BGS workforce data: background

How does the BGS get its workforce data?

The BGS works closely with the workforce team at RCP. Information on consultant numbers and other details such as projected retirements are  taken from the annual RCP survey, but unfortunately only around 50% of geriatricians respond to the survey invitation each year. The most recent results are available here.

A spot survey is completed by the TPDs (training programme directors) on March 1st and September 1st every year to provide information on the numbers currently training in geriatric medicine , and gives other details about less than whole time (LTWT) working, numbers taking additional training experience, and numbers obtaining their CCT.

Central bodies such as the JRCPTB and HEE hold data on the number of training posts within the specialty, but this is different to the results obtained from the biannual spot survey which is likely to be more accurate. 

The RCP collects data on consultant posts advertised, and whether they are filled or not, and shares this information on a quarterly basis with the BGS.

What is workforce data used for?

A workforce report containing available data and updates is presented to the SAC in geriatric medicine, BGS education and training committee and BGS policy committee quarterly. This information is used to inform and illustrate discussions with HEE and other organisations which can influence the number of training posts in geriatric medicine.

Summary data is presented as briefing papers, for example to the current RCP President who is keen to take our messages forward, and presented some of our workforce issues in the recent paper Underfunded, underdoctored, overstretched.

It is used to answer individual queries on workforce, job-planning and other connected topics that are received by the BGS.

How many geriatricians do we need per head of population?

There is no clear answer to this question. An estimate had been made previously, and was widely published, but has long been passed with no doubt that we still need more geriatricians. Diversity within local arrangements and system organisations  mean that there is no one size fits all model within the healthcare of older people, unlike for example specialties such as gastroenterology who can calculate numbers needed based on procedural demand.

Much thought and consideration has been given within the BGS to answering this question. Attempts have been made previously to commission an organisation such as the CfWI to carry out such a piece of workforce planning, however even they were unable to proceed. 

Why aren’t there enough registrars in geriatric medicine?

There are more training numbers in geriatric medicine than in the higher training programme decreasing from 13% in 2013 to 6% across the UK in September 2016.

15% of higher trainees in geriatric medicine work LTWT, and a considerable number take an OOPE (out of programme experience) year. These  events are positive for the speciality in the long term, but can cause short term inconvenience to departments who are reliant on registrars to deliver service in addition to receiving training. LAT posts have been abolished centrally, so Trusts have to recruit individually to short term contracts in order to fill rota gaps.

Calculations carried out for the Future Hospital Commission report concluded that to have one WTE male doctor it is necessary to train 1.2 WTE, and for female doctors the number is 1.5%. Therefore to minimise rota gaps within geriatric medicine we should look to over-recruit by a factor of 1.3 at ST3 level. The number of NTNs is controlled centrally, by HEE in England and the governments in the other regions of the UK. Ability to influence these is variable, but BGS centrally and the individual councils as well as colleagues with a remit for education and training constantly attempt to make an impact. 

TPDs and the SAC in geriatric medicine consistently give out the message that we have capacity to deliver high-quality training to many more junior doctors, but need to have more training numbers within the speciality.

Why can’t we recruit to our vacant consultant posts?

There is increasing demand for geriatricians and the skills we have to offer. This means that more than half of advertised posts are ‘new’ rather than replacement or retirement posts. Expansion of our work into areas such as POPS, the continuing growth of orthogeriatrics and front-door geriatrics means we are being spread more thinly.

Of all posts advertised (at each time of advertising) only one third are filled at interview. This is due to a combination of lack of applicants, or poor quality applicants. 

Anecdotally, we know that doctors are more likely to take up a consultant post in a hospital or unit they have worked in or have experience of while training. 

It is currently a ‘buyers market’ for those seeking consultant appointments, so job advertisments, conditions and job plans that are flexible or attractive to individuals are more likely to be successful.

Why can’t we bring in doctors from overseas?

There is no ready pool of geriatricians to recruit from elsewhere in the world. Some specialities have had success with the IMT programme, recruiting specialists to work at registrar level within the NHS to gain their higher training. However, because geriatric medicine is not developed in many countries the standard of those recruited via this route is often at SHO level rather than that required and so additional experience and supervision is needed before commencing a higher level post.