Exclusive: Royal college exposes widespread rota gaps on paediatric wards

The extent of the vacancy and rota gaps across children’s hospital wards has been exposed by a survey of 157 paediatric units (73 per cent of units in the UK) by the Royal College of Paediatrics and Child Health, shared exclusively with HSJ.

The survey also found that less than 30 per cent of the general and neonatal consultant workforce was permanently working resident shifts in their hospitals.

The royal college told HSJ the level of vacancies and gaps in hospital rotas reflected increasing demand for clinicians, as well as changes to immigration rules and trainee doctors increasingly choosing to work part time.

The survey showed there were 71 vacancies and gaps in rotas for ST1, ST2 and ST3 grade doctors, equivalent to 6.9 per cent of the rotas.

For more senior doctors at ST4 and above there were 141.5 full time equivalent gaps in the rota, the equivalent of 19.5 per cent.

The vacancy rate for middle grade doctors was highest on neonatal rotas, at 23 per cent, while on general paediatric rotas the vacancy rate was 18 per cent.

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Across all training grades there was a total of 212.5 full time equivalent gaps in rotas, or 12.1 per cent. Just under half of the gaps across all rotas were filled by a locum doctor at extra cost to the NHS.

Across all grades the RCPCH said the proportion of gaps in rotas had increased since 2012.

The survey also asked the unit leads how many consultants worked permanent resident shifts in their hospital. The RCPCH said it had weighted the responses to estimate 30 per cent of the consultant workforce were permanently resident, an increase from 2012 when only 20 per cent were resident in their unit each shift.

Simon Clark, workforce planning officer for the RCPCH, told HSJ there were multiple factors driving the vacancy rates, including the numbers of overall training places, demand for more clinicians following the Francis report, and changes to immigration rules that had made recruitment more difficult.

He added many more doctors were now working less than full time. He said: “There is also a change in the behaviour of doctors within training programmes themselves. Doctors are making completely appropriate lifestyle choices for a good work-life balance.”

Dr Clark continued: “The college is raising this because we want to express our concern about sustainability and the long term issues of working under such high pressure for a long periods. We are not suggesting the acute paediatric service isn’t coping, but this is about advocating for children and for policymakers to consider whether there need to be new ways of working which might reduce pressure on those remaining physicians.”

He said some of the solutions to the gaps in medical rotas included reconfiguration of smaller hospitals with larger neighbours, as well as the potential to expand the use of advanced nurse practitioners and physician associates.

The RCPCH has previously called for an increase in the number of paediatric consultants.

Dr Clark said it was important consultants were present seven days a week on paediatric units as “the wisdom and experience” to plan care for patients, but warned they should not be used to fill gaps in rotas.

The survey also found more than three-quarters of respondents were very or moderately concerned about how their service would cope with demand in the next six months.