Doctors warn that NHS could “reach breaking point within the next few years”

BMJ 2010; 341 doi: (Published 10 December 2010) Cite this as: BMJ 2010;341:c7166
  1. Helen Mooney
  1. 1London

The NHS could reach “breaking point within the next few years” because of a mixture of factors undermining the ability of doctors to give patients consistently high quality care, the Federation of the Royal Colleges of Physicians has warned.

Findings from the federation’s latest census of consultant physicians and medical registrars in the United Kingdom highlight the strain the NHS is already under in specialties caring for very sick patients.

The federation warns that an explosive combination of a rise in numbers of patients, a fall in training posts for would-be consultants, and the need to adhere to the European Working Time Directive has the potential to bring the NHS to crisis point. The federation’s medical workforce director, Andrew Goddard, said that these factors add “further stress to a system which may reach breaking point within the next few years.”

Although the figures show that the number of consultant posts rose by just over 10% in 2009, this reflects the expansion of medical school places created 15 years ago, and Dr Goddard said that the current financial climate meant that this rate of growth could not continue.

He also warned of the growing fear in the medical profession that there will not be enough extra training posts in the coming years for doctors in their last few years of training.

He said, “We have already seen a drop in the number of new posts being advertised in 2010, and although we have enough doctors in training to develop a consultant delivered NHS, these doctors need to have jobs to go into if this service is to be realised.”

The federation highlights cardiology and gastroenterology as the specialties that have seen the least growth in new training places, leaving them less able to cope with growing patient demand.

Questioned about the effect of the European Working Time Directive on consultant workload, doctors said that it was detrimental to their practice, with over 58% of consultants carrying out jobs that previously would have been done by junior doctors, while almost the same number reported that they had little or no time to support their trainees.

Although 93% of consultants reported that the trusts they worked for were complying with the directive, the federation warned that this didn’t necessarily mean that NHS organisations were compliant in practice, highlighting its findings from previous surveys that 40% of registrars reported working more than 50 hours a week.

Commenting on the findings, England’s health secretary, Andrew Lansley, agreed that patients deserved better.

He said, “I have already asked Medical Education England to consider—with the profession, the service, and the medical royal colleges—how best to secure better patient outcomes and the right level of supervision for trainees through greater consultant involvement in direct clinical care at night and at weekends.

“We are very much aware of concerns about support for junior doctors. We are clear that provision of service should not be the primary purpose of postgraduate medical training. Rather, the objective is to produce fully qualified specialists who are able to provide high quality and safe patient care and for the service component of training to be properly supervised.”


Cite this as: BMJ 2010;341:c7166