December 2004
GASTROENTEROLOGY MANPOWER REPORT
Nick Thompson, Chris Romaya
Consultant Expansion
As of 30/9/04 there were 826 Consultant Gastroenterologists across the UK, an increase
of 7.1% during the last year. Data for different parts of the UK are shown in Fig1 & Fig2.
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 4 of 53 advertised posts (41 of
which were new posts) not appointing over the past year.
Numbers of consultants in different parts of the UK by year
30/09/2000 30/09/2001 30/09/2002
30/09/03
England
523
552
600
643
Wales
25
30
32
34
Scotland
62
67
69
71
Northern
19
20
21
23
Ireland
30/09/04
688
37
76
25
Annual expansion (%) of consultants in different parts of the UK by year
30/09/2000 30/09/2001 30/09/2002
30/09/03
30/09/04
England
7.6
5.7
8.0
7.2
6.5
Wales
0
20.0
6.7
6.3
8.1
Scotland
8.8
8.1
3.0
2.9
6.6
Northern
0
5.3
5.0
9.5
8.0
Ireland
Fig 1. Numbers of consultant gastroenterologists in England & Wales against time
750
725
700
677
650
N umbe r of cons ultants
632
600
562
550
572
548
511
500
466 471
450
481
449
435
400
396 398
375
350
350
335
30.9.04
30.9.02
1.3.01
30.9.99
1.1.98
1.1.97
1.1.96
1.1.95
1.1.93
300
D a te
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December 2004
Fig 2. Consultant gastroenterologist expansion rates (England & Wales)
8
7.9
7
7
6.9
7.2
7.1
6.2
6
Expansion rate (% )
7.1
6.6
6.4
5
4.6
4.5
4
4
3
2
1
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
0
Year
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.
In England there will be 143 retirements by Gastroenterology consultants by 30/09/2014;
an average of 14-15 per year. There may be as many as 214 if all retired at 60 years of
age; an average of 21-22 per year. Due to the new consultant’s contract there may be an
increase in the numbers of retirements in 2007/08 when 22 consultants have indicated
they plan to retire. In Scotland there will be an average of 2 retirements per year for the
next ten years but if all retired at 60 this could rise to 2.5 per year.
Number of Consultant Gastroenterologists reaching retirement age in the next
decade.
Numbers at 30/09/04
England
Wales
Scotland
N Ireland
Totals
>60 years
52
3
8
2
65
=60 in next 10 years
214
11
25
12
262
=65 in next 10 years
143
7
19
7
176
Part-time and Academic appointments (30/09/04):
There are currently 26 consultants working part-time in England and 2 in Scotland. There
are 104 academic gastroenterologists in England (10 in Scotland, 3 in Wales and 1 in N
Ireland). In the tables of distribution of gastroenterologists 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.
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December 2004
Distribution of 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,i,n,a,e,g; 2l
2g,i,n,q,f
3m
2a,c,bm,p,,j,k,
h,d
3a,d,i,j,n
14e,c,f,i,j,m
14n,o,q,l,s,p
13a,b,e,h,d
13f,g,j,k,i
3l,b,g,f,k,
o,c,h
12n,h,j,w,q
12e,o,m,p,s
12t,u,d,i
10c,e; 3e
12a,g,c,f,k
12r,v,l
4a,b,c,d,e
4f,g,h
4l,m; 5h,I,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
9j,k,n,l
4n,6m,p,b,i
7e,f,n,p,
7k,l
8c,h,n,l,f,a,
m,j; 7b,g,i
5e,c,d,b
5n,f,g,j,k
6c,e,f,g,h,r
6a,d,j
6l,n,o,q
7a,c,d,j,o,q,h
8d,i,k,b,e,g
1,392.4
1,919.0
31 (27.4)
22 (22)
51,000
87,000
1,146.9
1,640.8
21 (20.2)
18 (17.2)
57,000
95,000
2,095.9
29 (28.2)
74,000
1,272.6
2,531.0
21 (18.2)
37 (35)
70,000
72,000
2,354.5
31 (29)
81,000
2,670.8
34 (31.6)
85,000
1,496.0
2,273.4
19 (19)
35 (32.6)
79,000
70,000
1,581.5
1,550.5
14 (13.2)
19 (19)
120,000
82,000
2,218.6
35 (32.6)
68,000
1,614.7
2,112.5
2,191.2
16 (15.2)
19 (18.2)
27 (25.8)
106,000
116,000
85,000
1,601.2
1,206.9
1,797.1
20 (19.2)
14 (14)
25 (21.4)
83,000
86,000
84,000
1,629.6
1,599.9
12 (12)
18 (17.6)
135,000
91,000
2,570.8
25 (23.4)
110,000
1,814.7
43 (36.6)
50,000
1,220.2
1,530.8
34 (28.8)
25 (20.6)
42,000
74,000
1,511.8
1,310.4
26 (22.8)
18 (16.4)
66,000
80,000
688(636)
78,000
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
Coventry, Warwicks, Herefords & Worcs
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
49,855.7
Total no
gastroenterologists
(WTE)
Population
served by 1
WTE
Consultant
Population data DoH 2003. WTE assumes that academics/part-timers work 0.6 for NHS.
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December 2004
Distribution of Consultant Gastroenterologists in Wales
Health Authority
Trust Code Pop
Total
(1,000s)
number
consultants
Gwent
Bro Taf
Iechyd Mog
Dyfed & Powys
North Wales
15c, 15j
15h,
15e, 15i,15k
15f, 15l, 15b
15a,15d,15m
Total
Population
served by 1
WTE
Consultant
9
5
10 (8.8)
4
9
2,938.0
37 (35.8)
82,000
Population figs DoH 2003. WTE assumes that academics/part-timers work 0.6 for NHS.
Distribution of Consultant Gastroenterologists in Scotland
SHB
Code Pop
No.
(1,000s) gastroenterologists
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
16c
16e
16f
16g
16h, p
16i
16j
16k
16n
Total
Population
served by 1
WTE
Consultant
440.4
523.8
103.5
345.9
272.1
506.1
927.7
276.8
562.5
749.6
394.0
5 (4.6)
3 (2.6)
2 (2)
5 (5)
3 (3)
8 (7.2)
18 (16.8)
4 (3.6)
6 (6)
16 (14.8)
6 (5.6)
96,000
201,000
52,000
69,000
91,000
70,000
55,000
77,000
94,000
51,000
70,000
5120.4
76 (71.2)
72,000
Population data 1999. WTE assumes that academics/part-timers work 0.6 for NHS.
Distribution of Consultant Gastroenterologists in Northern Ireland
HSSB
Code
Pop (1,000s) No.
gastroenterologists
(WTE)
Eastern
Northern
Southern
Western
Total
17a,f,g,i
17b,e,h
17c
17d
Population
served by 1
WTE
Consultant
667.8
415.4
298.8
262.5
14 (13.6)
5 (5)
3 (3)
3 (3)
49,000
83,000
100,000
87,000
1589.4
25 (24.6)
65,000
Population data 1999. WTE assumes that academics/part-timers work 0.6 for NHS.
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December 2004
Trainees in Gastroenterology in the UK
There are now a total of 550 trainees in gastroenterology, excluding those in LAS or senior
SHO posts. Since 30/09/03 there has been an increase of 60 trainees - an increase of 12%.
Compared to last year there are an additional 22 clinical SpRs, 30 research registrars and 20
visiting registrars but 21 fewer LATs across the UK. At least 93 of 115 research registrars
have an NTN.
Distribution of grade of those in Registrar posts is shown (30/09/04).
Specialist Registrar (Clinical)
Senior Registrar
England
Wales
Scotland
Northern
Ireland
265
10
22
6
1
Research Registrar
99
4
9
3
Out of Programme
11
1
1
3
Visiting Registrar, inc FTTA
53
10
LAT
28
1
2
Locum/Hon Consultant
21
26
34
Total
478
12
Approximately 27% of trainees are female. 23 (4.1%) trainees in gastroenterology are
in flexible training posts.
We have agreed with the Workforce Review Team (who report to WNAB) that SpR
“wastage” is 3% and that some 58% of VTNs opt to stay in the UK and take up
consultant gastroenterology posts here.
JCHMT also collect data concerning trainees in gastroenterology and they estimate
that there are 451 trainees, including NTNs, VTNs, LATs and ATNs. This figure will
not include all those in research or in out-of-programme experience and also requires
that trainees have registered with the JCHMT and this results in a degree of under
reporting of trainee numbers.
Total training time is averaging about 7.4 years (figure for England).
Expansion of NTNs over the past 3 years
There was an increase of 20 unfunded posts in 2002-03 and 50 unfunded posts in
2003-04, these were distributed by deaneries or WDCs. In 2004-05 there have been
approximately 55 additional “Hutton numbers” to help individual Trusts meet the
EWTD.
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December 2004
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. The results of the
50% (277 of 550 trainees) responders are shown below, Fig 3.
Fig 3, Career aims of SpRs (2004)
10%
gastroDGH
10%
42%
hepatolDGH
gastroTeach
hepatolTeach
27%
Academic
11%
Non-consultant career grades in Gastroenterology
Within the UK there are 79 Staff grade posts, 57 Associate specialists, 20 trust doctors and 85
Clinical Assistants in gastroenterology. In 2002 71 of these NCCGs expressed an interest in
obtaining a CCST. With the changes in post-graduate training and PMETB it is likely that
some of these individuals will seek to become consultants, possibly within a very short time.
It may well be that some NCCG posts will be converted into consultant posts. These events
may impact both on consultant expansion and on the number of CCST holders applying for
consultant posts.
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December 2004
Predicted dates for gaining CCST
The expected number of SpR’s gaining CCST’s in Gastroenterology is shown in figure (4a &
4b) but this takes no account of “CCST drift” which leads to many SpR’s delaying their
CCST by a few months or a few years in the case of research. As of 30/9/04 there were 42
trainees in gastroenterology who were >6 months beyond their CCST date.
Fig 4a: Predicted dates for
CCST for Gastroenterology
for SpRs in England.
60
55
No of SpRs attaining CCST
50
40
31
30
26
23
22
20
14 14
17
15
14
11
22 22 22
18
17 16 16
10
9
10
8
5
6
7
6
>2009
2009-3
Year - by quarter
Fig 4b: Predicted dates
for CCST for SpRs in
Wales, Scotland & N
Ireland.
60
5
4
No of SpRs at t ai ni ng CST
50
Wales
Scotland
Engl
N Ireland
4
4
40
30
20
10
3
2
2
2
2
2
2009- 3
3
2008- 3
33
2007- 3
3
2006- 3
3
<2003
0
33
2005- 3
No of SpRs attaining CCST
6
2009-1
2008-3
2008-1
2007-3
2007-1
2006-3
2006-1
2005-3
2005-1
<2003
0
Year - by quarter
22
2
1
1
1
1
1 1
1
1
1
0 0
0
and.
0 0
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>2009
2008-2
2008-1
2007-2
2007-1
2006-2
2006-1
2005-2
2005-1
<2004
0
Time by half year
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December 2004
Distribution of trainees in Gastroenterolgy across England
The distribution of trainees in Gastroenterology by English Region is shown in figure 5, and
the relationship between SpRs and population shown in Fig 6.
70
60
50
40
30
20
10
0
Numbers
ResR,OOPE,Cons
North West
Mersey
West Midlands
South & West
Oxford
Wessex
SW Thames
SE Thames
NE Thames
NW Thames
Anglia
Trent
Yorks
Number SpRs
Northern
Number
Fig 5, Number of SpRs & Research Registrars, OOPEs etc in gastroenterology by
English Region (September 2004)
Region
Fig 6, Relationship between Trainee numbers and population in English Regions
(September 2004)
250
161
161
150
99
58
64
NE Thames
95
100
124
117
111
106
NW Thames
Population (1,000s) per SpR
204
200
106
89
68
50
North West
Mersey
West Midlands
South & West
Oxford
Wessex
SW Thames
SE Thames
Anglia
Trent
Yorks
Northern
0
Region
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December 2004
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) a target number of 1625
consultant posts in England are required to deliver all the needs of gastroenterology –
assuming a need of 6.1 whole time equivalents (WTEs) for a population of 250,000. This
equates to around 1900 posts for the whole of the UK.
It is expected that 1625 posts would deliver 1250 WTEs of consultant work (on the
expectation that the WT/PT ratio lies between 1:1.2 and 1:1.4). This figure includes the
addition of 50 WTEs to deliver an expected colorectal cancer screening programme. If the
job description of consultant gastroenterologists were to change significantly, such as
reduction of GIM, then the need per population may change.
Over the past 5 years there has been a steady growth of around 7%. Assuming continued
growth at such a rate it will take 13 years to achieve 1625 consultant posts in England. Fig 7
shows a prediction of the annual excess of CCST holders of >6 months above advertised
consultant posts (CCST excess) and the cumulative excess of those in possession of CCST
for more than 6 months above consultant posts over the next few years
The assumptions used include:
 there will be a steady 7% growth in Consultant new posts
 17 retirements per year with no other replacement Consultant post (for other reasons)
 training takes 7 years
 58% of VTNs opt to stay in the UK and take up consultant gastroenterology posts here
 there are 440 NTNs (current 400 + a speculated 40 additional “Hutton numbers” for
2004-5 – this may increase to 55 by April 2005)
 No allowance has been made for effect of PMETB on NCCGs obtaining CCST (page 6)
Fig 7, Prediction of annual excess of CCST holders (for >6months) over
consultant jobs and cumulative excess in England (calculated Nov 2004)
>6 months CCST holders
75
>6m CCST excess
25
20
13
20
12
20
11
20
10
20
09
20
08
20
07
20
06
20
05
-25
20
04
0
20
03
Excess CCST holders
50
-50
Years
-75
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