Policy Information

Shape of the Medical Workforce in England

Background to the Debate

Medical care in NHS hospitals is still currently largely delivered by trainee doctors under consultant supervision. If consultant numbers stay as at present and do not undergo significant expansion by 2020 there will be a major over-supply of doctors who have completed their training. This presents a major challenge to the NHS, as it has been estimated that it could cost an extra £2.2 billion per year to create enough consultant positions for all doctors completing training. Conversely, non-expansion of the consultant workforce will result in considerable loss to the NHS and patients of experienced, fully trained, doctors, for whom there are no consultant positions available. There will also be a significant risk of alienating a generation of trainees.

Centre for Workforce Intelligence (CfWI)

Against this background, the CfWI has produced a high-level consultation document on ‘Shape of the Medical Workforce: Starting the Debate on the Future Consultant Workforce’ which presents a range of options for addressing this issue. This will be a key, and potentially controversial, area of debate, in the times ahead and the College will remain engaged as plans develop. Council recently considered this consultation and believes –

• the status quo is not sustainable to avoid unnecessary medical unemployment and secure valuable careers for our current trainees;
• a shift in balance between hospital medicine and primary care may be inevitable although much of the current rhetoric about managing patients safely and effectively in the community is neither evidenced not resourced;
• the move towards a consultant-present service offers better patient care, but only if improved access to consultants 24/7 is supported with the necessary diagnostic support services;
• the data on which much of the modelling is currently based is fundamentally flawed and must be corrected if workforce planning is to be accurate and safe;
• defining “trained doctors” requires attention to prevent the introduction of a sub- consultant grade that will limit the career aspirations of young physicians and deter high calibre candidates from choosing medicine;
• modelling cannot adopt a “one size fits all” approach and must take account of:

• the inaccuracies in the current baseline data on which many of the projections are made
• medical student numbers and the needs of academic medicine
• attrition rates from medicine
• an evidence-based multiplier to incorporate demographic changes and assumptions about future working hours

Our Trainees and Members Committee have been leading their colleagues in the Academy and other Colleges, and have already produced their response which will be submitted in addition to the College response to signal our support for the next generation of consultants. Fellows and Members can be assured that the RCPE will contribute fully to this debate. 

Benefits of Consultant Delivered (Consultant Present) Care

The evidence continues to grow in support of the benefits of rapid access to consultant opinion for patients who are acutely unwell. The Academy of Medical Royal Colleges’ Report  on the issue lays out much of this evidence and more recently, our sister College in London has published the results of a survey which has shown that patients have better outcomes and are less likely to be readmitted to hospital if cared for on wards where the physicians practising acute medical care do two or more ward rounds per day in the acute medical unit and are present in the unit for more than 4hrs for 7 days.