Hospital Dr News

Portfolio careers vital to retain older consultants in the NHS, report says

An ageing workforce in key specialties is one of the biggest challenges the NHS faces, a report claims.

The report, called Age and the Anaesthetist, examines the impact of an ageing workforce in an acute, high pressure specialty such as anaesthesia, on both NHS patients and the staff on whom they depend.

Two thirds of patients staying in hospital have contact with anaesthetists, specialist doctors who make up the largest group of hospital doctors (16% of NHS consultants). As well as anaesthesia for elective surgery, they also deliver acute and emergency care to patients, particularly at night and weekends.

The NHS is already under pressure from staff shortages and under-recruitment. The report shows that an ageing workforce (changes to the NHS Scheme mean staff having to work until age 67 to receive a full pension) may worsen these problems, forecasting a 28% increase in the number of consultants aged over 50 years.

Unless this issue is acknowledged, adjustments in working patterns needed by an ageing NHS workforce may result in a reduced service for patients.

A workforce crisis could occur much sooner than previous reports have predicted.

The Presidents of the AAGBI and the RCoA are urgently calling for a national response.

Over time, the mental dexterity, skills and reaction times of all doctors, including anaesthetists, diminish. Anaesthesia is a safety-critical specialty where a ‘routine case’ can change quickly to a life-threatening emergency and rapid action is required to manage the situation.

Research evidence shows that vigilance and some aspects of cognitive function become more variable with age. Older workers are more likely to have chronic health conditions, failing hearing and eyesight. The capacity to adapt to night work is reduced and tiredness can further worsen older workers’ performance.

Consultants aged 35 and 65 have different and varying experience, and mental and physical strengths, which all affect their ability to cope with longer working hours, on-call, or shift work.

Job and career plans for anaesthetists must take account of these differences, particularly around the 24/7 emergency service they provide already, and Government plans to further expand ‘seven day services’.

Unless this is addressed the RCoA estimate that by 2033 there could be a shortfall of 33% in the consultant numbers required to maintain expected levels of safe and effective healthcare. The NHS will need to retain older workers to have sufficient staff to meet ever-increasing demands.

The AAGBI report calls for a review of the demands on this older workforce so that they can continue to remain safe and productive in the later stages of their careers, and outlines how working patterns should be designed and adapted to meet the needs of older workers.

Dr Liam Brennan, president of the Royal College of Anaesthetists, said: “For anaesthesia and intensive care medicine, the stakes could not be greater. Ignoring the ageing anaesthetist is not an option, and there is a need for more focused research into this area. A consultant anaesthetist’s career cannot be the same at age 60 as it was at 35. The same will apply for those practising in intensive care and pain medicine.

“Portfolio careers are the way forward if older anaesthetists are to remain productive members of the team and continue to look after an ageing population. Professional organisations need to cooperate with employers and regulators to ensure that doctors remain fit to practise, in satisfying and sustainable careers, well into their seventh decade. It’s vital that healthcare organisations retain the wisdom and expertise of our older colleagues, so their talents can be used for the benefit of the profession and our patients.”

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