Workforce and the BGS
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.
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.
Summary of findings at March 2017
Recruitment levels to training posts in the speciality are the highest they have ever been, with sustained year-on-year improvement.
We have high numbers working LTWT and taking additional experience during their training programmes, and therefore need to be able to over-recruit to the programme, or mortgage training numbers. This needs to be supported at HEE and equivalent level across the four nations as there is variation between LETBs.
The current advertisement and recruitment process does not suit the needs of our speciality. One possible solution is to hold a third regional recruitment round per year.
Survey Findings
All TPDs in geriatric medicine in the UK were surveyed on March 1st 2017, covering 25 separate LETBs or training areas. Response rate was 100%.
NTNs and Vacancies
There are 742 NTNs in Geriatric Medicine in the UK. Of these posts, 31 (4.2%) were unfilled on the day of the survey. The table below shows the breakdown across the four nations.
| NTNs | Vacancies | Vacancy Rate | |
| England | 602 | 24 | 44% |
| Northern Ireland | 17 | 1 | 5.9% |
| Scotland | 70 | 0 | 0% |
| Wales | 45 | 6 | 13.3% |
| 743 | 31 | 4.2% |
14 areas had no vacant posts, and in the majority of cases the vacancy rate is under 10%.
LTWT Working
Of doctors working within the training programme at the time of the survey, 15.8% across the UK are less than whole time (LTWT).
| WT | LTWT | LTWT Rate | |
| England | 451 | 84 | 15.7% |
| Northern Ireland | 16 | 0 | 0 |
| Scotland | 62 | 13 | 17.3% |
| Wales | 31 | 8 | 20.5% |
| 560 | 105 | 15.8% |
Time out of Programme (OOPEs)
Doctors take time out of programme for a variety of reasons, including additional specialist training, research, maternity leave and occasionally other personal reasons.
48 doctors were undertaking work-related OOPEs at the time of the survey, with 16 training in Stroke. This is 7.8% of the NTNs in geriatric medicine. OOPE rates vary considerably between regions, from 0 – 26%.
6 doctors were taking time away from programme for sickness or other personal reasons, and 65 were on maternity leave. This accounts for 9.6% of the NTNs in geriatric medicine.
Academic Training
There are 17.75 academic training posts across the UK (either old-style or ACFs). These are shared between 11/25 regions. At the time of this survey, 2.75 were vacant.
LATs
There are no LAT posts in England or NI, however 6 remain in Scotland and 2 in Wales.
Single-accreditation
2 doctors are undertaking single speciality training. One of these already has a CCT in GIM and the other is an academic who dropped GIM only in her final year of training.
Completion of Training
In the 6 months leading up to this survey, 32 doctors obtained their CCT in geriatric medicine, and 3 used their grace period to extend their training for 6 months before taking up a consultant post. This is a lower number of CCTs than would be expected given ~650 doctors on a 5 year training programme, but is likely accounted for by breaks taken for maternity leave, OOPEs, and increased years of training due to flexible working.
Attrition
One doctor stepped down from a training post to continue as a speciality doctor in geriatric medicine for family and lifestyle reasons.
One transferred to respiratory medicine
One moved to Australia
One resigned (no further information available)
Two transferred regions but remained within the speciality
Two trainees (within the same region) received ARCP outcome 4s despite appropriate support and coaching.
Other Comments from the survey
Two areas (Severn and South Wales) have 3 new posts each, starting from August 2017.
North London are repatriating training numbers to East of England.
Several areas are still being prevented from advertising posts which have trainees in them at the time of job advertisement, but will be empty at the time any recruited doctors start work, therefore making 100% recruitment unachievable in these regions.
There is strong feeling from TPDs that over-recruitment is essential.
Appendices
Update at September 2016
Full responses were received from Wales and Northern Ireland.
One English region did not return the survey – London North and Central.
One Scottish region did not return the survey - Scotland East.
Posts filled and vacancy rates
| NTNs | Vacancies | Vacancy Rate | |
| England | 569 | 43 | 7% |
| Northern Ireland | 17 | 0 | 0% |
| Scotland | 71 | 7 | 14.3% |
| Wales | 42 | 7 | 14.3% |
| 699 | 52 | 6.9% |
The first survey in this format took place in June 2014, and vacancy rate at that time was 13%. This represents continued improved recruitment to geriatric medicine combined with low attrition rates throughout training.
It is vital that when talking about vacancies within the speciality, we only refer to posts that are genuinely unfilled, and not those where doctors are taking a break from speciality training for maternity leave, an OOPE, or working LTWT.
LTWT Working
| WT | LTWT | LTWT Rate | |
| England | 438 | 76 | 14.8% |
| Northern Ireland | 17 | 1 | 5.6% |
| Scotland | 53 | 9 | 14.5% |
| Wales | 33 | 9 | 21.4% |
| 541 | 95 | 15% |
Of those doctors currently within the training programme, 15% work less than whole time. This proportion has remained stable over the past few years, but with the improved fill rates to the speciality actually means that greater numbers are training flexibly.
Time out of programme
| Academic OOPE | Other OOPE | Stroke OOPE | Maternity Leave | Illness/personal | % OOP | |
| England | 12 | 27 | 11 | 41 | 2 | 16.3% |
| Northern Ireland | 0 | 0 | 0 | 1 | 0 | 5.9% |
| Scotland | 1 | 2 | 3 | 2 | 1 | 2.7% |
| Wales | 0 | 2 | 0 | 9 | 0 | 26% |
| 13 | 31 | 14 | 53 | 3 | 16.3% |
Generally, higher trainees in geriatric medicine are encouraged to take opportunities to gain additional experience which can have a significant impact on the service they are able to provide. The most common reason for time out of training is maternity leave, but anecdotally doctors who take maternity leave do still take other training opportunities available to them, in addition to working flexibly. This can extend a training programme from the standard 5 years to nearer 10.
Considering that most stroke medicine trainees come from the geriatric medicine programme, it should be of concern to that speciality that there are currently only 14 doctors undertaking the additional year in stroke medicine.
Small numbers need to take time from training for personal reasons.
Academic training in geriatric medicine
There are few academic training numbers in the speciality, and these are not well distributed.
15 in England, across 7 out of 16 regions and 3 in Scotland across 3 regions. No academic training is available in Wales or Northern Ireland.
LATS
There are no LATS in England, NI or Wales, and 5 remaining in Scotland.
CCTs and Dual Accreditation
1 academic trainee is single accrediting in Geriatric Medicine. Everyone else will obtain a dual CCT.
42 doctors achieved their CCT in the 6 months since the last survey, and nobody from a recognised training programme needed to enter the specialist register via the CESR route. Of these, 41 did not use their grace period. One doctor used 1 month of their grace period before starting a consultant post. An additional doctor has been allowed additional time to allow a further attempt at the SCE, but otherwise has fully completed their higher training.
Attrition
Attrition from the training programme is consistently low, in contrast with the perception held by bodies such as HEE and NHSI.
During the 6 month period of this survey, 5 doctors left their regions:
1 to train in GU medicine
1 to train in palliative medicine
2 transferred to different regions, but remained within geriatric medicine
1 left medicine altogether
Therefore attrition for this time period was 0.4%
Comments
Comments provided by the TPDs remain consistent. Key messages include:
- There is capacity to train more doctors if training numbers were available
- Insufficient doctors are being trained to meet the demand for consultants in geriatric medicine
- It is hard to fill gaps that occur due to OOPEs, maternity leave and flexible training, more so since the abolition of LATs. Over-recruitment is a potential solution to this.
- More interview rounds are needed per year to fill vacancies. The second centralised round which takes place in London does not meet the needs of areas north of London.