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Cap training posts in trauma and orthopaedics, government advisers say

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5753 (Published 18 September 2014) Cite this as: BMJ 2014;349:g5753
  1. Abi Rimmer
  1. 1BMJ Careers

Numbers of recruits to training in the trauma and orthopaedic surgery specialty should be capped until 2016, government advisers on workforce planning have said.

Recruitment into trauma and orthopaedic surgery in the third year of specialty training (ST3) should be capped at 122 posts a year in 2014-15 and 2015-16, the Centre for Workforce Intelligence has said in a report on the specialty’s workforce.1 The centre is commissioned by the Department of Health in England, Health Education England, and Public Health England to inform policy decisions on health workforce planning.

The report said that the consultant workforce in trauma and orthopaedic surgery had “grown strongly” over the past decade, from 1265 full time equivalent staff in 2002 to 2015 in 2012, a 59% increase.

Despite a 17% decline in ST3 posts in the specialty between 2010-11 and 2012-13—from 145 to 121—trauma and orthopaedic surgery has remained very popular, the centre said. “The competition ratio for T&O (trauma and orthopaedic surgery) is consistently higher than the average across all surgery ST3 posts and the fill rate has been at or near 100% over the last three years,” it said.

It predicted that by 2028 the NHS would need to employ 3030 full time equivalent consultants in trauma and orthopaedic surgery to meet patient demand, a 50% rise from 2012. “This is the level that would enable current levels of T&O services per patient to be maintained,” it said.

The report set out two possible workforce supply projections, based on two different models of trainee intake. It said that if trainee intake into ST3 remained at the current level until 2028 there was a risk that there would not be enough consultants until 2022, but then subsequently there would be an oversupply. Alternatively, if as many trainees as possible were recruited into ST3 training every year, which assumes that all trainees complete their training and all posts are refilled, meaning that around 170 trainees would be recruited into posts each year, the supply of consultants would outstrip demand.

A panel of experts set up by the centre estimated that by 2028 commissioned trauma and orthopaedic services would rise by just 10%. “There is a significant risk that the supply of T&O surgeons over the projection period will exceed the levels of service that the NHS can afford to commission. This may pose uncomfortable career choices for some new CCT holders over the projection period,” the centre’s report said.

The centre said that to “bring supply and demand into balance” Health Education England needed to cap ST3 recruitment at 122 trainees a year for the next three years. It said that its workforce report would then be updated before the end of 2016, taking into account the findings of a planned British Orthopaedic Association report, and the number of ST3 posts would be reassessed.

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