• Royal College of Paediatrics and Child Health criticises NHS’s failure to reorganise services
  • Vacancy rates for junior doctors in paediatrics have reached a six year high, according to workforce census
  • RCPCH calls for increases in training posts including nurses and training for GPs

Failure to reconfigure NHS paediatric services over the last six years has contributed to the highest vacancy rate among junior doctors in the specialism since 2010, a royal college has found.

The Royal College of Paediatrics and Child Health has issued the results of its latest annual workforce census and told HSJ the understaffing has been years in the making, with NHS managers failing to reconfigure services and act on its recommendations.

Nine out of 10 clinical directors told the college they were concerned about how their service will cope in the next six months. More than half of paediatric units were not meeting recommended staffing standards.

HSJ analysis of the last six annual reports by the RCPCH shows there has been fluctuation in vacancy rates across paediatrics and neonatal services since 2009-10 (see table below).

That year there was an overall vacancy rate for trainee doctors of 9 per cent, which rose to 13 per cent in 2010-11 before reducing to 10 and 11 per cent in 2011-12 and 2012-13 respectively. In 2014-15 the overall vacancy rate was 12 per cent but this increased to its highest level of 15 per cent last year.

Vacancy rates for junior doctors in paediatric units, 2010-2016

 YearTier oneTier twoOverall vacancy rateClinical directors concerned about their services
2009-10 3% 14% 9% 73%
2010-11 6% 20% 13% 86%
2011-12 5% 16% 10% 76%
2012-13 7% 15% 11% 72%
2013-14 No survey
2014-15 7% 20% 12% 78%
2015-16 10% 20% 15% 89%

The RCPCH data also shows the biggest increase in vacancies over the six years was among the most junior trainees – tier one – which increased from 3 per cent in 2009-10 to 10 per cent in 2015-16.

The RCPCH published new standards for paediatric services in its Facing the Future report in 2010, which it revised in 2015. It called for a reorganisation of paediatric services to ensure they were sustainable.

RCPCH workforce officer Simon Clark said the paediatric workforce was “at breaking point and children’s healthcare is increasingly being compromised”. He added: “There is no escaping the fact that an increase in junior and consultant posts is urgently needed, coupled with a radical redesign of services.”

He told HSJ the problem had not been addressed despite warnings going back years. “This is certainly not a new issue and one that isn’t just stemming from the junior doctor contract. Year after year we have raised concerns about the pressures faced by the paediatric workforce and year after year, we are seeing a picture that suggests the service will not be able to cope going forward.

“We have long called for better workforce planning, a shift in the way services are configured, a drive to improve multidisciplinary working and immediate opportunities for our GP colleagues to access child health training. With 89 per cent of clinical directors concerned about how the service will cope in the next six months, an increase again on last year’s figures, we call for urgent action now,” he said.

The annual survey showed 60 per cent of tier one rotas and more than three-quarters of tier two rotas, filled by more senior trainees, were not able to attract the full complement of 10 full-time staff recommended in Facing the Future.

The college said NHS managers needed to break down barriers to multidisciplinary working, increase the number of children’s nurses and improve child health training for GPs.

The imposition of the new junior doctors’ contract appears to have had an impact on vacancy rates in England in 2015-16 – with the RCPCH reporting 100 per cent of posts at junior trainee level were filled in Wales, Scotland and Northern Ireland, compared with 93 per cent in England.

Dr Clark said: “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. In the long term, more care should be delivered in the community by multidisciplinary teams of paediatricians, GPs and nurses.”

In a reference to a recent interview with HSJ by NHS Improvement chief executive Jim Mackey, Dr Clark said: “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.

“A healthier population will spend more time in work and less time needing healthcare. Investment in children’s services is a win-win for everyone.”

The RCPCH survey of 214 units ended in mid-March with a response rate of 44 per cent.