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Royal College of Physicians

Clinical Articles, News & Views

Concern over NHS relying on consultants’ good will

Consultant physicians are increasingly working above and beyond their contracted hours, while the amount of time consultants have to spend with trainees is decreasing and some specialties are experiencing low levels of growth in consultant numbers, according to a census1 conducted by the Federation of Royal Colleges of Physicians.

Dr Andrew Goddard, Director of Royal College of Physicians (RCP) Medical Workforce Unit, said, “This census shows that senior doctor expansion has fallen and that the NHS remains reliant on doctors working longer than their contracted hours. Consultants contracted hours have fallen significantly as hospitals strive to save £20 billion over the next three years. Despite this, consultants continue to work the hours they have done in previous years and so the amount of ‘goodwill work’ is increasing year-on-year”.

“Furthermore, consultants are finding themselves less available to teach trainees, often having to do jobs that would have previously been done by junior doctors. This is really worrying as training of future senior doctors is vital to high quality patient care in the NHS,” he added.

Each week, consultants are working 11.5% of their contracted hours extra free, says the census, this figure jumping to 14% for doctors who work part time. Overall, this ‘goodwill’ work accounts for the equivalent of 1,450 fulltime consultants, up by 205 compared to 2009. Despite working longer hours, 51.8% of consultants say that time available to spend with trainees has reduced during the past three years.  This change may result from the fact that consultants are spending more time doing jobs that would previously have been done by a junior doctor.

The European Working Time Directive (EWTD) continues to be seen by many as the main culprit responsible for the disintegration of the clinical team and training. The 2010 census, in addition to showing that the majority of consultants work more than 48 hours a week, also shows that 29.6% of departments do not work EWTD compliant rotas in practice – despite 94.7% being compliant on paper. Significant concerns remain about the impact of the EWTD on training and patient care.

74.9% of consultant said pressure at work had increased. 66.3% of consultant physicians reported their job always, often or sometimes ‘got them down’. The RCP is concerned that this is affecting consultants’ career planning. 51.3% of consultants currently intend to retire at 60 years of age or younger and the main reason given was pressure of work (27.9%).

Overall, consultant expansion slowed in 2010 to 6.7% from 10.2% in 2009. However, the expansion was not evenly spread across the 31 specialties. Large expansions were seen in cardiology and respiratory medicine, accounting for 39% of the new consultants. However, the increases seen in these two specialties were mostly due to improved data collection. If these two specialties are excluded, the expansion was only 4.1%, which is low compared to the last 10 years.

However, the RCP is concerned that six of the 31 specialties saw either no expansion or a reduction in numbers. One of these specialties was geriatric medicine, which is of particular concern since the population in the UK is aging. However, it is likely that some geriatricians have been reclassified as stroke physicians (stroke medicine saw a 48% expansion), and the RCP will be monitoring this specialty carefully in future census surveys to monitor whether the NHS will employ enough geriatricians to treat the increasing numbers of patients who are old and have complex conditions.


1 Census of consultant physicians and medical registrars in the UK, 2010. Federation of the Royal Colleges of Physicians. (Available from:

Published on: January 10, 2012

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