Key findings 48% 20% 20% 10% 74%

of consultant and SAS physicians said they undertook some work remotely more than their contracted hours

While those working less than full time worked more than their contracted hours, mainly due to clinical workload

Contract 9

More than half of physicians did not take all of their annual leave entitlement

Geographical Distribution Of Hsts

The census reveals that over half (52%) of advertised consultant posts were unfilled in 2021. This is the highest proportion of unfilled posts since current records began in 2008, and the first time that more than half of advertised posts went unfilled. In three-quarters of cases, posts went unfilled because there were simply no applicants.

The census also shows that workforce pressures will become even more severe without determined action. Almost half (44%) of the consultant physician workforce is set to reach retirement age in the next decade. At the same time, demand for care will increase as the population ages: the ONS projects that the number of people aged 85 and older will double between 2020 and 2045. In this context the wellbeing and development of trainees, who represent the future of the NHS workforce, is particularly important.

The census shows that Covid-19 has had a significant impact, with three-quarters (74%) of higher specialty trainees (HSTs) missing training opportunities. They also missed out on providing outpatient care (67%), local teaching (64%) and gaining exposure to procedures (50%). Nearly a third (30%) had been required to work in an environment that was not relevant to their training.

LESS-THAN-FULL-TIME WORKING IS ON THE RISE

Another key trend for both consultants and HSTs is the continuing rise of less-thanfull-time (LTFT) working. A quarter of consultants and 18% of HSTs worked LTFT in 2021. A higher proportion of women worked LTFT: among consultants, 42% of women compared with 13% of men, and among HSTs 29% of women compared with 7% of men. Coupled with the fact that the proportion of women in the workforce is rising – 39% of consultants and 52% of HSTs were women in 2021, compared with 23% and 42% respectively in 2004 – this has important implications for workforce planning. Two-thirds (62%) of HSTs would like to work on a less than full time basis due to wanting an adequate work–life balance (83%), avoiding burnout (73%) and gaining exposure to other aspects of medicine such as quality improvement, research and leadership (65%). This suggests that the demand for LTFT will only increase, so we will need a higher overall number of doctors.

Our Solutions

A long-term solution requires proper workforce planning that aims to match supply of clinicians with demand for care, and the sustained investment necessary to deliver it. But even if that was done today, the length of time it takes to train a doctor means we won’t see the impact for many years, so we also need to think about what we can do now. We have used the findings of the census to emphasise the urgent need for action to ease pressure on the NHS workforce. In short, we need to increase the workforce, improve retention and support doctors who are approaching retirement.

Enabling physician associates to play a bigger role in the delivery of care would be an important part of increasing capacity within the workforce, so we need to bring them into regulation at the earliest opportunity.

While overseas recruitment should not be seen as the primary solution to the workforce crisis, without further significant investment in training more people in the UK this will have to be part of the short- and medium-term solution. And formalising the foundation interim year 1 programme and reforming the CESR system to make it easier for SAS doctors to become consultants are other measures that can be taken.