The results of the 2009 Census of Psychiatric Staffing are
now available.
This year’s census of the psychiatry workforce
across England, Wales and Northern Ireland (Scotland carries out
its own separate census) as on 31 December 2009 has taken place at
a time when the NHS in England and Wales has been facing
considerable financial pressures. After a decade of
continuous growth in resource and service delivery it has found
itself charged with achieving efficiency savings on an
unprecedented scale. Both frontline clinicians and the whole
supporting infrastructure have been challenged to do more with
less.
Anecdotally there is an impression that the
financial stringencies are starting to bite. Consultants
report that vacated posts are not being replaced, or at least not
without some delay. Regional Advisers report a reduction in
consultant job descriptions coming through for College review.
Additional paid Programmed Activities (PAs) above the core
ten and time for Supporting Professional Activities (SPAs) are each
coming under close scrutiny. Many Trusts are actively
promoting unpaid extra leave not merely as a work-life quality
benefit but also as a means of achieving cost savings.
In contrast there is an impression of marked
difficulty in recruiting to both training and non-training
sub-consultant posts. Many adverts for Specialty Doctor posts
go unanswered. Despite the successes of a move to nationally
co-ordinated recruitment to core training, progression through core
training remains problematic. Higher trainees are
experiencing increasing competition for consultant posts.
This background means that accurate workforce
figures are needed more than ever. In times of growth the
throughput of job descriptions by Regional Advisers or the number
of Advisory Appointment Committees held could act as proxy measures
of the state of consultant staffing. In steady state or
shrinkage but survey methods such as this census become more
important and yet more challenging to carry out as Trusts look to
prioritise only the absolutely needful. Triangulation of
census data therefore is important.
It is clear that some large Trusts have failed
to participate in the census and this will have had a
disproportionate effect on figures in some regions and
specialities. Trust reconfigurations and extrapolation of
missing data in the census of previous years make attempts to
address this by further extrapolations inappropriate.
The Advisory
Committee on Clinical Excellence Awards (ACCEA) nominal roll
lists those Trusts recorded by ACCEA as awarding clinical
excellence awards to consultants whose main specialty is listed as
“Psychiatry”. Furthermore, the
NHS Information Centre (NHS IC) publishes data on what it
believes to be the NHS workforce in England gathered on 30
September each year. Comparisons of its data are included in
the tables of the census results.
Overall the picture remains one of a move to
more posts filled substantively and fewer by locums. The
response rate makes it difficult to comment upon absolute numbers
but the results are consistent with last year’s view that ‘the
growth in consultant posts appears generally to have come to an
end’. The numbers of non-consultant career posts (Associate
Specialist, Staff Grade, and Specialty Doctor) depart from the NHS
IC figures and this may reflect the process of moving to the new
contract.
We again included questions
about retirement plans of consultants but the number of Trusts
providing this information was insufficient to provide robust data.
This is probably because such information and that on
retirement plans is not readily available to the individuals,
usually in Human Resources Departments completing the census.
As Trusts become ever larger, this problem is likely to be
compounded although it should be in Trusts interests to have an
accurate profile of their consultant workforce for future
planning.
The College census remains an important part
of its workforce intelligence and is sought by others (e.g. Centre
for Workforce Intelligence, NHS Confederation) in their planning
also. However it will need to review its methodology to
ensure fitness for purpose in the new economic climate to achieve
better penetration and fuller data gathering. As other data
sources become more available there is increased opportunity for
triangulation and also for more precise targeting of questions.
Historically the census has focused purely upon NHS
provision. As we move to a more devolved system with an
increasing plurality of providers it may be appropriate also to
look at independent and not-for-profit sector employers of
psychiatrists.
Finally I am grateful to Charlotte Collins,
College Workforce Manager, for her relentless pursuit of Trusts,
for her collation and analysis of the data, and for production of
this report. Thanks are also due to Medical Directors and
Human Resources Managers for the time they have given to this
task.
Dr Andrew Clark
Royal College of Psychiatrists’ Workforce Lead
October 2010
Census results from previous years:
Page last updated 15 November
2010