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Paediatrician shortfall jeopardising child health services

Workforce data reveal widespread vacancy rates for senior doctors and trainees

Caroline White

Thursday, 27 April 2017

Gaps in paediatric rotas, uncertainty over the status of non-UK nationals working in the NHS, poor planning, and a demoralised workforce, are putting child health  under increasing pressure jeopardising the quality of care, concludes a report from the Royal College of Paediatrics and Child Health (RCPCH) published today.

The report,* which draws on data from the RCPCH Workforce Census 2015, with additional data from the Office of National Statistics, and RCPCH trainee recruitment processes, shows that demand for children’s healthcare has risen sharply.

Between 2013-14 and 2015-16, the number of hospital admissions for children rose by 25% from 1.2 million to 1.5 million, while children’s A&E attendances grew by 7%, from 4.5 million to 4.8 million over the same period.

But in the year to September 2015, shortages of nurses and/or doctors forced nearly a third (31%) of inpatient units and four out of 10 (41%) neonatal units to impose periods of closure to new admissions.

There are substantial vacancies at both consultant and trainee levels, highlights the report, adding that academic consultants are few and far between while GPs and practice nurses have limited training in child health.

Workforce data show that an estimated 241 whole time equivalent (WTE) career grade posts (consultant level paediatricians) remain unfilled. But at least 752 WTE extra consultants are required to meet RCPCH recommendations and specialist services standards.

General paediatric and neonatal rotas are currently having to cope with an average vacancy rate of 14%, the figures indicate, yet a 15% increase (from 2016) in the number of trainees entering paediatrics to 465 in each training year is required to meet RCPCH standards to ensure appropriate growth in senior doctor numbers.

Academics now make up 4.2% (168 of 3,996) of the consultant-level workforce compared with 8.7% (191 of 2,186) in 2001.

RCPCH President, Professor Neena Modi, said: “The facts speak for themselves: the situation is serious. There simply aren’t enough doctors to meet the needs of infants, children and young people, and advance their healthcare through clinical research.

“It’s a credit to the existing workforce that that they are - just - managing to continue to deliver the care children need. This is a dangerously under resourced service, yet the means to redress the situation exist. It is legitimate for us, and the UK public, to ask why, when solutions exist, the health and wellbeing of children are being placed in jeopardy?”

Recent “reconfigurations” had not eased the pressure on services or been enough to maintain standards.

“In this run-up to the election we ask for a clear commitment to put in place the straightforward actions that will redress this appalling situation,” she demanded.

The report highlights the contribution of non-UK nationals to the paediatric workforce, with 40% of career grade paediatricians having qualified outside the UK, and the College wants paediatrics to be placed on the shortage occupation list, and to be exempted from the resident labour market test.

“These colleagues are a valued and crucial component of the UK child health workforce and a simple assurance that their right to work in the UK will be protected, and their conditions secured, would be immeasurably helpful,” continued Professor Modi.

The RCPH is now calling on the next government to identify a responsible body for integrated national and regional workforce planning and to fund an increase in the number of paediatric trainees over the next five years.

Integrated primary and secondary care child health training is also needed for GPs and paediatric trainees, says the College.

“Our report highlights the many serious difficulties that risk medicine becoming a less sought-after profession and which are compromising patient care, the health of the population, and the reputation of the UK as a global leader in clinical practice, applied research, and innovation. Urgent action can address these problems; we call on whoever forms the next government to make this a top priority,” urged Professor Modi.

* The state of child health: the paediatric workforce. Royal College of Paediatrics and Child Health, April 2017

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