The Royal College of Surgeons’ 2001 report, The Surgical Workforce in the New NHS, identified a shortfall of 1454 surgeons on the targets set for 2010. It takes between six and ten years to train a medical graduate to be a surgeon, and workforce development has lagged behind the needs of the service for many years. Currently, there are only 5214 surgeon consultants working in England and Wales.
While there have been a number of short-term policies aimed at increasing capacity within the NHS, the longer-term implications of many service needs and the Government’s changes mean that an additional 2760 posts will be required by 2010. More training opportunities and resources are imperative now.
Developing a Modern Surgical Workforce, published today by the Royal College of Surgeons, is a comprehensive census of surgery in England and Wales. It is endorsed by the nine surgical specialist associations.
The NHS Plan, launched in July 2000, promised 7500 more consultants in England by 2004; an additional 1000 specialist registrars by 2004; and an increase of 1000 medical students across the UK by 2002. So far, the only target that has been met is the expansion of medical students. Whilst additional training posts have been offered, not all can be taken up due to lack of central resources and service pressures in hospitals. The Royal College of Surgeons insists that new training opportunities are able to deliver training of the required standard.
Hugh Phillips, President of the Royal College of Surgeons, said: "The College’s prime responsibility is the improvement of surgical standards for patient care. Our survey shows that because of the numerous changes in the NHS – new technologies, new treatment opportunities, and the increased demands of training and education – more surgeons are required if they are to deliver patient safety: this is the price of improved surgical opportunities. The NHS improvements are welcome, but the Government has failed in its calculations as to who is actually going to do the work. The target-driven environment of the NHS is not conducive to the provision of quality training for junior surgeons, nor to the prioritising of patients in order of clinical need."
Increasing sub-specialisation and the requirement for trainees to increase the time spent in training rather than providing service, coupled with the requirement for them to work shorter hours under the European Working Time Directive (EWTD) means that more consultants are required to ensure that adequate training is provided and that service needs are met. Trainees should not be used to provide service cover unsupervised to the detriment of their training, particularly at night.
There are other challenges facing surgery including the Modernising Medical Careers initiative, the implementation of the new consultant contract and job planning process, and, significantly, an increase in the number of surgeons choosing to take early retirement. Changes to pension rules mean that a large number of consultants will reach maximum achievable pension by 2006/2007.
"In addition," said Mr Phillips, "the promised review of NHS pension rules, which have been instrumental in maintaining the commitment of surgeons to late in their professional careers, will mean that many consultants will retire early. We need to retain their wisdom and training potential but remove them from the most onerous aspects of service delivery.
"The productivity of the existing workforce is often limited by lack of resources and poor infrastructure. Against a backdrop of Government targets, a new training programme, changes to service procurement, progressively shortened working hours, the growing number of women in surgery, and the increased need for flexible working within the health service, the inescapable conclusion is that more consultant posts are needed now to carry out the surgical work and to train their successors. There are 12 million admission episodes each year, 6 million of which require surgery. The College is determined to see that the workforce required is appropriately trained and appropriately resourced to do the work. The challenge is in making optimum use of existing staff, and to urgently develop the efficiency and efficacy of training methods. The College has the experience and the vision to do this, but urgently requires the financial resources to realise this potential. This must be a large and long-term investment."
The College is currently carrying out a survey of the impact of the EWTD and will be announcing its results within the next few weeks.