The content of this website is intended for healthcare professionals only

UK children’s units face double whammy of winter pressures and severe workforce shortages

Services facing ‘unprecedented demand’ warns Royal College in new report

Caroline White

Friday, 21 December 2018

Children’s units are facing a double whammy of winter pressures and severe workforce shortages, the Royal College of Paediatrics and Child Health (RCPCH) has warned in a new briefing report*.

Patient demand is strongly outstripping the supply of doctors as the usual seasonal increase, combined with a rise in children’s emergency admissions, is placing unprecedented demand on services, says the report.

The report reveals chronic understaffing in clinics, with demand for paediatric consultants in the UK around 21 per cent higher than 2017 levels. Services are 850 consultants short of being able to provide a safe and sustainable service, it says.

Meanwhile, with winter pressures taking effect, paediatricians across the country are reporting that staff are being pulled from treating children to care for adults.

The report, which sets out headline results in advance of the full report due in January, also shows that around 600 additional training posts each year for the next five years will be needed to account for the growth in less than full-time working, doctors taking on different roles, and the high trainee drop-out rate.

The number of consultants working less than full-time working (LTFT) in the UK has risen to 24.2 per cent in 2017, up from 21.5 per cent in 2015, while the number of applicants to paediatric training from the European Economic Area (EEA) fell from 97 in 2015 to 41 in 2017─a fall of 58 per cent in two years

The number of children’s consultants in the UK grew from 3996 in 2015 to 4306 in 2017, representing a 7.8 per cent rise in headcount, but only 6.4 per cent in terms of Whole-Time Equivalents (WTE) since 2015. For every additional consultant the increase in WTE is only 0.77.

And vacancy rates are increasing, the analysis shows: 11.1 per cent on tier 1 (junior) rotas and 14.6 per cent on tier 2 (middle grade) rotas; in 2015, these were 6.3 and 13.7 per cent, respectively.

But employment levels for advanced nurse practitioners, physician associates, and trainee GPs working on junior paediatric rotas haven’t budged since 2015.

Children’s emergency admissions have also been rising. Between 2013-14 and 2016, they rose by 13 per cent in both England and Scotland, and by 17 per cent in Wales, a trend which doctors say is placing unprecedented demand on services.

Professor Russell Viner, RCPCH president, said that despite paediatrics seeing a slight increase in its consultant workforce in the past two years, the increase in demand, combined with growth in LTFT working, has meant there are not enough doctors coming through training to provide the best care for their young patients.

He commented: “Paediatrics is a family friendly specialty and we pride ourselves in having a work ethos that reflects that. This is one of the many reasons why so many of our doctors choose to work less than full-time. Therefore, we must take this into account when we calculate the number of doctors needed to train and work in paediatrics.

“Across tier 1 rotas, 11.1 per cent of posts remain unfilled, increasing to 14.6 per cent for middle grade rotas, resulting in an overstretched workforce who find themselves exhausted and at risk of becoming sick themselves.”

He added: “In reality, due to the modern style of working our doctors quite rightly favour, we have the equivalent of ¾ of each doctor employed, available to actually deliver care. That’s why we urgently need hundreds more, allowing paediatrics to be a modern career choice and one that fosters the health and wellbeing of our members and our patients.”

Policy-makers need to develop a bespoke child health workforce strategy and recruit and train an additional 600 paediatricians in the UK in each training year for the next five years, with an additional year of GP training to include paediatric and child health training, he says.

The Medical Training Initiative scheme, which allows doctors from outside the UK to train and develop their skills in the NHS, should also be expanded, and the tier 2 cap permanently removed so that the UK attracts paediatricians overseas with the right skills into the NHS.

A recent winter pressures survey of emergency care professionals, led by the RCPCH, echoed many of the concerns raised in the report, citing pressures on staffing and a rise in attendance as key drivers. But it also revealed that staff rostered for children’s departments are being pulled away to treat adult patients.

The three main pressures faced in emergency departments during the winter period are workforce shortages (35 per cent), bed pressures (23 per cent) and a rise in attendance (18 per cent). Shortages in nurses are the biggest problem in emergency departments and on the ward in winter, resulting in bed closures

Higher pressures in emergency departments were cited as preventing staff from taking adequate breaks, resulting in staff burnout and fatigue, often leading to increased sickness.

*Workforce Briefing Winter 2018. A report prepared by the Royal College of Paediatrics and Child Health, 20 December 2018.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470