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RCP census suggests NHS “May reach breaking point”

The 2009 census of the Federation of the Royal Colleges of Physicians of the UK shows the current strain the NHS is under in specialties caring for very sick patients.

Dr Andrew Goddard, RCP director of medical workforce, suggests that increasing hospital admissions, inflexibility of junior doctors’ hours due to the European Working Time Directive, and fewer new consultant posts being created “are adding further stress to a system which may reach breaking point within the next few years.”

In 2009 the number of consultant posts created across the UK increased by 10.2%, which reflects the expansion in medical school places seen 15 years ago and the subsequent rise in numbers of physicians in training posts.  However, the financial climate means that this is not likely to be continued, and there are growing fears that there will not be enough extra training posts in future for doctors who are currently in the last couple of years of training. Dr Goddard 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 specialties with the biggest increases since last year are in acute medicine and geriatric medicine, and are most welcome, but cardiology and gastroenterology have not increased at the same rate, and there is a worry that they are not likely to cope with the increasing numbers of patients to be seen in future years.

Sir Richard Thompson, president of the RCP, said:  “Patients deserve better care at night and at weekends, delivered by consultant physicians, and this will only be achievable if we continue to increase the number of posts, particularly in acute medicine.”

The census also shows that within their contracts, consultant physicians are working harder than ever, and 59.2% of consultants often or always have to work faster on ward rounds than recommended by the RCP.  The equivalent figure for outpatient clinics is 57.2%, and together is more evidence of the increasing pressures on consultant time.

The European Working Time Directive (EWTD) is also having a detrimental effect on the consultant workload, with 58.1% of consultants doing jobs that previously would have been done by junior doctors (up from 55.3% in 2008).  Almost the same percentage report they have little or no time to support their trainees, which is very worrying given the increase in the number of trainee assessments to perform.

93% of consultants say their Trusts are complying with the EWTD, but this does not necessarily mean they are compliant in practice, and other surveys from the College show that 40% of registrars reported working more than 50 hours a week.

Published on: December 9, 2010

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