Key points:

  • On 1st June 2015 there were 1370 substantive gastroenterology consultants in the UK, a 3.3% expansion from 30/09/14. 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 20 locum consultants in post and a third of advertised consultant posts are not filled (despite there being 110 UK CCT holders without a substantive consultant post).  If all advertised posts had been filled then there would have been a 9.2% expansion in 2014.
  • Despite recruitment difficulties, gastroenterology and hepatology expanded the most of all medical specialties in 2013.
  • In 2011 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 (146 more). As 11% of consultants work less than whole time we need a total of 1584 consultants (214 more). If expansion continues at 5% per year then this will take 3 years to achieve. However, the UK population is expanding and aging and there have been major service changes that were not included in the 2011 figures (e.g. bowel scope & 7 day services) so further expansion will be required.
  • Over the last 5 years our gastroenterology & hepatology training programmes have produced an average output of 87 CCTs per year. Once retirement posts have been replaced, this number would only be sufficient to produce an average consultant expansion rate of 4.7% per year over the next 5 years.
  • There is significant regional variation in consultant gastroenterologist provision in the UK; North East England & London have exceeded the RCP recommended number per population, Wales, East Midlands and South East Coast/South Central England have the least consultant gastroenterologists per population. There is a similar regional variation in the number of trainees per population. Redistributing NTN posts to areas of consultant under-provision could help consultant recruitment in these areas.
  • The proportion of female gastroenterologists is increasing (18% consultants & 37% trainees are female) but remains much lower than other medical specialties (32% consultants, 48% trainees), medical students (57%) and doctors in training (54%) presumably as some females struggle to see how GIM & endoscopy on call rotas are compatible with family life.
  • 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 but only 51% of advertised LAT posts resulting in gaps in training programmes. Health Education England (HEE) increased the number of CMTs by 23 in 2014/15, a further 104 increase is planned for 2015/16.
  • There will be no change in the number of gastroenterology or hepatology NTNs in 2015/16 but HEE are reducing the number of LAT posts by 20% in 2015 & abolishing LATs in 2016. This may drive trainees to take an NTN in their second choice specialty rather than a service post in gastroenterology, which could reduce gastroenterology CCT output (inhibiting consultant expansion) and cause rotation gaps unless the number of NTNs posts are increased to compensate (HEE have no plans to do this).
  • The number of trainees doing a post CCT fellowship has increased significantly in the last year.