December 2006
GASTROENTEROLOGY MANPOWER REPORT
Nick Thompson, Chris Romaya
Consultant Expansion
As of 30/9/06 there were 903 Consultant Gastroenterologists across the UK, an increase
of 2.3% during the last year, although in the last 6 months of this period there was a net
loss of 2 consultant posts across the UK. Over recent years there has been a consistent
7% growth in posts – if that rate of growth had been maintained an additional 42 posts
would have been created. Data for different parts of the UK are shown below. The
agreed long-term aim is that there should be 6.1 whole-time equivalent gastroenterologists
per 250,000, which equates to around 1900 consultant posts in the UK and 1625 posts in
England (see page 9 for details). There was little evidence of difficulty in appointing
consultants in gastroenterology, with only 6 of 53 (11%) advertised posts not appointed or
cancelled over the past year (RCP confirmed data). 85 (9%) consultants reported that they
were not members of the BSG.
Numbers of consultants in different parts of the UK by year
30/9/00
30/9/01
30/9/02
30/9/03
30/9/04
England
523
552
600
643
688
Wales
25
30
32
34
37
Scotland
62
67
69
71
76
Northern
19
20
21
23
25
Ireland
UK
629
669
722
771
826
30/9/05
737
40
81
25
30/9/06
752
43
82
26
883
903
Annual expansion (%) of consultants in different parts of the UK by year
30/9/00
30/9/01
30/9/02
30/9/03
30/9/04
30/9/05
England
7.6
5.7
8.0
7.2
6.5
7.0
Wales
0
20.0
6.7
6.3
8.1
8.1
Scotland
8.8
8.1
3.0
2.9
6.6
6.6
Northern
0
5.3
5.0
9.5
8.0
0
Ireland
UK
6.4
7.9
6.8
7.1
6.9
30/9/06
2.0
7.5
1.2
4.0
2.3
Fig 1. Numbers of consultant gastroenterologists in England & Wales against time
900
777
795
725
700
677
632
600
582
548
511
500
466
481
435
30.9.06
30.9.05
30.9.04
30.9.03
30.9.02
30.9.01
30.9.00
30.9.99
30.9.98
300
30.9.97
400
30.9.96
Number of consultants
800
Date
1
December 2006
Retirements Expected
Most gastroenterologists currently retire between the ages of 60 and 65 years. Thus the
number reaching 60 or 65 gives an indication of the number of retirements and posts
likely to require replacing. Over the past 4 years the average of those retiring has been
62.6 years (based on 58 consultant retirements). In England there will be at least 140
retirements by Gastroenterology consultants by 30/09/2016; an average of 14 per year.
There may be as many as 221 if all retired at 60 years of age; an average of 22 per year. At
present, 199 consultants across the UK have indicated that they would plan to retire by
2016 (numbers per year vary from 11-29). In Scotland there will be an average of 1.6
retirements per year for the next ten years but if all retired at 60 this could rise to 2 per
year.
Number of Consultant Gastroenterologists reaching retirement age in the next
decade.
Numbers at 30/09/06
England
Wales
Scotland
N Ireland
Totals
>60 years currently
53
2
4
3
62
=65 in next 10 years
140
5
16
5
166
=60 in next 10 years
221
11
19
8
259
Part-time and Academic appointments (30/09/06):
There are currently 52 consultants who report working part-time in England, 2 in Wales
and 2 in Scotland; representing 6.2% of the workforce. There are a total of 108 academic
gastroenterologists representing 11.9% of the workforce; 93 in England, 11 in Scotland, 3
in Wales and 1 in N Ireland. There are no reliable central data on the number of
gastroenterologists employed wholly by universities. In the tables of distribution of
gastroenterologists across the UK it is assumed that on average academic
gastroenterologists spend 0.6 of their time in NHS work, as do those reporting that they
work part-time. 115 consultant gastroenterologists (12.7% of the workforce) are women,
of whom 36 (31%) work part-time – in the 2004 RCP census 23% of consultant
physicians in the UK were female.
Distribution of Gastroenterologists by Health Authority or Board
The average, whole-time equivalent (WTE) gastroenterologist across the UK serves a
population of 66,000 – 71,000. There are 3 Strategic health authorities in England and 1
in Wales and 2 Health Boards in Scotland and 1 in Northern Ireland where a WTE
gastroenterologist serves a population of over 100,000. There is wide variation in the
numbers of consultant gastroenterologists per head of population; part of the reason for
this variation may be that other health care professionals are delivering
gastroenterological services for those patients and may reflect particular referral patterns.
The population figures for England and Wales are drawn from GP lists and so may underrepresent the total population by not including those registered with a GP. Those for
Scotland are derived from the 2001 census. In England there are 15 consultants who work
as the only gastroenterologist in their hospital, similarly 2 in Wales, 1 in Scotland and 3 in
N Ireland.
2
December 2006
Distribution of Consultant Gastroenterologists in England
Strategic Health Authority
Trust Code
Pop
(1,000s)
Northumberland, Tyne and Wear
Cumbria and Lancashire
1f,d,h,i,m,o
1c,1p,
14b,g,h,k,t,a,d
1j,l,n,a,e,g,r
2g,i,n,q,f,3m
2a,c,b,m,p,,j,k,
h,d
3a,d,i,j,n
14e,c,f,i,j,m,n,
o,q,l,s,p
13a,b,e,h,d,f,g,
j,k,i,l
3l,b,g,f,k,o,c,h
12n,h,j,w,q
12e,o,m,p,s,t,
u,d,i
3e,p,q
12a,g,c,f,k,r,
v,l
4a,b,c,d,e,f,g,h
4l,m,q; 5i,m
10b,g,f,a,d,h
11a,b,e,f,j,l;
9b,h,f
11c,d,g,h,k
11i,m; 9c,m,i
9a,d,e,g,j,l,n
4j,k,n,o,p
7e,f,n,p,k,l
8c,h,l,f,m,j;
7b,g,i; 9o
5e,c,d,b,n,f,g,j,
k
6c,e,f,g,h,r
6a,d,j,l,n,o,q
7a,c,d,j,o,q,h
8d,k,b,e,g
1,388.6
1,904.9
34 (29.6)
24 (24)
50,000
79,000
1,146.5
1,617.7
2,104.7
23 (22.2)
20 (19.2)
30 (27.6)
52,000
84,000
76,000
1,277.2
2,567.8
21 (20.6)
37 (34.2)
62,000
75,000
2,360.7
35 (33.4)
71,000
2,637.3
1,469.3
2,301.0
39 (36.6)
16 (15.2)
43 (41.4)
72,000
97,000
56,000
1,502.7
1,542.9
16 (15.2)
21 (20.2)
99,000
76,000
2,183.1
1,637.0
2,140.3
2,177.4
40 (36.8)
17 (16.2)
20 (18.8)
28 (26.8)
59,000
101,000
114,000
81,000
1,582.8
1,191.1
1,766.1
1,606.6
1,595.9
2,537.2
24 (24)
15 (15)
24 (21.2)
14 (13.6)
18 (17.6)
30 (28.8)
66,000
79,000
83,000
118,000
91,000
88,000
1,824.6
44 (40)
46,000
1,218.4
1,540.8
1,507.2
1,303.0
35 (30.2)
33 (27.8)
29 (26.2)
20 (17.2)
40,000
55,000
58,000
76,000
County Durham and Tees Valley
N & E Yorkshire and N Lincolnshire
West Yorkshire
South Yorkshire
Greater Manchester
Cheshire & Merseyside
Trent
Shropshire & Staffordshire
Birmingham & Black country
Leics, Northants & Rutland
West Midlands South
Norfolk, Suffolk and Cambridge
Bedfordshire & Hertfordshire
Thames Valley
Avon, Gloucs and Wilts
South West Peninsula
Dorset & Somerset
Hampshire & Isle of Wight
Essex
Kent & Medway
Surrey & Sussex
North West London
North Central London
North East London
South East London
South West London
Total
49,632.4
Total no
gastroenterologists
(WTE)
Population
served by 1
WTE
Consultant
752(701.6) 71,000
Population data DoH 2004. WTE assumes that academics/part-timers work 0.6 for NHS.
3
December 2006
Distribution of Consultant Gastroenterologists in Wales
Health Authority
Trust Code Pop
Total no
(1,000s)
gastroenterologists
(WTE)
South East Wales
Mid & West Wales
North Wales
15c, 15j,15h,
15e
15f, 15l, 15b,
15i, 15k
15a,15d,15m
Total
Population
served by 1
WTE
Consultant
1,282.6
22 (21.6)
59,000
995.4
11 (9.8)
102,000
674.5
10 (10)
67,000
43 (41.4)
71,000
2,952.5
Population data 2004. WTE assumes that academics/part-timers work 0.6 for NHS.
Distribution of Consultant Gastroenterologists in Scotland
SHB
Code Pop
Total no
(1,000s) gastroenterologists
(WTE)
Argyll & Clyde
Ayrshire, Arran, (incl Dumfries & Galloway)
Borders
Fife
Forth Valley
Grampian
Greater Glasgow
Highlands (incl Shetland,Orkney & Western Isles)
Lanarkshire
Lothian
Tayside
16a
16b,d
16c
16e
16f
16g
16h, p
16i
16j
16k
16n
Total
Population
served by 1
WTE
Consultant
420.5
515.9
106.8
349.4
279.5
525.9
867.2
276.6
552.8
778.4
389.0
4 (4)
4 (3.6)
2 (2)
5 (5)
3 (3)
9 (8.2)
16 (15.2)
4 (3.6)
9 (9)
18 (16)
8 (7.2)
105,000
143,000
53,000
70,000
93,000
64,000
57,000
77,000
61,000
49,000
54,000
5,062.0
82 (76.8)
66,000
Population data 2001. WTE assumes that academics/part-timers work 0.6 for NHS.
Distribution of Consultant Gastroenterologists in Northern Ireland
HSSB
Code
Pop (1,000s) Total no gastroenterologists (WTE)
Eastern
Northern
Southern
Western
Total
17a,f,g,i
17b,e,h
17c,k
17d,j
Population
served by 1
WTE
Consultant
664.0
435.9
321.4
288.9
11 (10.6)
8 (8)
3 (3)
4 (4)
63,000
54,000
107,000
72,000
1710.3
26 (25.6)
67,000
Population data 2004. WTE assumes that academics/part-timers work 0.6 for NHS.
4
December 2006
Trainees in Gastroenterology in the UK
There are now a total of 668 trainees in gastroenterology, excluding those in LAS or
senior SHO posts. Since 30/09/05 there has been an increase of 43 trainees - an increase
of 7%. This is almost exactly the same number of posts which might have been expected
had consultant growth continued as previously experienced. Compared to last year there
are an additional 7 clinical SpRs, 10 visiting registrars, 6 in out of programme or locum
consultant posts, 3 research registrars and 17 LATs across the UK. At least 101 of 124
(81%) research registrars have an NTN. There are now 16 identified Hepatology posts. It
is planned that there will 27 academic posts in gastroenterology/hepatology in England
over the next 5 years which will receive direct partial funding.
Distribution of grade of those in Registrar posts is shown (30/09/06)
England
Specialist Registrar (Clinical)
312
10
30
Northern
Ireland
7
Research Registrar
113
3
7
1
124
Out of Programme
10
0
0
4
14
Visiting Registrar
77
10
2
2
91
LAT
50
3
0
2
55
Locum/Hon Consultant
24
0
1
0
25
586
26
40
16
668
Total
Wales
Scotland
UK
359
Approximately 26% of trainees are female (compared to 27% in 2003). 31 (4.6%) trainees
in gastroenterology are in flexible training posts (compared to 4.9% in 2003). The mean
total training time for consultants appointed in the UK over the past year was 7.5 years,
which is largely unchanged over the past 3 years (7.2 years in 2003).
Verification of Trainee numbers
JCHMT also collect data concerning trainees in gastroenterology and they estimate that
there are 564 trainees (on 29/6/06) with an increase of 30 (6%) trainees over the last year.
This figure includes NTNs, VTNs, LATs and ATNs but does not include anyone with, or
recommended for, a CCT (our database includes 50 trainees with a CCT date before
30/09/06). The JCHMT figure will not include all those in research, or in out-ofprogramme experience and also requires that trainees have registered with the JCHMT
and this results in a degree of under reporting of trainee numbers.
Expansion of NTNs over the past 5 years
There was an increase of 20 unfunded posts in 2002 and 50 unfunded posts in 2003, these
were distributed by deaneries or WDCs. In 2004 there was an increase of 60 trainees and
in 2005 an increase in 75 trainees with expansion of posts by Trusts seeking to meet
EWTD demands, so-called “Hutton numbers”. There has, therefore, been an increase of
over 50% in the number of trainees in the past 5 years.
5
December 2006
Trainees more than 6 months past their CCT date
At 30/9/06 there were 33 trainees who had not yet obtained a substantive consultant post
and who were more than 6 months past their CCT date (this has not increased over the
past year). 15 were working as locum consultants, 9 as Specialist registrars, 4 as Visiting
registrars, 4 as Research registrars, 1 in Out of programme experience. There were 50
trainees who were beyond their CCT on this date.
Career aims of SpRs in gastroenterology
NTN holders have been asked to indicate their preferred final post type: whether their
target career is in a DGH or a teaching hospital, whether they aim for a gastroenterology
or a hepatology post or plan an academic career – some responded positively to more than
one option. The results of the 338 of 668 trainees (51%) who responded are:
 123 (36%) wished for a gastroenterology post in a teaching hospital
 198 (59%) wished for a gastroenterology post in a DGH
 51 (15%) wished for a hepatology post in a teaching hospital
 55 (16%) wished for a hepatology post in a DGH
 54 (16%) wished for an academic post in either gastroenterology or hepatology
 Only 16 trainees explicitly stated that they wished to work part-time as consultants
 Only 3 trainees reported they were not dually accrediting in gastroenterology & GIM
 49 of 54 (91%) visiting registrars who expressed an opinion wished to remain in the
UK.
Non-consultant career grades in Gastroenterology
Within the UK there are 63 Staff grade posts, 67 Associate specialists, 64 Clinical
Assistants, 51 Hospital practitioners and 21 trust doctors working at least part-time in
gastroenterology. In addition 54 General practitioners contribute to gastroenterology, the
majority working only 1 session per week. There are also 25 consultants from other
specialties (not including surgery eg care of the elderly) who contribute to providing
gastroenterology, mostly 1 or 2 sessions per week. 39 associate specialists, clinical
assistants, hospital practitioners and trust doctors have reported that they have registered
with PMETB for entry onto the Specialist register via Article 14. JCHMT confirm that 5
Gastro applications were considered between January and Nov 06; of these 3 were
successful under Article 14 and 2 recommendations (for rejection) are with the PMETB.
It is likely that some of these individuals will seek to become consultants and it may be
that some NCCG posts will be converted into consultant posts.
Nurses in Gastroenterology
There are 479 nurses working in clinical gastroenterology in a specialized capacity across
the UK. These include 181 nurse endoscopists, 121 nurse practitioners and 115 nurse
specialists (including inflammatory bowel disease, liver, hepatitis and alcohol liason
nurses). At least 272 nurses perform a minimum of one endoscopy session per week
(median 2 sessions per week). There appears to have been an increase of 19% in such
posts over the past year but this may represent increased reporting of these posts and these
figures may still under-represent the numbers actually working in gastroenterology across
the country.
6
December 2006
Predicted dates for gaining CCT
The expected number of SpR’s gaining CCTs in Gastroenterology is shown in Figs 2 & 3 but
this takes no account of “CCT drift” which leads to many SpR’s delaying their CCT by a few
months or a few years in the case of research or out of programme experience. As of 30/9/06
there were 33 trainees in gastroenterology who were >6 months beyond their CCT date (this
figure was 40 on 30/09/05). Figures for 2005 include anyone with a CCT before this year as
well and for 2011 includes those with a later CCT date. These figures include data from 567
trainees (ie not LATs, research registrars without an NTN or those not giving information).
In England over the past year there seems to have been a marked drift of CCT with fewer
CCTs in 2006 than expected (37 versus 62 predicted from last year) but more in 2008/9 (218
versus 157 predicted from last year).
Fig 2: Predicted dates for
CCT for Gastroenterology
for trainees in England.
140
122
No of SpRs attaining CCT
120
96
91
100
93
80
60
37
40
33
21
20
2011
2010
2009
2008
2007
2006
2005
0
Year
Fig 3: Predicted dates for CCT
for Gastroenterology for trainees
in Wales, Scotland & N Ireland.
10
9
60
9
No of SpRs at t ai ni ng CST
50
7
7
30
20
10
6
6
2009- 3
2008- 3
2007- 3
<2003
2006- 3
Engl
2005- 3
0
7
Year - by quarter
6
6
5
5
Wales
Scotland
N Ireland
4
4
3
3
3
3
3
3
and.
2
2
1
1
1
0
0
2011
2010
2009
2008
2007
0
2006
No of SpRs attaining CCT
8
40
Year
7
December 2006
Distribution of trainees in Gastroenterolgy across the UK
The distribution of trainees in Gastroenterology across the UK by region is shown in figure 4.
The regional variation between trainee numbers and population is shown in Fig 5 and
between trainees and consultant numbers is shown in Fig 6.
Fig 4: Number of Trainees in gastroenterology across UK (September 2006)
70
66
61
60
Number
40
49
46
50
61
49
41
39
31
40
30
34
31
30
29
26
19
16
20
10
N Ireland
Scotland
Wales
North
West
Mersey
South &
West
West
Midlands
Oxford
Wessex
NW
Thames
NE
Thames
SE
Thames
SW
Thames
Anglia
Trent
Yorks
Northern
0
Region
172
124
124
124
105
96
77
107
N Ireland
Scotland
Wales
North West
Mersey
West Midlands
Oxford
Wessex
South & West
57
SW Thames
NW Thames
127
114
82
71
63
SE Thames
55
NE Thames
58
Anglia
Trent
71
Yorks
200
180
160
140
120
100
80
60
40
20
0
Northern
Population (1,000s) per SpR
Fig 5: Relationship between Trainee numbers and population across
UK (September 2006)
Region
3
2.5
2.1
1
1.4
1
1
1.1
1.7
1.6
1.3
1.1
1
Oxford
1.4
Wessex
1.3
SE Thames
1.2
NE Thames
1.5
1.7
Wales
1.6
North West
1.9
NW Thames
2
1.1
0.5
N Ireland
Scotland
Mersey
West Midlands
South & West
SW Thames
Anglia
Trent
Yorks
0
Northern
Ratio of Consultants : trainee
Fig 6: Relationship between Trainee numbers and numbers of
consultants across the UK (September 2006)
Region
8
December 2006
Future Expansion & Targets
Based on data from the Royal College of Physicians document “Working for Patients”
and from discussions with the Workforce Review Team (for WNAB) it is estimated that
6.1 whole time equivalent consultant gastroenterologists are required for a population of
250,000. These calculations estimate that this population would require 65-74 PAs of
activity which equates to around 6 consultants working 10-12 PAs per week. This would
then require a need for target number of 1625 consultant posts in England which would
deliver 1250 WTEs of consultant work (on the expectation that the WTE:overall number
of consultants ratio is 1:1.3, currently around 1:1.2). This equates to around 1900 posts
for the whole of the UK.
This figure includes the addition of 50 WTEs to deliver a colorectal cancer screening
programme. If the job descriptions of consultant gastroenterologists were to change
significantly, such as reduction of GIM, then the need per population may change.
Endoscopic workload may also be delivered in other ways eg Independent treatment
centres or by other professionals eg nurse specialists and this might also affect the
numbers of consultants needed (there is some evidence for an expansion in nurse
specialists, see p6). There are so many uncertainties that predicting future demand over 510 years is extremely difficult.
We have agreed with the Workforce Review Team (WRT) that SpR “wastage” is 3% and
that some 58% of VTNs opt to stay in the UK and take up consultant gastroenterology
posts here (this may be an underestimate – see p6). No account has been taken of the
effect of permit-free training however the effect on overall numbers is likely to be small.
Over the previous 5 years there has been a steady growth of around 7%. If the past year is
an aberration and growth of 7% were to resume it will take 12 years to achieve 1625
consultant posts in England; to maintain that steady expansion would require an
additional 100 posts per year in the later part of that expansion. If expansion were to
continue at a slower pace then it would take considerably longer to meet the target.
Impact of MMC
It is not yet clear what effect MMC will have. If the training period is made substantially
shorter then the numbers obtaining CCT will increase. The WRT had previously agreed
that gastroenterology numbers should not increase due to the recent marked expansion
and uncertainty regarding consultant expansion however training figures have not yet
been given for each region.
Possible models of growth
Fig 7 shows a prediction of the cumulative excess of CCT holders above expected
consultant posts over the next few years in England. Predictions are made assuming
either 7%, 5% or 3% annual growth. At 30/9/06 there were 46 trainees, in England, with
CCT who did not yet have a substantive consultant post (33 trainees who were 6 months
beyond their CCT date). No account has been made of CCT holders in GIM and
gastroenterology taking up posts in Acute medicine and gastroenterology. There are
likely to be significant numbers of posts with a major commitment to Acute medicine and
these will need to be filled by GIM CCT holders in the short to medium term.
9
December 2006
The assumptions used include:
 there will be 18 retirements per year
 around 80% of research registrars already have a NTN
 there are 500 trainees who will obtain CCT (includes 312 SpRs, 93 Research
registrars, 45 Visiting registrars who will elect to stay in the UK, 50 LATs).
 training takes 7 years, ie 500 trainees spread over 7 years – some account of likely
CCT drift has been taken.
 there are no further increases in trainee numbers
 no allowance has been made for NCCGs obtaining CCT via Article 14.
It should be emphasized that all predictions are likely to be inaccurate when trying to
predict over a period of 5-10 years for all the reasons given before.
Fig 7. Predicted cumulative number of CCT holders in England
5% growth
7% growth
3% growth
200
150
100
50
2012
2011
2010
2009
2008
-50
2007
0
2006
Number of CCT holders
250
-100
Year
10