Key points:

  • On 30th Sept 2016 there were 1455 substantive gastroenterology consultants in the UK, a 2.9% expansion from 30th Sept 2015. The mean annual expansion over the last 10 years has been 4.9% per year but this is lower that it could have been as there are many vacant posts, as well as locum consultants in post.
  • In 2013 the RCP predicted that we need 6 whole-time equivalent consultants per 250,000 population (1 per 41,667) doing 11.5 PAs of gastroenterology & GIM, a total of 1516 consultants (61 more). As 14% of consultants work less than whole time (6.7 PAs on average) we need a total of 1610 consultants (1 per 39,243 population) or 155 more. If expansion continues at 5% per year then this will take 1-2 years to achieve. However, the UK population is expanding and aging, this figure does not take into account the provision of tertiary services and there have been major service changes that were not included (e.g. bowel scope & FiT testing, out of hours bleed rotas, 7 day services and increased access to endoscopy). There is a plan to expand the non-medical endoscopist workforce to help meet the increased demand for endoscopy, but further consultant expansion will still be required.
  • There remains significant regional variation in consultant gastroenterologist provision in the UK; London & North East England have exceeded the RCP recommended number per population. South East Coast/South Central England, East Midlands and Yorkshire & Humber have the least consultant gastroenterologists per population. As most trainees would like a substantive consultant post in the region in which they trained, redistributing NTN posts to areas of consultant under-provision or those with recruitment difficulty could help consultant recruitment in these areas.
  • The proportion of female gastroenterology consultants has increased (19% consultants) although remains much lower than other medical specialties (34% UK consultant physicians, 53% medical higher specialty trainees female), medical students (55%) and doctors in training (57%) presumably as some females struggle to see how GIM & endoscopy on call rotas are compatible with family life.  Encouraging LTWT training & working and flexibility of job planning would help. This would also help older consultants who wish to return to work after taking their pensions.
  • 48% of 172 advertised consultant posts in England & Wales were not filled from 1st Sept 2015 to 31st Aug 2016.
  • Our gastroenterology & hepatology training programmes have produced an average output of 99 CCTs per year between 2011-2015.  Once retirement posts have been replaced, this number is sufficient to produce a consultant expansion rate of 5.7% next year.
  • The number of attempted consultant appointments in England & Wales increased 87% in 2015 compared to the average from 2008-2011. There has been a 22% increase in successful appointments but a 437% increase in unfilled posts in the same time frame. CCT output has increased from an average of 77 from 2007 - 2011 to an average of 99 from 2012 to 2016 (a 29% increase) but this increase is insufficient to meet the unprecedented demand.
  • There is a shortfall of 300 CMT posts below requirements so it is impossible to fill medical ST3 posts beyond the 70-80% level. Gastroenterology remains a popular specialty filling 100% NTN posts. Health Education England (HEE) has no plan to increase the number of CMT posts in 2016/17 as all available funding is being used to create more GP training posts and without additional foundation trainees, they probably wouldn’t be filled.
  • There will be 1,500 more medical school places in 2018 to help tackle the shortfall in junior doctor numbers.
  • There will be no change in the number of gastroenterology or hepatology NTNs in 2016/17 but HEE have stated that TPDs & LETBs should over-recruit NTN posts according to the number of trainees out of program to try to ensure that clinical training posts remain filled at all times (1.36 times the number of clinical training posts is a rough guide).
  • The proposed conversion of clinical fellow posts to gastroenterology medical registrar posts (3rd year of internal medicine stage 1 training) with the introduction of shape of training may increase the gastroenterology CCT output.