Medical registrars are the backbone of any hospital delivering patient care round the clock. However, the heavy workload for medical registrars, compounded by limited training opportunities and an unequal distribution of senior specialist doctors across the country is posing a major threat to high quality hospital care. These are the three key findings of the Royal College of Physicians (RCP) new report Hospital workforce: Fit for the future? The RCP is calling for urgent action to resolve these issues to prevent patient care being threatened.
The report, based on the largest surveys of UK hospital doctors, has three key findings:
- Heavy workload for medical registrars: The workload of the medical registrar is now at crisis point. Medical registrars are the backbone of the hospital medical services, particularly at
night. The RCP’s hard hitting report highlights 37% of trainee physicians describe the workload of the medical registrar as ‘unmanageable’ and 59% describe it as ‘heavy’. This is compared to less than 5% of general practice registrars who believe their own workload is either heavy or unmanageable, resulting in a risk the best medical trainees will not choose a career that
involves acute medical care. - Limited training opportunities: 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.
- An unequal distribution of senior specialist doctors across the country: Senior specialist skills are not evenly distributed across the country. Patients in London have almost double the number of consultants per head of population compared to the East Midlands. There are big differences in provision across the 30 medical specialties in availability to patients. The amount of patients requiring general skills is increasing with the ageing population and frail elderly patients’ needs are best met by geriatric specialities but in 2011 it was not possible to fill 50% of consultant posts advertised in geriatric medicine. Teaching hospitals are often large enough to attract the best candidates for jobs and diversify training but these problems are compounded in district general hospitals (DGHs)
To meet the challenges highlighted in Hospital workforce: Fit for the future? the RCP is calling for:
- a greater proportion of doctors being 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
- the role of the medical registrar must be reassessed with their skills used more efficiently to better meet patients’ needs
- we must re-examine the way DGHs work to address this, which is being looked at by the RCP’s Future Hospital Commission.
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.
Suzie Hughes, chair of RCP’s patient and carer network, said:
The potential threat to patient care is alarming. Physicians are now reporting that patients are at risk of being unsafe. The skills we train our doctors to have must be developed around patients’ needs. If this is not urgently addressed, frail elderly people who require hospital care will be poorly serviced by the NHS. We cannot risk providing substandard care to such a vulnerable group.
Sarah Logan, medial registrar and report author, said:
Medical registrars are struggling up and down the country to provide good care to patients. Instead of facilitating this, too often the system makes this difficult to achieve. Changes within hospitals, such as improved staffing deployment would help. Crucially, the out-of-hours workload in particular must be better shared across the wider clinical team.
To arrange an interview with Dr Andrew Goddard, director of the RCP’s Medical Workforce Unit, or medical registrars, or for further information, please contact Linda Cuthbertson, head of PR, on +44 (0)203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk
- Hospital workforce: fit for the future? brings together learnings from The medical registrar: Empowering unsung heroes of patient care and 2011 Consultant Census . The RCP conducts a census of the consultant workforce each year. The medical registrar is a one-off research project based on quantitative and qualitative data.
- The RCP’s Future Hospital Commission (FHC) is reviewing models of hospital services to better meet patients’ needs, including many of the issues above. It will report in June 2013.