This week, figures released showed that the NHS faces an ‘unprecedented workforce crisis’ with NHS doctor shortages, as vacancies rise 10 per cent in the last year. But what does this mean for the key obstetrics and gynaecology speciality? Here, Professor Mary-Ann Lumsden, vice-president of the Royal College of Obstetricians and Gynaecologists, answers some of our questions.
1. What is the current shortfall in gynaecologists/obstetricians in England and Wales or and or the UK? How many are needed per capita?
A recent survey of our workforce has identified gaps in trainee obstetrics and gynaecology (O&G) rotas that many units are in excess of 30% of the time – and this is consistent across the UK. These rota gaps have traditionally been filled with locum doctors and doctors who, whilst specialist, are not training to be Consultants. However, the pool of locum staff has diminished considerably. Going forward it is anticipated that rota gaps will persist and worsen in most units.
2. Why is there a shortfall?
Currently about 80% of O&G trainees are female leading to a high rate of maternity leave and less than full time working. Trainees also go out of programme to do research and undertake work overseas. The ability to recruit alternative non-training middle grade staff – such as locum doctors – has been reduced over the last decade due to training changes within obstetrics and gynaecology, financial drivers and immigration regulations, since many come from overseas.
While we haven’t noticed a significant decrease in the numbers of medical students applying to the O&G training programme over the last decade, we believe around 30% of trainees who start the programme don’t make it through to the end, and 25% of those that qualify as consultants don’t secure an NHS post within three years of finishing their training, although they may come into the system at a later date. We are working to identify the reasons why doctors are leaving the speciality in order to try and mitigate it.
3. What are the consequences for patient services? Will patients be put at risk?
The UK is a safe place to give birth and doctors and midwives work in multi-professional teams to ensure women receive a high-quality and safe service. All consultant-led maternity units currently have 24-hour access to consultant obstetricians on-call. There is always a specialist doctor on the delivery suite round-the-clock who is fully trained in obstetric emergencies. Consultants filling rota gaps is not the answer as it is expensive and takes them away from other duties, such as training.
4. What do you feel about the solution to train up nursing staff and midwives to carry out many tasks in specialist centres previously done by obstetricians?
The College promotes provision of clinical care by a team of professionals. Our doctors work very closely with midwife and nursing colleagues but there are significant shortages of midwives and so trying to change their roles may simply exacerbate a problem elsewhere. However, in some areas of both obstetrics and gynaecology it does occur and is an option many units are exploring. For example, midwives could be trained to do ventouse deliveries and the development of nurse specialists in specific roles such as colposcopy and out-patient hysteroscopy already occurs and should be expanded.
5. What do you think about importing specialists into the UK from abroad?
Around half of O&G consultants working in the NHS obtained their medical degree outside the UK. Locum doctors, other speciality doctors and trainees, also come from overseas and this must be allowed to continue and even increase in some instances. The difficulty of filling rota gaps with locum doctors who trained outside the UK has been impacted by changes in immigration regulations. This must be reviewed as a matter of urgency.