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NHS ‘heading into extremely difficult autumn’ amid rising rota gaps

Healthcare services and its professionals are “heading into an extremely difficult autumn”, the Royal College of Physicians (RCP) has warned as the latest workforce survey from the RCPCH revealed widespread staff shortages and rising rota gaps in the field.

The survey, which has been collecting evidence since 2009, found that more than one in four general paediatric posts at senior trainee level are now vacant, with over half of paediatric units not meeting recommended staffing standards. To keep services running, consultants are increasingly providing unplanned cover in addition to covering their own roles.

Perhaps even more worryingly, four out of five, or almost 90%, of clinical directors are worried about how services will cope in the next six months. Doctors argued children’s services are “at a breaking point, sustained by existing junior doctors and consultants struggling to plug vacancies”.

Almost 80% of tier 2 and 60% of tier 1 rotas, which are mainly made up of junior doctors, have not been able to attract the necessary 10 full-time staff. The rise in junior doctor vacancies has then led to an increase in the amount of consultants filling in rota gaps at short notice.

Dr Simon Clark, workforce officer at the RCPCH, argued “there is no escaping the fact” that more junior and consultant posts are “urgently needed”, coupled with a “radical redesign of services”.

“It can take up to 8 years to complete paediatric training and just as long to implement a service redesign, so the RCPCH has made a number of immediate recommendations that we hope will help sustain services for children in the short-term,” he said. “We call for managerial leadership to break down barriers to multi-disciplinary working, an increase in children’s nurses and immediate opportunities for our GP colleagues to access child health training.”

Since the imposition of the “highly damaging” junior doctor contract, Dr Clark added, the RCPCH has evidence from its recruitment data that morale is “at an all-time low”.

“I urge decision makers to increase trainee and consultant numbers, better map training places to demand, and plan emergency and non-emergency rotas well in advance,” he continued. “In the long term, more care should be delivered in the community by multi-disciplinary teams of paediatricians, GPs and nurses.

“Only one in three GPs have worked in a paediatric department; they deserve better opportunities to equip them with the skills they need to manage children’s health needs safely at home and to keep children out of hospital.

“We have rejected comments made recently suggesting that trusts do not need to provide staffing in keeping with standards set by regulators and royal colleges. Investment in children’s services is not only morally right, but necessary if they are to become healthy, productive adults.”

RCP registrar Dr Andrew Goddard said the situation across paediatrics is “worrying familiar”, with physicians also having to deal with vacancy issues.

“Physicians are also facing rota gaps, consultants acting down into trainee positions, inability to recruit to posts in key specialties due to a lack of trainees, and difficulties in covering day-to-day services,” he said. “We’re heading into an extremely difficult autumn.”

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