At Remedium, we are on a mission to solve the UK healthcare staffing crisis. For our NHS, nowhere is this crisis more prevalent than for consultant level clinician posts. For instance, according to the Royal College of Physicians (RCP), 45% of all medicine consultant posts advertised last year remained unfilled 5. In the case of emergency medicine consultants, the Royal College of Emergency Medicine (RCEM) admits that “emergency departments have insufficient resources to meet the minimum number of consultants/senior decision makers required per 100,000 attendances”.1
current deficit of WTE emergency medicine consultants 1
current deficit of WTE paediatric consultants 2
vacant WTE consultant psychiatrist posts - doubled over past six years 3
vacant WTE consultant clinical radiologist posts - highest reported in past five years 4
of all medicine consultant posts advertised last year remain unfilled 5
Where have all the consultants gone?
With an ageing population and an increase in patients with complex health problems, the NHS demand for experienced consultants is increasing. However, consultant retention is at an all-time low, with many entering early retirement5. Chronic understaffing across all clinical roles means that the remaining workforce is left to pick up the pieces, leading many consultants and clinicians to burnout and leave the profession. Of course, when burnt-out staff leave, they are not always replaced, which only exacerbates the problem further.
According to RCEM, recent initiatives increasing flexibility in training have decreased resignation from training rates but have also reduced the overall WTE workforce, with less than 50% of trainees completing training directly taking up consultant posts. In the future, it seems that this problem is set to only get worse, as the number of clinicians entering training at grass roots level is not in line with expected demand.
What can be done?
Historically, there has been an inconsistent approach to workforce planning across the NHS and more must be done to address not only current clinical staffing challenges but also to plan for the future. In practice, this means that individual NHS trusts must begin by modelling future workforce demands across all specialties based on what existing service and future services will look like. When embarking on any partnership, we always consult our clients to begin with capacity demand modelling so that bespoke rotas can be built that better serve the current and future needs of your trust.
Once accurate demand has been ascertained, a carefully considered strategy combining increased international recruitment and improved workforce retention can help to bridge the future gap. Of course, more training places must also be made available in order to ensure that enough doctors are directly taking up consultant posts upon completion. However, such change must be implemented at a national level and is beyond the remit of individual trusts.
Recruiting more international doctors and health professionals
Historically, the NHS has relied heavily on the skills and expertise of doctors from outside the UK. Often, clients have come to us requesting to recruit UK-trained consultants, on the basis that there is no need for them to learn how to adapt to working in a new healthcare system and culture. However, stealing consultants with UK experience from one trust in order to fill an urgent vacancy in another is only exacerbating the problem. Unless more is done on a national level to improve consultant retention and to put more through successful training, then in the immediate and medium-term, we must look outside of the UK to fill the gap.
“Increased ethical international recruitment will be vital to addressing the current NHS workforce crisis.”
– The King’s Fund, independent public health think tank 6
At Remedium, we have supported our clients to recruit clinicians from over 40 countries around the world. Our proactive approach to recruitment has long recognised the importance of providing international clinicians access to appropriate guidance and support in order to ensure their successful adjustment to working in the UK system. For instance, Remedium’s CPD-accredited induction programme is designed to proactively tackle the common challenges that may otherwise impede the successful integration of an overseas clinician into the NHS. The course is informed by the experiences of our own clinicians and their recruiting trusts who help us to constantly develop and improve the content of our programme via the feedback we ascertain.
Improving Consultant Retention
Ultimately, NHS consultants do not work in a vacuum and it is the national shortage of nurses, allied health professionals and clinicians at other grades that contributes greatly to consultant burnout. In the words of RCEM, “understaffing means our existing workforce suffers from burnout… which leads to many staff leaving.”1 How then, can we improve retention amongst consultants if we do not first address these chronic shortages in the multidisciplinary teams in which they work?
It is for this reason that Remedium advocate for a ‘recruitment first’ approach to consultant retention. If NHS trusts begin by filling these huge vacancy gaps by recruiting more permanent clinicians, nurses and allied health professionals, this will already reduce the excessive workload placed on consultants (and all clinical staff across your service). Once this is achieved, more appropriate job planning and addressing workplace cultural issues, such as introducing more effective multidisciplinary team working, would also contribute significantly to improving consultants’ ability to do their jobs effectively in the longer-term.
Ultimately, in order to address the consultant shortages in the short to medium-term, NHS trusts must recruit international consultants in order to plug the gap nationwide. Our executive search experts are already supporting trusts across the country to do this, which is helping to relieve the burden on their existing teams; contributing to better staff retention rates and to more efficient, patient centred care. However, in the long-term, systemic workforce issues that are contributing the NHS-wide healthcare staffing crisis must be addressed on a national policy level, or else the problem will only continue to manifest.