 of the workforce and so 3 FTE consultants per 250,000 (or 1 FTE per 80,000) represents a more accurate figure. Mean working hours are higher at than contracted 9.01, but are overall lower compared to most specialties reflecting the high proportion of less-than-full-time working. In contrast, both contracted and working supporting (2.12 and 2.65 respectively) are higher than those of the average consultant (1.97 and 2.45 respectively), which may indicate a higher proportion of management roles that are undertaken. Consultants in palliative medicine spend a smaller proportion of time in academic activities per week (0.27 ) than the other medical specialties (0.76 ). 1 Association for Palliative Medicine/SAC. Internal report: 2013 (unpublished) 2 Joint Royal Colleges of Physicians Training Board. Internal data: 2014 (unpublished) 3 Royal College of Physicians. Consultant physicians working with patients: the duties, responsibilities and practice of physicians in medicine, revised 5th edn. London: RCP, 2013:

3 In the last decade, the consultant expansion rate has not reached the estimate of need across the UK of 584 FTE (approximately 769 headcount), a shortfall of 177 FTE (see table 1 below). Currently, while there is no problem in recruiting to NTNs, there are insufficient NTNs, given unmet need, major geographical variation and the existing consultant vacancy rate. Consideration needs to be given to recruit additional funded NTNs in these areas, recognising that a large proportion of trainees are women and LTFT who currently apply mainly in their training region. Additional issues for the specialty are the potential commitment to training and service delivery in acute medicine, and extending the current models of 7-day out-of-hours services to encompass community, hospice and hospital sites that will require expansion of consultant numbers. April 2015 Dr Stephanie Gomm Consultant physician in palliative medicine Workforce lead, Association for Palliative Medicine Table 1. Estimated consultant workforce numbers and FTE compared to current provision (SAC data 2013) Nation Population estimate in millions* RCP estimate SAC 2013 data Headcount FTE Headcount FTE England Northern Ireland Scotland Wales United Kingdom * Office for National Statistics. Annual mid-year population estimates, London: ONS, stb---mid-2013-uk-population-estimates.html [Accessed April 2015] Based on the participation ratio ( ) for FTE and headcount in each country using SAC 2013 data Association for Palliative Medicine/SAC. Internal report, September 2013 (unpublished) 3

4 Consultant workforce by specialty and nation, with expansion since previous census England Northern Ireland Scotland Wales UK ( ) UK ( ) Expansion All specialties 10, , ,597 12, Change in total number of consultants over time ( ) Total number of consultants Census year Consultant expansion in specialty vs all specialties ( ) 18 Annual consultant expansion () All specialties Census year 4

5 Number of consultants reaching 65 years of age over the next 10 years Total of specialty All specialties , Average intended age of retirement UK England Northern Ireland Scotland Wales All specialties and category of contract/funding Pure NHS Pure Academic/ Research Joint NHS/ Academic (majority NHS) Joint NHS/ Academic (majority Academic) Other Joint NHS with Other Joint Academic/ Research with Other All specialties Full-time and less-than-full-time working by gender All consultants Female Male Less than full time Full time Less than full time Full time Less than full time Full time All specialties 5, Number of higher specialty trainees (HSTs) in specialty by gender Actual headcount Total number training in specialty Number of HSTs Male Female Number of HSTs Male Female All specialties 6,

6 Consultant workforce by age and gender All specialties Age group (years) Total consultants Female consultants Male consultants of gender Number of age group of gender Number of age group 34 or younger Older than Unknown Total or younger , , , , , , , , , , , Older than Unknown Total 12,597 4, , Consultant appointments (AACs) made, not made, or cancelled (Jan Dec 2013) Appointment made No appointment made Appointment cancelled All specialties ,296 Total AACs Mean programmed activities () contracted per week Total Clinical Academic Supporting All specialties 5, Other Mean programmed activities () worked per week Total Clinical Academic Supporting All specialties 5, Other 6

7 Mean programmed activities () worked by gender All specialties Gender Total Clinical Academic Supporting Female Other Male Total Female Male Total Commitment to acute medicine Yes No Mean total acute Mean clinical acute Mean nonclinical acute Acute internal medicine Cardiology Clinical genetics Clinical pharmacology and therapeutics Dermatology Endocrinology and diabetes mellitus Gastroenterology General internal medicine Genitourinary medicine and HIV/AIDS Geriatric medicine Haematology Hepatology Immunology Infectious diseases and tropical medicine Medical oncology Neurology Paediatric cardiology Rehabilitation medicine Renal medicine Respiratory medicine Rheumatology Stroke medicine All specialties 2,

8 Commitment to diabetes medicine Yes No Mean total diabetes Mean clinical diabetes Mean non-clinical diabetes Acute internal medicine Cardiology Clinical pharmacology and therapeutics Endocrinology and diabetes mellitus Gastroenterology General internal medicine Geriatric medicine Immunology Medical ophthalmology Metabolic medicine Nuclear medicine Rehabilitation medicine Renal medicine Stroke medicine Summary 1, Commitment to stroke medicine Yes No Mean total stroke Mean clinical stroke Mean non-clinical stroke Acute internal medicine Cardiology Clinical genetics Clinical pharmacology and therapeutics Endocrinology and diabetes mellitus Gastroenterology General internal medicine Geriatric medicine Neurology Nuclear medicine Rehabilitation medicine Renal medicine Respiratory medicine Rheumatology Stroke medicine Summary 1,

9 Population served by each full-time equivalent (FTE) specialty consultant physician United Kingdom Key and scale: FTE : population 1: fewer than 120,000 1:120,000 1:139,999 1:140,000 1:149,999 1:150,000 1:165,999 1:166,000 1:179,999 1:180,000 1:189,999 1:190,000 1:209,999 1:210,000 or greater No data available Miles Scotland Northern Ireland Northern North West (incl Isle of Man) Yorkshire and the Humber East Midlands Wales East of England West Midlands Thames Valley Wessex South West North East and Central London North West London South London Kent, Surrey and Sussex CALIPER

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