Poor Paediatric workforce planning and career structures

Other countries have drop out rates, but the UK is particularly bad for Paediatrics and A&E medicine (Emergency departments). Comparisons to other countries are irrelevant when they recruit graduates to medical school compared to undergraduates in the UK. The dominance  of women at undergraduate recruitment, combined with their preference for paediatrics as an initial training path, means that too few complete and become competitors for consultant posts.

I am informed that the training is too long compared to other countries, and there is a focus on time served rather than experience or ability. There are also long hours in hospital just at a time when a woman might be planning / expecting to have a family. Paediatric workforce planning has been a disaster.

Add to this the fact that half of GP trainees miss out on a paediatric rotation, and readers will appreciate why the demand on paediatricians is so great. When there is so much competition for medical school places, this has happened because  of short term rationing of training places, as well as misguided manpower planning, poor training programmes (GPs could do 3 months Paediatrics) and a hierarchy which, once they reach the top, seem unable to change the route they had to take.

Time we cut our cloth to suit our means.

Martyn Halle and Robin Henry report in the Sunday Times 14th August 2016: Babies ‘at risk’ as NHS runs short of paediatricians

The country’s most senior paediatrician has warned that chronic staff shortages are putting children and newborn babies at risk.

Neena Modi, president of the Royal College of Paediatrics and Child Health (RCPCH), said: “We already have fewer paediatricians than comparable European countries. If we don’t act soon, we will fall even further behind and will struggle to find paediatricians to run some services.”

A report by the RCPCH to be published this week will show that more than half of paediatric units are understaffed and 89% of clinical directors fear their paediatric services will become unsustainable in the next six months.

Modi, who works at Guy’s and St Thomas’ hospital in London, said she feared the situation could get much worse as many of the services used by children were seen as a soft target for cuts.

She warned that the impact on children of 40% reductions in neonatal care and extra cuts of £7m to public health services in 2016-17 would be severe and could lead to rises in the rates of childhood obesity, sexually transmitted diseases and neo-natal deaths.

Among the services facing cuts are sexual health education and programmes to stop drug misuse and tackle obesity.

“These are key areas of public health where for relatively small investment we are getting good returns. The government really needs to listen to these concerns,” she said.

Modi said cuts to the Public Health England training budget had contributed to a 20% shortfall in the number of junior doctors needed to train to become the next generation of paediatric consultants.

The RCPCH study found that more than a quarter of general paediatric posts at senior trainee level were vacant. Dr Simon Clark, the RCPCH workforce officer, blamed the “imposition of the highly damaging new junior doctor contract” for a fall in morale and recruitment.

He said the RCPCH had made a number of immediate recommendations to tackle the problem in the short term but that in “the long term, more care should be delivered in the community by multi- disciplinary teams of paediatricians, GPs and nurses”.

His comments were echoed by Nigel Edwards, chief executive of the Nuffield Trust charity. “This is one among several examples of serious miscalculations in long-term planning of the NHS workforce,” he said.

“The simple fact is that we have not trained as many paediatricians as we need in the current system, given the rise of part-time working and the exacting standards we expect.”

Last week, Edwards warned that the next few years would see “widespread hospital closures” as the NHS sought to save tens of millions of pounds.The Department of Health said: “We’re helping the NHS cope with increased demand by recruiting more staff, with 9,100 extra doctors and 11,200 more nurses on our wards since May 2010.”

Meltdown. Living with increased risk in Maternity, Paediatrics and Neonatal Health…. and in Ambulances

Making rural hospitals sustainable – It is both quality hospital doctors and GPs we are short of… Please don’t be tempted to reduce standards..

Child health care: adequate training for all UK GPs is long overdue



This entry was posted in A Personal View, Consultants, General Practitioners, Junior Doctors, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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