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Growing gaps in paediatric workforce are compromising NHS services, report reveals

Funding pressures, the junior doctor contract, and a reliance on locums is putting paediatric services in the NHS under increased pressure, says the royal college.

New figures published by the Royal College of Paediatrics and Child Health (RCPCH) highlight an urgent and growing problem in the paediatric workforce.

The study shows that almost 1 in 5 of paediatric trainee positions are currently vacant even though trainees themselves report high levels of enthusiasm for the speciality.

This figure jumps to nearly 1 in 4 in more senior trainee positions and almost 90% of children’s units express concern over how they will cope over the coming six months.

The RCPCH annual ‘Rota Vacancies Survey’, now in its seventh year, involves a poll of clinical directors and workforce leads for paediatrics.

Sixty seven per cent of respondees said that the contract is having a negative impact on recruitment and retention.

One survey respondent said: “The impact of the contract is to make working hours and conditions less attractive and therefore likely to deter doctors from wanting to enter the speciality of paediatrics.”

Four out of every ten vacancies are being filled by locums, whose services are expensive compared to full time staff.

Dr Simon Clark, RCPCH Officer for Workforce Planning, said: “Large gaps in the paediatric workforce have a serious impact on doctors and vital hospital services. The shortages create very difficult working environments resulting in low morale amongst doctors and a lack of time for training and education.

“More senior doctors end up back-filling the gaps which, in turn also leads to cancelled services.”

Despite the prevalence of locums, the locum pay gap is putting strain on many units which are desperate to fill gaps.

Clark added: “Whilst recognising the need to curtail costs, the pay cap was a simplistic short-term approach to a complex problem; it does not go to the root of the problem and as such is working for nobody.

“These figures should act as a wakeup call for Government to act now. Health Education England is responsible for training but has insufficient funding; NHS employers have insufficient funding; yet this problem is here and now. Efforts need to be coordinated across the now multiple components of a fragmented NHS. And with paediatric trainees excluded from the Home Office Shortage Occupation List in England, Wales and Northern Ireland, hospitals and doctors have been left in a difficult and unsustainable position.”

The RCPCH is calling for urgent action from Government to fix the growing crisis in the paediatric trainee workforce, through measures including:

  • Identifying a responsible body for integrated national and regional workforce planning, co-ordinated across all relevant agencies, identifying paediatric training, non-training, and consultant-level requirements, and aligning these projections with nursing and other child health workforce requirements
  • Centrally funding an increase in the number of paediatric trainee places to 465 in each training year for the next 5 years in order to achieve an expansion in the consultant-level workforce by 752 WTE
  • Committing to funding integrated primary/secondary care child health training for general practice and paediatric trainees
  • Immediately placing paediatrics on the shortage occupation list, with exemption from the resident labour market test.

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