The Royal College of Physicians (RCP) has raised concerns that consultant physicians are increasingly working above and beyond their contracted hours. In a statement, the College reported that the NHS is relying on this good will to deliver the services that patients need.
The amount of time consultants have to spend with trainees is decreasing and some specialties are experiencing low levels of growth in consultant numbers. Dr Andrew Goddard, director of Royal College of Physicians Medical Workforce Unit, said: “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.” Each week, consultants are working 11.5% of their contracted hours extra free. This figure jumps 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 said that time available to spend with trainees has reduced during the past three years. The RCP’s 2010 census of consultant physicians and medical registrars showed that the majority of consultants work more than 48 hours a week. In addition, around 30% of departments do not work European Working Time Directive (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. These changes are resulting in doctors feeling under more pressure at work – nearly 75% of consultants said pressure at work had increased. Over 66% of consultant physicians reported their job always, often or sometimes ‘got them down’. The RCP is concerned that this is affecting consultants’ career planning. Over 51% 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. 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 ageing. 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. Census of consultant physicians and medical registrars in the UK 2010 is the 21st survey of the Federation of Royal Colleges of Physicians.
