Growing gaps in paediatric rotas threaten children’s healthcare, says royal college

BMJ 2016; 354 doi: (Published 16 August 2016) Cite this as: BMJ 2016;354:i4495
  1. Ingrid Torjesen
  1. London

Paediatricians are calling for an urgent increase in training numbers and for consultant service redesign because UK paediatric services have been struggling with growing gaps in staff rotas.

More than half of paediatric services in the UK were not staffed to recommended levels, shows the latest workforce survey, published on 16 August by the Royal College of Paediatrics and Child Health. Services were struggling to cope with rising numbers of vacant posts and had to rely on consultants to cover gaps in rotas because they could not get locum cover.1

The survey adds to mounting evidence of the growing crisis affecting the medical workforce. In June a report from the Royal College of Anaesthetists said that the rate at which consultant anaesthetists were joining the NHS workforce needed to double to meet the growing demand for staff.2

The paediatrics survey, which has been undertaken every year since 2009, showed that vacancy rates in tier 1 (mainly junior trainees) and tier 2 (more senior trainees) rotas were now 10.4% and 20.3%, respectively. Across both tiers the vacancy rate had risen from 12.1% in January 2015 to 14.9% in January 2016.

The vacancies meant that 60% of tier 1 rotas and 77% of tier 2 rotas had fewer than 10 whole time equivalent staff—the recommended standard set in the royal college’s Facing the Future report.

Difficulties finding locums meant that, across both rota tiers, the number of vacant posts filled by locums fell from 47.3% in January 2015 to 46.5% this year. Accordingly, consultants were increasingly stepping in to provide unplanned cover. Such unplanned cover occurred in a higher proportion of units in January 2016 (38%) than in January 2015 (35%) and was needed more often: on an average of 3.1 occasions over the four weeks preceding the survey in January 2016, against 2.4 in January 2015. In 2016 89% of clinical directors were concerned about how the service would cope over the next six months, up from 78% last year.

Simon Clark, workforce officer at the Royal College of Paediatrics and Child Health, said that the current situation was unsustainable. He said, “The paediatric workforce is at breaking point, and children’s healthcare is increasingly being compromised. There is no escaping the fact that an increase in junior and consultant posts is urgently needed, coupled with a radical redesign of services.”

Clark added, “Since the imposition of the highly damaging junior doctor contract, we have evidence from the college’s existing recruitment data that morale is at an all time low. In a reversal of previous years’ figures, junior doctors are choosing to move out of England: 100% of posts at junior trainee level were filled in Wales, Scotland, and Northern Ireland, compared with 93% in England.”

Andrew Goddard, registrar of the Royal College of Physicians, said, “The situation our paediatric colleagues are in is worryingly familiar. Physicians are also facing rota gaps, consultants acting down into trainee positions, inability to recruit to posts in key specialties due to a lack of trainees, and difficulties in covering day to day services. We’re heading into an extremely difficult autumn.”

In paediatrics the vacancy rate was highest in tier 2 general paediatric rotas, where the recorded vacancy rate has risen from 18% in January 2015 to 27.6% this year. There were also regional differences: the highest vacancy rates in tier 1 rotas were in Northern Ireland (19.2%), while the highest in tier 2 were in England (21.7%).


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