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Heavy med registrar workload threatens care

The role of the medical registrar is now characterised by heavy workloads and limited training opportunities – and it’s threatening the quality of patient care.

These are the findings of a Royal College of Physicians report which warns that, with medical registrars being the backbone of any hospital delivering acute care, urgent action is needed.

The report, called Hospital Workforce: Fit for the Future?, also suggests that consultants are not evenly distributed, with London having almost double the number of consultants per head of population compared to the East Midlands.

The amount of patients requiring general medicine skills is increasing with the ageing population, it says, but in 2011 it was not possible to fill 50% of consultant posts advertised in geriatric medicine. Teaching hospitals fare better than DGHs.

The RCP believes that the workload of the medical registrar is now at crisis point. Thirty seven per cent of trainee physicians describe the workload of the medical registrar as ‘unmanageable’ and 59% describe it as ‘heavy’. This compares to less than 5% of general practice registrars who believe their own workload is either heavy or unmanageable.

The college finds that the training of registrars in general medicine  is highly variable and is too often compromised by the heavy workload. The report highlights that only 38% of registrars feel that their training in general medicine was good or excellent compared to 75% in their main specialty.

The report recommends that a greater proportion of doctors be trained in the skills of emergency, general, acute and geriatric medicine; the hospital workforce must be reorganised to meet the need of frail elderly patients; and, the role of the medical registrar must be reassessed with their skills used more efficiently to better meet patients’ needs, particularly in DGHs.

Dr Andrew Goddard, director of the RCP’s Medical Workforce Unit, said: “Medical registrars are the unsung heroes of hospital care. But their skills are not being used to best meet patients’ needs. The NHS will soon struggle to provide the best care for patients if this situation is not urgently reviewed.

“The data regarding the availability of consultants to patients across the country shows that the NHS is not effectively planning its medical workforce. National and local education and training structures must get to grips with this straight away.”

Commenting on the report, Dr Ben Molyneux, chair of the BMA’s junior doctors committee, said the current negotiations with government over the juniors’ contract must tackle such issues.

“Medical registrars should not be drowning under the weight of their workload – this is not conducive to good training or high quality patient care,” he said. “Hospital services need to be redesigned to ensure that frontline service delivery should not fall disproportionately on this group of doctors in training. If we don’t do this we risk the next generation of consultants avoiding careers in acute medical specialties.”

However, Dean Royles, chief executive of the NHS Employers organisation, commented: “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.”

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