A mail from a postgraduate medical education director, summary
of which is have pasted here. Let me know your thoughts
Subject: Fw: NACT Cascade: Shortage of Doctors
To all NACT UK members
I am sure we are all involved in counselling young doctors who have
notyet been offered a job and who are starting to consider leaving
medicine or going abroad. This information is very comforting to
them. My advice to those who have not got an ST1 post yet is to
consider atrust post / locum post for experience and reapply in the
next round. There is plenty of work out there and we don't want our
young grads emigrating.
LOCUMS – RECRUITMENT ISSUES
Email sent to SHA WFD 7th February 2008 – Steve Buggle
Anecdotally we are aware that service in some Trusts may be
experiencing problems in finding locums (possibly because trainees
are avoiding LAT/LAS posts) and that Trusts may also be having
problems in appointing to posts which fall vacant throughout the year
because the new appointment process has provided trainees to a
national timetable.
We do not have a feel for how widespread this problem is, or what the
real causal factors are. We would therefore be very grateful if, on
an informal basis, you could provide some rapid FEEDBACK
via reply to
this email, on the extent and nature of these issues within your
Trusts.
If there are problems it would helpful if you indicate whether they
are specialty-specific, at what levels they are being experienced (eg
senior grades), and whether they are specific to a particular
geography. it would also be helpful to know whether any problems
relate to short-term locum posts, longer term placements, or both.
At a glance overview of the issues identified
SHO level = ST1/2;
SpR level = ST3/4
Deanery/SHA Specialty Level Comments
Wessex Surgical ST1 Issues are extensive for PHT. We are
having increasing difficulty filling any and all vacancies and locum
requests
Orthopaedic ST1/2
All FY2 gaps FY2
Emergency ST1/2
Neonates ST1/2
Renal ST1/2
ENT
ST1/2
MAU ST1/2
West Midlands Medicine ST1/2 No suitable candidates apply
Unable to cover vacancies at SpR or SHO level
Acute Medicine/Emergence ST3/4
Paediatrics
All levels
North East SHA Anaesthetics ST3/4 We currently have over 42
vacancies with 28-30 of these being at SpR level for which we are
unable to find either LAT/LAS or locums. This applies across all
specialties but anaesthetics, renal medicine and haematology appear
most difficult to fill. We are also unable to fill trust doctor
posts especially in surgical specialties.
Renal ST3/4
Haematology ST3/4
Surgical ST3/4
South East SHA Plastic Surgery Tba Rely on goodwill of doctors
in post and extended others who are due to leave
Unable to recruit for 4 Paediatric SHO in January
Response is patchy to adverts, we are lucky if applicants attend the
interview.
Increasingly reliant on Agency Locums, but they are frequently not
able to supply
Virtually no response to adverts.
OMFS Tba
Paediatric All levels
General Medicine ST1/2
A&E ST1/2
T&O ST1/2
Obs
& Gynae
All levels
Acute Medicine
Oncology
Dermatology
Anaesthetics ST3/4
North Western Paediatrics
Tba Appears that posts have to be
advertised several times to get filled
Geriatrics Tba
London A&E ST1/2 There are reported difficulties in recruiting
middle grade locums due to the impact of MMC, where jobs have been
found for most junior doctors, so there are less locums available.
There are also issues with recruiting to posts in certain
organisations due the reputation of the organisation as a good
working environment.
In addition, there are reports of doctors giving very late notice in
terms of sickness/attendance , which makes it too late for the
organisation to find alternative staffing solutions
OMFS ST1/2
Full details of the responses received:-
Wessex Deanery – Vicky Osgood Director of Postgraduate Medical and
Dental Education
I would say that the issues are extensive for PHT. We are having
increasing difficulty filling any and all vacancies and locum
requests.
The main issues are:
Locums - we have been unable to fill SHO levels in MAU, Orthopaedics, Emergency, Neonates and ENT
(short term requests) SpR levels in Emergency, Neonates and Renal (short and longer term - deanery have been unable to provide LAT's) Consultants in Emergency (short term)
Vacancies - we have had difficulty recruiting to:
All FY2 gaps
Surgical ST1 level
Orthopaedic ST1 level
Added to this our tier one agency providers fill rate has dropped
from 91% to 60% over the past 3 months.
West Midlands SHA - Peter Blythin Workforce Director
In Medicine as a whole, despite national advert and local
interviewing we have failed to appoint to medical SHO vacancies (no
suitable candidates apply) and we also have serious difficulty
finding short term locums.
We have also been unable to cover vacancies at medical registrar
level (eg. Acute Medicine/Emergency Medicine at registrar and SHO
level)
Local difficulties in covering Paeds at all levels.
North East SHA – Sheila Macphail Assistant Medical Director NUTH
We have been experiencing significant difficulties in filling posts
at all levels in the trust. We currently have over 42 vacancies with
28-30 of these being at SpR level for which we are unable to find
either LAT/LAS or locums. This applies across all specialties but
anaesthetics, renal medicine and haematology appear most difficult to
fill. We are also unable to fill trust doctor posts especially in
surgical specialties.
The difficulty was replicated in most other NE trusts.
South East Coast SHA – Eileen Sanderson
Collated FEEDBACK
from various staff across the SHA
NAME Sue Plummer
ORGANISATION Queen Victoria NHS Foundation Trust
We have very few locums, although have required more since last
August when the Deanery did not appoint to all our posts, and they
have proved difficult, if not impossible to find in Plastic Surgery
and Oral and Maxillofacial surgery and we have to a large extend
relied on the goodwill of the doctors in post and extended others who
were due to leave. At the moment we have a full complement of staff
which is the first time in six months so I hope it will continue.
NAME Louise Hewitt
ORGANISATION Surrey & Sussex NHS Trust
We were unable to recruit for 4 Paediatric SHO posts in January. It
has been difficult to get short term locums both at SHO and middle
grade level - we had to run the service on several occasions without
the required number of doctors. We have 2 middle grade vacant LAT
posts (1 at present and one from 1st March) which has not attracted
any appointable candidates despite being advertised twice. The Lead
Clinician for Paediatrics
also added that her understanding was that
finding locums at short notice for sick leave etc is proving
difficult as there are no longer many extra doctors around needing
extra shifts due to the new training schemes. Recently they almost
had to use a consultant to be resident on-call to cover middle grade
sick leave. Drs who are working with us currently were unwilling to
do extra shifts on that occasion. Our Medical Director is also aware
that there have been difficulties in a number of specialties e.g.
Paediatrics
, O&G, general medicine, Surgery, T&O.
NAME John Holland
ORGANISATION East Sussex Hospitals
This is something that we are having trouble with. We have a variety
of vacancies that have not been recruited to via the Deanery for a
number of reasons, and are having very little success recruiting
Locums to replace these posts. When we do advertise for Locums, the
response is patchy, with either low quality applicants, or a very
poor response rate. Of those that we shortlist, we are lucky if the
applicants attend for interview, and on a number of occasions there
have been no applicants to interview on the day. Increasingly, we
are becoming more reliant on Agency locums, but there appears to be a
shortfall of suitable doctors on the Agencies books, as frequently
they are not able to supply a doctor for the booking. This applies
to both short term and long term placements, especially in areas such
as General Medicine, A/E, Paediatrics
T&O and O&G, and appears to
reflect the situation nationally
NAME Natalie Kenn
ORGANISATION Brighton & Sussex University
Brighton have similar problems to those who have already applied; we
have very few application for LAS and LAT posts, particular areas of
concern at the moment are: Acute Medicine LAS (General Med o/call
not ICU) Oncology LATs - 2 x vacant posts - unable to recruit to
Dermatology
LAT It is particularly problematic when people resign
mid way through a post and we are experiencing the same problems as
Worthing in trying to find locums to cover shifts which causes no end
of service issues.
NAME Jane Burrage
ORGANISATION Brighton & Sussex University
We've just advertised for 3 LATs in oncology and had one applicant.
We are also advertising for the 2nd time round for a LAS in Actute
Medicine
NAME Janet Miller
ORGANISATION South Downs
No problems for South Downs Health although we are a small Trust
(Community and Specialist Rehabilitation) 4 trainees and 33 other docs
NAME Jane Keappock
ORGANISATION South Downs
We do not employ a lot of doctors in our Trust and as such our
requirements around locum cover is very limited anyway so I don't
think we would be able to give you that much detail, as we only tend
to book locum's to cover ad hoc periods rather than needing this kind
of cover regularly.
NAME Peter Murphy
ORGANISATION East Kent
We in EKHT are having these problems, FEEDBACK
from doctors is that
many LAS and LAT posts are not attractive because they are so short
term or at a distance from primary residence. Currently, despite
personal phonecalls to doctors our DNA rate has reached 80%. This
situation is excerbated by the time for CRB clearance.
NAME Janet Botting
ORGANISATION East Sussex
I can only concur with your email; we too are having extreme
difficulty in recruiting to vacant posts, short listed doctors have
either got a job beforehand or do not turn up for interview. We are
having to re advertise posts more than once and in some cases three
times. Agency locums are almost non existent and this week we have
had 3 resignations from doctors accepting jobs in London. This
applies to all specialties and the Trust has never really recovered
from MMC August 2007 when many of our posts were not appointed to.
We are monitoring the doctors with diary cards and holding our breath
for non compliance. We are relying on the goodwill of doctors to
cover vacant posts and this weekend we are short [email address in profile]
N in Orthopaedics
and Urology due to the GP Recruitment and Selection day and not being
able to find agency locums. The new immigration rules will
exacerbate our problems.
NAME Carol Church
ORGANISATION Kent & Medway NHS & Social Care Partnership Trust
We had two ST3 vacancies which we started the recruitment process for
in December. Using all the Deanery paperwork etc. We only had one
applicant who was already working with us. We went out to
advertisement again for the Learning Disability part of the rotation
and received 3 applications, two of whom have been shortlisted and
will be interviewed on Monday. We are also struggling to fill
vacancies at Locum Staff Grade where we thought we would be inundated
with doctors who were looking for a stop gap until the next round of
recruitment began, it was not, however, the case. We also had a
GPST1 LAS vacancy which we were unable to recruit to
NAME Jan McClean
ORGANISATION Worthing & Southlands
WASH have spR vacancies in O&G, Anaesthetics and Medicine to which
the Deanery have been unable to appoint. Despite advertising several
times there has virtually been no response at all to the adverts. We
have had two resignations from juniors this week and we have a total
of 6 vacancies in Gen. Medicine, Medicine for the Elderly and A&E
(all these posts are for. A doctor was appointed to an Elderly
Medicine post this week and she promptly pulled out the following
day, presumably receiving a better offer elsewhere and being better
geographically placed. To add to our problems there seems to be a
national shortage of locums available.
NAME Nisha Patel
ORGANISATION Dartford & Gravesham
We have experienced the same problems with recruitment and doctors
are equally moving around after one month on appointment. Mainly
Paediatrics
& Obstetrics and Gynaecology
at middle grade level
NAME Elaine Beaumont
ORGANISATION Ashford St Peter
We are experiencing problems with all levels of junior doctors
specifically in A & E, Anaesthetics, Paediatrics
and some areas of
Medicine for short or long term bookings. We are also experiencing
problems in getting locums from agencies. We are advertising in
Polish Medical Journal for A & E Doctors.
NAME Melanie Clay
ORGANISATION Royal West Sussex
Yes we are experiencing problems with appointing LASs/LATs. We have
managed to appoint 2 LATs & 2 LASs to date although we are currently
recruiting to 6 more posts. Quite often we find that if we have
short listed candidates for interview that they either pull out
before the interview, don't turn up on the day without informing us
or withdraw from the post if they have accepted it. The main problem
areas so far are Paediatrics
& Anaesthetics (although the other
specialties aren't much better) We are also experiencing very big
problems trying to fill our vacant posts with agency locums as there
seems to be a real shortage in all specialties.
North Western Deanery – Jacky Hayden PG Dean
Concerns have been raised across the patch in hard to fill
specialties. Paediatrics
and Geriatrics have been brought to my
attention recently. The table below shows the LAT vacancies and the
difficulties in filling.
Specialty No of times advertised No of Vacancies Filled Yes/No
(If no reason for vacancy) No of remaining vacancies
Diabetes 4 3 Yes 0
Haematology 2 2 Pending interview. Only one
application received. TBC
Clinical Oncology 2 1 Yes 0
Medical Oncology 2 2 Yes 0
Rheumatology 3 2 1 Post filled 1
Neurology 2 1 Interviews 25.2.08 TBC
Nephrology 3 3 1 Offer declined, 1 Offer accepted 2
Palliative Medicine 1 1 No. No applications 1
Neurosurgery 1 1 Pending interview. TBC
Orthopaedics 1 6 Filled 5, 1 Offer declined 1
Paediatrics
1 4 3 appointed 1
Plastic Surgery 1 2 No. Offer declined 2
Geriatric Medicine 1 2 No. Offer declined 2
Respiratory Medicine 4 TBC Yes 0
Rehab Medicine 1 1 Yes 0
Cardiology 2 9 No. Readvertising 2
Dermatology
4 2 No. Readvertising 2
Obs
/Gynae
2 11 Yes 0
Immunology 1 1 Yes 0
Paediatric Surgery 2 2 Yes 0
GU Medicine 1 1 Yes 0
Emergency Medicine 1 4 No 4
Gastroenterology 2 5 Yes 0
Ophthalmology
1 4 No. Readvertising. 1
London Deanery - Jennie Lau
Briefing on Locums and Medical Vacancies – Jennie Lau, London Deanery
The latest vacancy figures available are from the 2007 3-month
Vacancy Report from the Information Centre. These do not indicate a
widespread issue with vacancies across London:
Vacancy Rates
Medical Grade Vacancy Rates Workforce FTE Workforce Headcount
All Doctors 0.7% 19787 18183
All Consultants 0.7% 6219 6917
Specialty Group Vacancy Rates
Accident & emergency 0.8%
Anaesthetics 0.6%
Clinical oncology 0.0%
Dental group 0.8%
General medicine group 0.6%
Obstetrics & Gynaecology
0.3%
Paediatric group 1.6%
Pathology
group 0.5%
PHM & CHS group 2.1%
Psychiatry
group 1.1%
Radiology group 0.5%
Surgical group 0.6%
Other doctors & dentists (excluding training grades) 0.4%
A review of the FIMS data does not indicate that there are issues
with Trust finding locums, with organisation using more locums that
planned for the period up until month 9:
Organisation Type Planned Locum Usage (£000's) Actual Locum
Usage (£000's) % Variance
Trust 21,038 24,510 16.5%
PCT 2,029 2116 4.3%
A review of the Bank and Agency usage for Trusts in London indicates
a similar conclusion as for Locums.
Planned Bank Usage (FTE) Actual Bank Usage (FTE) % Variance
69 190 175.36%
A review of the current situation indicates that there are growing
concerns about the ability of organisations to find locums when
needed and the availability of doctors to fill posts that have fallen
vacant throughout this year.
These concerns seem to be more common in organisations within South
London, although there are issues being raised in North West and
North East London as well. It is often organisations that are having
performance issues which are reporting issues in terms of recruitment
of locums and filling vacancies.
Listed below are the reasons put forward by organisations for the
difficulty in obtaining locums when needed and the issues with
recruitment:
• There are reported difficulties in recruiting middle grade
locums due to the impact of MMC, where jobs have been found for most
junior doctors, so there are less locums available.
• There are also issues with recruiting to posts in certain
organisations due the reputation of the organisation as a good
working environment.
• In addition, there are reports of doctors giving very late
notice in terms of sickness/attendance , which makes it too late for
the organisation to find alternative staffing solutions.
The issue appears to be concentrated in A&E, although there is some evidence that there are some issues occurring in other specialties,
such as maxillofacial, but there is no common theme to the reports
received.
The issues reported about finding locums to fill gaps is being reported mainly in relation to middle grades.
The issues reported about finding staff to fill vacant posts is being
reported in relation to both middle grades and consultants.
Further work is being undertaken to understand the volume and impact
of the issues being raised.
I doubt if it is a very good news... cause most vacancies are in the non training area...
Also for the vacant training positions they might prefer EU candidates.
Nevertheless looking at the data above - the Post PLAB
doctors will have enough work and unemployment is a now a thing of past!
it is bad news . a lot of vacant positions are ST level which by the new rules post PLAB
doctors can't apply for anymore . only people on HSMP before 29th feb can do . and the non training posts also require work permits and they prefer european graduates .
Those locum and trust grade posts......that no British Doctor wants to take!
Yes there is a shortage of junior doctors but only on non-substantial non training posts. THESE JOBS WILL ALWAYS BE THERE IN PLENTY, thing is, are you willing to take up those posts?
As everyone knows, only HSMP can apply for ST posts, and only those who got their HSMP on or before 29 Feb, the competition for ST posts will increase in next two years, then will plateau, and steadily decline making cooling down the situation, but only for those who have right to work. As more and more suh people will b able to take up trainee posts, there is going to be a severe shortage of doctors to do locums and trust grades.
This is the sole reason why people have been lured into a phase of euphoria, building them up to take up rubbish posts in the near future, and hence make up for this deficit.
comments Munish?
Those locum and trust grade posts......that no British Doctor wants to take!
Yes there is a shortage of junior doctors but only for non-substantial non training posts. THESE JOBS WILL ALWAYS BE THERE IN PLENTY, thing is, are you willing to take up these posts?
As everyone knows, only HSMP can apply for ST posts, and only those who got their HSMP on or before 29 Feb, the competition for ST posts will increase in next two years, will plateau, and then steadily decline cooling down the situation, but only for those who have right to work. As more and more such people will be able to take up trainee posts, there is going to be a severe shortage of doctors to do locums and trust grades.
This is the sole reason why people have been lured into a state of euphoria, anticipating greener pastues, being prepared to to take up rubbish posts in the coming future, and hence make up for this deficit.
comments Munish?
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