WHY IS THE NHS SO SHORT OF DOCTORS?
We know all about the lack of GPs. But today we expose an alarming shortfall in the number of HOSPITAL doctors — from A&E to children’s care — and the devastating problems it’s causing
Anyone who’s tried to get an appointment with their GP lately will know there aren’t enough family doctors to go round. The average wait to see a GP is now 13 days, according to a survey by Pulse, the GP magazine, and last week the nHS announced it will recruit an extra 2,000 GPs from overseas to help make up the shortfall.
But it’s not only GPs who are thin on the ground. Many vital specialties, including paediatrics, emergency medicine and mental health, are struggling with severe staff shortages.
In fact, as we reveal here, the nHS shortfall could run to thousands of doctors — and this has very real consequences for patients, from children waiting six months or longer just to see a paediatrician to potentially lifethreatening conditions being missed in A&e.
Although there is a chronic shortage of senior consultants — the top rank of hospital doctors — the problem starts with junior doctors, who are in training as the next generation of specialists.
The number of junior doctors in england applying to start training in key hospitalbased specialities has dropped 8 per cent in three years — a new low — according to figures published last year by Health education england (Hee). They are going into non-training roles, research roles or leaving for higher pay, and less stress, in Australia.
But this is not just a new crisis of struggling to fill advertised posts: specialties such as allergy and dermatology say they have long been under-prioritised, with the number of jobs allocated in those areas falling far short for the number of patients.
So at least part of the problem lies with planning. every year, the individual nHS Trusts, informed by clinicians and professional bodies, produce annual workforce plans to meet the needs of their patients. They send these figures to Hee, which then calculates the number of training places for each specialty.
But because it takes at least three years to train a nurse and twice that to train a GP or hospital doctor, the trusts need to forecast future patient demand.
Hee can get it wrong, too. ‘It is difficult to get planning perfect for every one of 50 or 60 specialties all of the time,’ says Dr Mark Porter, immediate past chair of the British Medical Association. Shortages
are wide ranging. The royal College of Anaesthetists has warned that operations could be delayed or patient safety threatened as there aren’t enough anaesthetists to meet demand.
The nHS has agreed that by 2033 there should be 11,800 anaesthetists, which means as of now we need 300 more a year — but the college says just 130 a year have been added.
There are also shortages of junior doctors choosing to specialise in cardiology, haematology and respiratory medicine. And a chronic lack of neurosurgeons has led to this specialty having the worst patient-waiting times. Here, we identify some of the key areas where the number of specialists is falling short — and what it means for you. MISSING 2,443 A&E DOCTORS A ‘wAr zone’ is how A&e departments have been described, as the demands of a growing and ageing population, combined with a lack of social care provision and inadequate out- of- hours GP services have seen ever more people turning up.
Just how bad things are can be seen in this extraordinary figure: we need at least 50 per cent more A&e doctors to cope with current demand, according to the royal College of emergency Medicine, who are calling for an extra 2,200 emergency medicine consultants in england alone.
Last year, Hee proposed an extra 58 training posts — well below what the college says are needed. However, hospitals can’t even fill current posts. Data obtained from more than 100 trusts and health boards showed 243 vacancies for consultants in emergency medicine in england and wales and northern Ireland out of a total 2,209 available. WHY IS THERE A SHORTAGE? A& e DoCTorS work long, unsociable hours often in highly stressful situations and the specialty is struggling to attract junior doctors.
As Dr Taj Hassan, President of the royal College, says, doctors are overstretched and ‘working to the very limits of their abilities to provide safe, compassionate care — this is leading to burnout and doctors leaving the profession, creating a vicious circle.’ In 2015 it was reported that 600 A&e consultants and trainees had left to work overseas over the previous five years. WHAT IT MEANS FOR YOU LonGer waiting times. Four- hour waiting limits are increasingly a thing of the past, with an investigation last november revealing a 60 per cent rise in delays in a two-year period, with some patients waiting up to nine hours in an ambulance before they are seen. And chances are you will not see a consultant, but a junior doctor. And juniors may not always have the experience to deal with complex cases or recognise symptoms such as appendicitis — which can be life-threatening.
A junior doctor is left in charge for 40 per cent of the time, according to a 2016 audit of hospital trusts in england. In some units, a junior doctor with just one year’s clinical practice since leaving medical school is the most senior person on duty.
research published in January suggests more than ten avoidable patient deaths a year are linked to overcrowded A&e departments because of the ‘ overstretched system’. Dr Hassan says: ‘Most doctors will agree that our services at a senior level are stretched to their very limits and safety is compromised as a result.’ MISSING 335 ALLERGISTS THere are only around 40 allergy specialists in the UK: if we were to match the proportion of allergists in Germany, we would need 375. Consider this: there is just one consultant allergist per 2 million people in the UK, according to the charity Allergy UK.
And yet allergies of all types, including food allergies, are on the rise and nHS allergy services are unable to keep up, says Dr George Du Toit, paediatric allergy consultant at St Thomas’ Hospital and King’s College London.
one in 30 children now suffers from a potentially life-threatening peanut allergy and it is estimated that 44 per cent of adults have at least one allergy.
Despite the shortfall, for 2016/17 Hee said there should be no additional training places in this specialty — keeping the number of places at 12. WHY IS THERE A SHORTAGE? MULTIPLe studies have found that funding is ‘woefully poor’ — the problem is allergies are not regarded as a serious condition, despite the fact that food allergies
can be life threatening. It’s also a relatively new specialty, which has gained prominence only in the past few decades as allergy has reached epidemic proportions. WHAT IT MEANS FOR YOU Few people are referred to specialsts, even those at risk of lifehreatening anaphylaxis. There’s been a 615 per cent increase in the rate of hospital admissions for anaphylaxis between 1992 and 2012.
Provision of allergy services is patchy, so many have to travel long distances to see a consultant in one of the few clinics where they work. As a result, it is usually GPs who diagnose and treat most people with allergies.
The lack of specialists means a risk of having an allergy misdiagnosed, says Dr Adam Fox, a consultant allergist at Guy’s and St Thomas’ Hospital Trust in London.
He often sees children referred at a very late stage. ‘I look at them and think, my goodness, they should have been here years ago. They come in with multiple allergies, which have affected their lives. And allergies which are poorly controlled can be dangerous.’
MISSING 1,350 PSYCHIATRISTS
THere are currently around 100 vacant consultant posts — around 6 per cent of the total — and only 70-80 per cent of training places for unior doctors to be psychiatrists are filled, says the royal College of Psychiatrists.
In fact, the NHS needs 250 more child psychiatrists and 1,000 adult psychiatrists to meet a five-year plan set out by NHS england, explains Professor Sir Simon wessely, president of the royal College of Psychiatrists. But Hee has allowed for just hree further training posts in both specialties in england — hardly putting a dent in the shortfall. WHY IS THERE A SHORTAGE? ProFeSSor wessely says poor recruitment is partly down to ‘oldfashioned’ attitudes: ‘I have heard people say to medical students, “you are too good a doctor to be a psychiatrist”.’
However, recent reforms that require medical students to take on psychiatric jobs as part of their training should help recruitment. WHAT IT MEANS FOR YOU You might not get any treatment at all — just under half of people referred to a mental health specialist by their GP never get treated, according to a 2014 report by the NHS’s Health and Social Care Information Centre.
Children with mental health problems, including eating disorders and self- harm, are already waiting up to three years for treatment.
MISSING 952 PAEDIATRICIANS
THere are currently 200 vacancies for paediatric doctors across the NHS, including 133 consultants — but, in fact, 752 more consultants above the 133 are needed to meet recommendations from the royal College of Paediatrics and Child Health.
Many children’s wards are on the brink of collapse owing to doctor vacancies, a new report by the college found, with nearly a fifth of all posts for paediatric doctors currently unfilled.
According to latest official data, there are 3,219 paediatric doctors in NHS hospitals altogether. Hee recommended one extra training post in paediatric and perinatal pathology, making 14 in total, 41 training posts in paediatric cardiology, the same as the year before, and 92 posts in paediatric surgery — down two from the year before. So despite the shortages, there will actually be one fewer training post overall than last year. WHY IS THERE A SHORTAGE? oNe issue is that female doctors — who increasingly dominate paediatrics at the junior end — are more likely to go on maternity leave or opt to work part-time, suggests the royal College of Paediatrics and Child Health.
women represent 52 per cent of the consultants, but 74 per cent of the trainee paediatric workforce as younger women choose this option. Around one third of female consultant paediatricians work less than full-time, compared to 9 per cent of male consultants.
Brexit is also having an impact because of confusion around employment status of non-uK nationals, according to the royal College: 40 per cent of qualified paediatricians gained their first qualification outside the uK. WHAT IT MEANS FOR YOU Fewer children’s wards open, for a start. Around one third of the uK’s 195 trusts and health boards temporarily closed children’s wards owing to staff shortages in 2015, according to the royal College.
And those waiting for non-urgent treatment may face longer waits — six months or more to get an appointment for a tonsillectomy with a paediatrician after being referred by a GP.
‘I’m worried about the wellbeing of patients today,’ says Professor Neena Modi, the college’s president and a professor of neonatal medicine at Imperial College London.
‘when resources are insufficient, hard decisions have to be made and those who have the most urgent need will be seen first. But children with less urgent problems could be forced to wait even longer.’
MISSING 400 DERMATOLOGISTS
AS MANY as a quarter of the 800 dermatologist posts have not been filled, says the British Association of Dermatologists.
even filling these would mean we don’t have enough dermatologists — we need another 200 on top of what we’ve got, according to the royal College of Physicians (it recommends one full-time consultant per 62,500 of the population, a target which in dermatology is not achieved in any region in Britain). we’re still way behind other countries: for instance France has one full time consultant for every 120,000 people compared with one per every 200,000 in the uK. WHY IS THERE A SHORTAGE? THere are two problems — a government failure to plan for the numbers needed, and a botched restructure, says Dr David eedy, president of the British Association of Dermatologists. Introduced in 2007, this aimed to move medical facilities closer to where people live — dermatology moved to GPs with a special interest in it and away from consultantled teams in hospitals. Dr eedy says there aren’t enough dermatology trainees coming through to replace retiring staff and with the significant rise in skin cancer cases — up 400 per cent over the past 35 years — demand is increasing. WHAT IT MEANS FOR YOU
IN SoMe parts of the uK it’s now almost impossible to see a dermatologist on the NHS. London is relatively well catered for, but the North east and the South east coast have just 0.69 and 0.64 full-time consultants per 100,000 population. In england, waits of four or five months for referrals for severe acne are common — only consultant dermatologists can prescribe treatments such as roaccutane.
Dr Tamara Griffiths, a consultant dermatologist at Salford royal NHS Trust, says this means many people who need help are not getting it. ‘The real issue with skin disease is that it may not be life threatening, but can be life ruining.’
worryingly, a study by the university of Manchester last year found that more than a third of children and young people who committed
suicide between January 2014 and april 2015, had a physical health problem, the most common being acne.
GPs also may be less knowledgeable about the early appearance of potentially deadly skin cancers, too. a report from the national Cancer intelligence network last year found GPs failed to refer almost one in three patients with malignant melanoma for urgent tests. early diagnosis is critical as it’s treatable in the initial stages.
MISSING 1,000 OBSTETRICIANS & GYNAECOLOGISTS
tHere are currently 5,500 obstetricians and gynaecologists in the nHS, according to the Department of Health, including 2,000 consultants. the royal College of obstetricians and Gynaecologists carried out a recent survey of their workforce and found a shortfall in trainees on staff rotas of at least 30 per cent of the time. the estimated shortfall in the specialty is around 1,000 doctors. However, last year, Hee actually reduced the number of obstetrics and gynaecology trainees from 1,724 to 1,719.
WHY IS THERE A SHORTAGE?
tHiS is a specialty increasingly dominated by female doctors, according to Professor Mary ann lumsden, vice president of the royal College of obstetricians and Gynaecologists. ‘about 80 per cent of trainees are female, leading to a high rate of maternity leave,’ she says.
But demand is growing: a recent baby boom, coupled with a trend towards women having babies later in life has increased complications in childbirth, as has obesity.
one in five doctors in this speciality leaves training before they complete it, but senior doctors are also leaving. ‘the heavy toll of night shifts, anti-social hours and increased litigation against doctors has also increased “burnout”,’ says Dr Clare Gerada, former Chair of the royal College of GPs.
HOW THIS AFFECTS YOU
‘woMen are already having to travel longer distances to get the specialist gynaecological care they need to deal with common complaints like fibroids and cysts,’ says Mike Bowen, a consultant gynaecologist who has worked in the nHS and now works privately in oxford and london.
Mums-to-be with high-risk pregnancies may also have to travel long distances and make sure they get to a centre in time for help from specialist obstetricians.
Studies show that stillbirths and neonatal deaths rise if mothers are forced to travel long distances. in fact, a 2011 study, published in the British Journal of obstetrics and Gynaecology, found risks started rising if a woman had to travel just 20 minutes or more by car to a hospital while in labour.