Registrars survey sparks call for contract change and seven day working

The results of the major survey were published by the Royal College of Physicians in a report Hospital workforce: Fit for the future? today.

Based on one of the largest ever surveys of UK hospital doctors, the study produced three key findings about how patient care is being threatened.

It highlights the heavy workload undertaken by medical registrars - saying the situation is now at crisis point. It revealed that 37 per cent of trainee physicians describe the workload of the medical registrar as ‘unmanageable’ and 59 per cent describe it as ‘heavy’.

In addition, the report claimed that limited training opportunities and an unequal distribution of senior specialist doctors across the country is posing a major threat to high quality hospital care.

It found that only 38 per cent of registrars feel that their training in general medicine was good or excellent compared to 75% in their main speciality, while also discovering that senior specialist skills are not evenly distributed across the country.

A greater proportion of doctors being trained in the skills of emergency, general, acute and geriatric medicine are needed to meet the challenges head on, said the RCP. The body also called for a reorganisation of the hospital workforce to meet the need of frail elderly patients, as well as a reassessment of how best to use the skills of medical registrars.

NHS Employers director Dean Royles acknowledged the concerns highlighted in the report but said it pointed to the need for greater out-of-hours working by consultants, and the need for contractual change.

He said: “The report is timely but misses a trick in the important debate about how to improve medical services and working arrangements. We need changes to contractual working arrangements for medical staff and more of our existing consultants working over seven days.

“There have been great steps forward in obstetrics, gynaecology and paediatrics around consultant level doctors sharing the burden with registrars during evening and weekend shifts. If consultant level doctors in all medical fields embraced out-of-hours shifts, it would go a long way towards ensuring there are enough experienced doctors available at all times, and that registrars were being well trained and supervised. That has to be better for patients.

“Employers will welcome working alongside the Royal College of Physicians and other organisations to develop the medical workforce. We want to keep exploring areas where improvements are possible, for example around career pathways and developing how and when doctors work, before simply calling for more and more doctors.

“Discussions are taking place to modernise the junior doctors’ contract and this would itself be part of the solution to these issues, as would repurposing the outdated Clinical Excellence Awards system so that it awards on delivery of excellent local services.”