Summary
 There have not been any significant changes to the characteristics of the
UK medical workforce since the previous briefing.
 There has been a slight fall in the number of GP contractors,
specifically in England, in the last year and a smaller rise in the
number of salaried GPs in the UK than seen in previous years.
 A considerable proportion of SAS doctors and GPs are approaching
retirement age. 11 per cent of SAS doctors and 9 per cent of GPs are aged
60+.
Background
This briefing note includes a summary of the 2012 medical workforcei with a
focus on doctors in training. The summary of the 2012 medical workforce
also includes 10 year trends in the overall UK medical workforce, 10 year
trends in the general practice workforce, and breakdowns of the 2012
workforce by country in the UK, gender, country of qualification and age.
The NHS has seen a significant increase in medical workforce numbers since
2000 as a result of significant funding borne out of The NHS Plan1. The NHS
Plan was a 10-year plan that not only increased numbers of trained UK
doctors but also involved a national campaign that boosted the number of
medical consultants and the overall number of doctors from outside the UK.
In May 2010 the Conservative/Liberal Democrat Coalition Government was
formed in England.
The 2010 Government Spending Review
outlined that in real-terms, settlement spending for the NHS would remain
virtually static until 2013/14.
The Government also required efficiency
improvements of
4 per cent per annum within the NHS; £20 billion
by 2014/15. In addition, the Coalition Government’s Health and Social Care
Act has resulted in the initiation of Clinical Commissioning Groups (CCGs)
in England, involving substantial participation of the medical workforce.
These changes have considerable potential implications for the UK medical
workforce. One of the groups of doctors who are significantly affected by
these changes are public health doctors.
Before the Act was implemented
public health doctors were primarily employed by Strategic Health
Authorities (SHAs) or Primary Care Trusts (PCTs). As of April 2013 public
health doctors are primarily employed by either Public Health England or
Local Authorities. Unfortunately, workforce data for public health doctors
is limited and this group of doctors are not explicitly mentioned within
this report; however, it is possible to speculate that as the NHS no longer
employs public health doctors, this may result in a rise in the number of
non-clinical public health doctors in the future.
i
Statistics for the Wales medical workforce were not available for 2012 on
publication; therefore the 2011 data for Wales were used for this publication.
Health Policy & Economic Research Unit
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Other doctors greatly affected by the Act are general practitioners. From
April 2013, CCGs are responsible for commissioning local health services.
CCGs are formed of member GP practices, therefore it is reasonable to
suggest that GPs’ workload will inevitably be affected.
This change may
deter some doctors wanting to work in general practice or indeed, may
inspire some doctors to want to work in general practice.
For doctors working in hospital career grades; consultants, specialty
doctors and associate specialists and doctors in training, the potential
affects of the Act are less clear; however, there are a number of other
factors that could affect the hospital medical workforce in the future
including a potential oversupply of consultants2, a shortage of foundation
training places and the possible reconfiguration of hospital services.
Another potential factor which may significantly influence the UK medical
workforce is changes to public service pensions.
In April 2012 doctors
experienced a rise in pension contributions, this is due to increase again
in 2013 and 2014, with the highest earners contributing over 14 per cent of
salary by 2014, in addition, the age of retirement also changed to be in
line with the State Pension Age, resulting in many doctors in the future
having to work to the age of 68 to be able to draw a full pension.
Although doctors within 10 years of retirementii would not have to work
longer or receive worse pensions as a result of the changes, they would
still pay more in contributions; therefore this could potentially result in
increased numbers of doctors retiring.
At this time it is too early to tell if the implementation of the Act and
the pension changes will have a significant effect on the medical
workforce. Whilst the statistics for the UK hospital medical workforce are
fairly robust and reliable, there is a distinct lack of data available for
GP locums; therefore, it will not be possible to establish with any
certainty if the numbers of GPs in the UK are increasing or falling.
Focus on: Doctors in training
Numbers of doctors in training
Postgraduate medical education has also undergone significant changes in
the last decade.
In 2005 Modernising Medical
Careers (MMC) training was introduced in the UK.
Prior to MMC, medical
graduates worked as a Pre-Registration House Officer (PRHO) for one year,
before progressing onto the specialist training programme.
The former
medical training programme allowed doctors to work in a variety of
specialities in Senior House Officer (SHO) posts for two to three years or
more, before deciding on a certain speciality where they worked in a
registrar post to train for a CCT in that particular field.
The
MMC training programme was intended to improve medical education with an
efficient career path for doctors, thus, one of the aims was to reduce the
amount of time that doctors spent working in SHO posts.
The first phase of implementing the MMC training programme involved the
introduction of the Foundation programme.
This two year programme was
designed to give trainees exposure to a range of competencies across a
broad spectrum of specialties.
In 2007 the Modernising Medical Careers (MMC) Specialty Training programme
was introduced.
Acceptance to specialty training and in some specialties
ii
On 1 April 2012
Health Policy & Economic Research Unit
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(e.g. surgery, emergency medicine), progression is now competitive. Thus,
not all doctors completing their Foundation Programme are able to secure
National Training Numbers (NTNs), or are offered a speciality training
post. In addition, some doctors are not able to secure a NTN to progress
through specialty training after completing the two or three years of their
prerequisite ‘core training’.
Figure 1 illustrates the headcount of doctors working as a foundation year
one (FY1) doctor (formally a house officer), and foundation year two (FY2)
doctors (formally senior house officers). Coinciding with the introduction
of MMC, in 2007 the number of FY2 posts dramatically dropped. The numbers
of FY2 doctors have continued to fall since this point; however, the number
of FY2 posts still continues to exceed the number of FY1 posts in the UK by
approximately 1,300.
The primary source of this disparity can be
attributed to the medical workforce in England as in 2012 there were 956
doctors still working in old SHO posts; however, this is also the case for
Wales where there are 228 more FY2 doctors than FY1 doctors. Conversely in
Scotland, for the last two years, the number of FY1 doctors exceeded the
number of FY2 doctors by 228.
This indicates considerable attrition in
Scotland at the transition between FY1 and FY2iii.
Figure 1 - Headcount growth of UK Foundation Year 1 and Foundation Year 2 doctors
since 2000
iii
Data is not available in this detail for Northern Ireland.
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Figure 2 shows the headcount for both hospital and GP registrars since
2000.
This illustrates that the numbers of (hospital) registrars
significantly
increased
in
2007
(+68
per
cent;
14,629
doctors
year-on-year); again, this coincides with the introduction of the MMC
specialty training programme.
However, the numbers of registrars have
continued to increase each year since this point. In contrast, the number
of GP registrars increased by just 9 per cent in 2007. Although there was
a substantial rise in
GP registrars in 2008 (+31 per cent, 911 GP
Figure 2 - Headcount growth of the Registrar group and GP Registrars since 2000
registrars), overall the relative increase since the introduction of MMC in
2007 has not been as large for GP registrars (+85 per cent; 2,338 GP
registrars compared with
+114 per cent; 24,559 registrars).
Country of qualification
Figure 3 illustrates that the vast majority of FY1 doctors (93 per cent)
qualified in the UK.
However, the proportion of doctors in training who
qualified in the UK decreases in line with career progression.
The
proportion of FY2 doctors who qualified outside of the EEA is considerably
higher when compared to FY1 doctors (12 per cent and 5 per cent
respectively). This is surprising as FY1 and FY2 are run-through with no
additional recruitment for FY2.
However, when the senior house officer
posts (in England) are removed from this analysis, this trend is reversed
Figure 3 - Grade of doctors in training by country of qualification
and the data reveals that
qualified within the UK.iv
iv
similar
proportions
of
FY1
Data for Wales is not available by Country of qualification
Health Policy & Economic Research Unit
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and
FY2
doctors
Overview of doctors in training data
Whilst it is possible to draw a number of conclusions from the data
presented above, there are a number of questions that still need answering.
There are inconsistencies in the way that the four UK nations record their
workforce data, therefore, it is not possible to draw any robust inferences
on participation rates of doctors in training by gender. In addition, as
highlighted above, both England and Wales continue to refer to the obsolete
grades of house officers and senior house officers. While this could be a
matter of terminology, the data suggests that there continues to be glut of
doctors employed as SHOs and these doctors are much more likely to have
qualified from outside of the EEA.
There are also a number of doctors in ‘training’ without a national
training number, particularly in Scotland and England. This anomaly again
causes concern, as doctors without a national training number are not
working under national terms and conditions and are also technically not
considered to be a ‘doctor in training’.
Furthermore, at this time, there is no way of tracking the career paths of
doctors in training. Therefore, it is not possible to establish the number
of doctors who leave each year to work overseas or indeed, the numbers of
doctors who return from working overseas to work in the UK.
This is an
important limitation of workforce data as there is a predicted future
oversupply of CCT holders in the UK and BMA surveys3 have consistently
revealed that doctors in training would be more likely to leave the NHS to
work overseas in the event of not securing a consultant post, than relocate
within the UK.
Trend in overall UK medical workforce
Figure 4 provides a graphical representation of the headcount growth in the
number of medical staff in the UK by grades of consultant, SAS, GPs and all
Health Policy & Economic Research Unit
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training grade doctorsv from 2003 to 2012. Overall the number of doctors
across the UK has increased by 29 per cent in the last decade (from 135,227
in 2003 to 174,481 in 2012) and by 1 per cent year-on-year.
Since 2007,
the number of consultants within the UK medical workforce has surpassed the
number of GPs.
Figure 4 – 10 year headcount growth UK medical workforce (2003 to 2012)vi
Table 1 includes the one, five and 10 year percentage growth rates in
headcount number of doctors by grade. The numbers of hospital doctors have
increased at a similar rate over the last 10 years with consultants seeing
the biggest increase (41 per cent). However, GPs have only increased by 16
per cent over the same period.
This trend reinforces the Centre for
Workforce Intelligence’s4 predictions that there is likely to be an
oversupply of consultants in the future and a shortage of general
practitioners.
Table 1 - One, five and 10 year percentage growth rates in UK medical workforce
Consultants
Associate specialist/staff
doctor gradesvii,viii,
v
vi
vii
grade/specialty
1 year
3.0%
0.1%
5 year
14.8%
6.2%
10 year
41.1%
37.5%
Registrars, specialist registrars, GP registrars, GP specialty training, SHOs,
FTSTAs, FY2s, FY1/PRHOs.
Wales data for hospital doctors in 2006 was not available therefore data used
for 2006 is 2005 data. Data for GPs in Northern Ireland in 2011 and 2010 was
not available therefore data used for 2011 and 2010 is 2009 data. Data for GP
Registrars does not include Northern Ireland GP Registrars.
Data for
Salaried/Other GPs does not include data from Northern Ireland. Data for SAS
grades includes associate specialists, staff grade, speciality doctors and
other grades.
Not including ‘other grades’, or data for associate specialist/staff
grade/speciality doctor grades in Scotland.
Health Policy & Economic Research Unit
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Training grades
GPs (excl retainers)
1.0%
-0.1%
8.9%
4.6%
39.8%
16.2%
Trend in UK general practice medical workforce
Overall there has been a 0.1 per cent decrease in the general practice
workforce in the last year.
There has been a slight drop
in the number of contractor GPs within the UK in the last year.
This
decrease is in line with the previous downward trend of the number of
contractor/partner GPs in the UK which has been evident since 2005, with
the exception of 2011 when contractor numbers increased slightly
(in England only). The UK wide decrease can be primarily attributed to a 1
per cent fall in the number of contractor GPs in England within the last
year (-332 contractor GPs).
The trend of a significant increase in the number of salaried GPs has
continued, from 9,378 in 2011,
to 9,697 in 2012; a 3 per cent
increase.
Although the number of salaried GPsix appear to be rapidly
increasing while the numbers of contractors are decreasing, it is pertinent
to highlight that salaried GPs only comprise just over one-fifth of the UK
general practice medical workforce.
The numbers of salaried GPs have
increased significantly since 2003 when the nGMS contract was introduced
(when 8 per cent of GPs were salaried); however, the growth in salaried GPs
is now at a much steadier rate.
Whereas the numbers of GP registrars increased by 90 per cent in the past
decade, the number of registrars working in hospital posts rose by 170 per
cent within the same timeframe (table 2, figure 5).
Limitations of data
contractual status
-
no
locum
data
-
cannot
illustrate
change
of
Table 2 – One, five and 10 year percentage growth rates in UK general practice
workforcex
Contractor GPs
Salaried GPs
GP Registrars
GP Retainers
1 year
-1.0%
3.4%
7.4%
-9.5%
5 year
-1.5%
33.3%
30.4%
-31.8%
10 year
-5.0%
409.6%
90.4%
-59.5%
Figure 5 – 10 year growth in contractor GPs versus salaried GPs
viii
ix
x
Including Scotland, England, Wales and Northern Ireland, the one year growth
rate for SAS doctors (including other grades) is -1.4 per cent, five year is 0.8 per cent and 10 year is -0.5 per cent.
Not including freelance/locum GPs.
Data for GPs in Northern Ireland in 2012, 2011 and 2010 was not available
therefore data used for 2009 to 2012 was 2009 data. Salaried GPs’ data does
not include Northern Ireland.
Health Policy & Economic Research Unit
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2012 UK medical workforce by country
82 per cent of the UK medical workforce works in England, 10 per cent in
Scotland, 5 per cent in Wales and 3 per cent in Northern Ireland. This is
the same distribution as in previous years (figure 6, table 3).
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Figure 6 - 2012 medical workforce by country
Table 3 – 2012 medical workforce by grade and countryxi
England
Scotland
Wales
All medical staff
All
Hospital
career
grades
Consultant
SAS gradesxii
Associate Specialist
Staff Grade
Other gradesxiii
All training grades
Registrar Group
GP Registrar
144,123
51,359
17,381
6,773
8,453
3,299
39,613
11,746
3,364
6,535
1,847
56,659
38,866
4,426
4,717
2,056
1,466
590
6,186
3,983
447
2,256
1,043
385
474
184
3,085
2,012
202
FY2
FY1
GPs
(excluding
retainers)
GP provider/performer
Salaried/Other GP
GP retainers
7,022
6,215
35,784
764
992
4,284
526
345
2,022
26,886
8,898
321
3,745
539
138
1,762
260
47
Northern
Ireland
5,030
2,097
1,494
603
151
288
164
1,777
1,247
Not
available
530
1,156
1,156
Not
available
UK
174,981
63,528
48,080
15,448
2,785
67,701
46,108
5,075
8,842
7,552
43,246
33,549
9,697
506
Where data is unavailable by country, UK totals have been calculated where
data is available.
xii
SAS grades includes associate specialists, staff grade, speciality doctors and
other grades.
xiii
Other grades include Hospital practitioners, clinical assistants.
xi
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2012 UK medical workforce by gender
46 per cent of doctors in the UK are female; however, there is a wide range
depending on the grade of doctor.
32 per cent of consultants are female
compared to 54 per cent of training grade doctors.
General practice has a higher proportion of women compared to hospital
medicine both at the career grade level and at the speciality
training/registrar group level; however, within general practice just
41 per cent of contractor GPs are female compared to 69 per cent of
salaried GPs (figure 7, table 4).
Figure 7 – 2012 UK medical staff by grade and gender
Table 4 – 2012 UK medical workforce by grade and gender
Totalxiv
All medical staff
All Hospital career
grades
Consultant
SAS Gradesxv
All training gradesxvi
Registrar Group
GP Registrarsxvii
FY2xviii
FY1
GPs (excl retainers)
GP provider/performer
Salaried/Other GP
172,911
63,244
47,951
15,293
67,119
45,912
4,873
8,785
7,549
42,548
32,392
9,697
Male
Headcount
%
93,849
54.2%
40,913
64.7%
32,375
67.5%
8,538
55.8%
30,696
45.7%
22,073
48.1%
1,760
36.1%
3,757
42.8%
3,106
41.1%
22,240
52.3%
19,190
59.2%
3,045
31.4%
Female
%
Headcount
79,062
45.7%
22,331
35.3%
15,576
32.5%
6,755
44.2%
36,423
54.3%
23,839
51.9%
3,113
63.9%
5,028
57.2%
4,443
58.9%
20,308
47.7%
13,202
40.8%
6,652
68.6%
Totals differs for UK total due to incomplete data.
SAS grades includes associate specialists, staff grade, speciality doctors and
other grades.
xvi
Includes ‘other doctors in training’ for England.
xvii
Does not include Northern Ireland.
xviii Includes data for Northern Ireland PRHO/FY1.
xiv
xv
Health Policy & Economic Research Unit
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GP retainers
459
5
1.1%
454
98.9%
2012 UK medical workforce by country of qualification
Figure 8 illustrates that 70 per cent of the UK medical workforce received
their medical qualification from within the UK, 24 per cent from outside
the European Economic Area (EEA) and 6 per cent from within the EEA. This
distribution remains unchanged from the previous year.
The highest proportions of doctors from outside the UK are SAS grade
doctors with 49 per cent from outside the UK. Foundation year one doctors
have the lowest proportion of doctors with a medical qualification from
outside the UK at 4.5 per cent (table 5).
Figure 8 - 2012 UK medical workforce by country of qualification
Table 5 – 2012 UK medical workforce by grade and country of qualification
Total
All medical staff
All Hospital gradesxix
Consultant
SAS gradesxx
All training grades
Registrar Group
FY2
FY1
151,63
1
58,132
44,330
13,802
57,972
42,849
7,786
7,207
UK
HC
102,97
3
35,314
29,810
5,504
40,160
28,099
6,115
5,843
%
69.8%
62.2%
68.4%
41.8%
72.7%
67.8%
83.2%
93.1%
Rest of EEA
HC
%
9,124
4,211
3,022
1,189
3,298
2,808
333
150
Does not include Wales and Northern Ireland.
SAS grades includes associate specialists,
doctors and other grades.
6.2%
7.4%
6.9%
9.0%
6.0%
6.8%
4.5%
2.4%
Outside EEA
HC
%
35,378
17,231
10,768
6,463
11,750
10,550
903
280
24.0%
30.4%
24.7%
49.1%
21.3%
25.4%
12.3%
4.5%
Unknown
21,570
4,212
2,342
1,870
9,058
2,901
1,117
319
xix
xx
Health Policy & Economic Research Unit
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staff
grade,
speciality
GPs (excl retainers)xxi
xxi
35,527
27,499
77.6%
1,615
4.5%
Does not include Scotland and Northern Ireland.
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6,397
18.0%
7,741
2012 UK medical workforce by age
Each of the career grades of doctors (consultants, SAS and GPs) has onefifth of its population over the age of 55; however, the distribution for
GPs and SAS doctors reaches its peak at an older age with the highest
proportion in the 50 to 54 age range compared to the highest proportion of
consultants which falls in the 40 to 44 age range (figure 9, table 6).
Figure 9 – 2012 UK medical workforce by grade and age
Table 6 – 2011 UK medical workforce by grade and agexxii
All medical
staff
All Hospital
gradesxxiii
Consultant
SAS gradesxxiv
All training
grades
Registrar Group
GP Registrarsxxv
FY2xxvi
FY1
GPs (excl
retainers)
xxii
xxiii
xxiv
xxv
xxvi
Total
171,92
2
<30
30,02
2
30-34
25,42
0
35-39
27,11
8
66,262
276
2,344
9,961
48,665
17,530
46,450
447
9,322
7,609
2
271
29,31
1
14,88
2
218
7,368
6,843
1,064
1,280
18,57
9
16,84
8
131
1,107
493
7,374
2,586
10,96
4
10,23
1
62
496
175
41,832
435
4,497
6,193
63,828
40-44
23,46
0
13,97
9
11,18
4
2,785
45-49
21,83
7
14,00
8
10,81
4
3,176
50-54
19,14
2
11,78
2
55-59
13,54
0
>60
9,341
8,399
5,478
8,553
3,210
6,074
2,310
3,583
1,891
3,467
1,028
335
91
46
3,186
29
190
62
905
6
91
26
289
1
35
10
73
0
18
0
35
0
11
0
6,014
6,801
7,025
5,050
3,817
Data for England includes dentists.
Does not include Wales.
Including Associate specialists, staff grade/ speciality doctor, other grades
Does not include Northern Ireland.
Includes data for Northern Ireland PRHO/FY1.
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References
1
Department of Health.
The NHS Plan: A plan for investment, a plan for
reform.
Available
at
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsa
ndstatistics/publications/publicationspolicyandguidance/dh_4002960
Last
accessed 29 April 2013.
2
Centre for Workforce Intelligence. Shape of the medical workforce:
Starting the debate on the future consultant workforce. 2012. Available at
http://www.cfwi.org.uk/workforce-planning-news-andreview/publications/leaders-report-shape-of-the-medical-workforce.
Last
accessed 29 April 2013.
3
BMA Survey of the Future UK Medical Workforce: Career Intentions.
Available
at
https://bma.org.uk/working-for-change/negotiating-for-theprofession/workforce/future-medical-workforce/career-intentions-survey2012. Last accessed 29 April 2013.
4
Op cit.
Shape of the medical workforce 2012.
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NHS Hospital and Community
Health Service (HCHS) Workforce Statistics in England, Medical and Dental
staff
–
2002-2012,
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at
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September.
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2012.
Available
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http://www.isdscotland.org/HealthTopics/Workforce/Publications/data-tables.asp?id=837#837
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Available at: http://www.isdscotland.org/Health-Topics/GeneralPractice/GPs-and-Other-Practice-Workforce/
Wales
StatsWales.
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Available at:
https://statswales.wales.gov.uk/Catalogue/Health-and-Social-Care/NHSStaff/Medical-and-Dental-Staff
Health Policy & Economic Research Unit
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StatsWales.
General Medical Services.
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Available at:
https://statswales.wales.gov.uk/Catalogue/Health-and-Social-Care/GeneralMedical-Services
Northern Ireland
DHSSPSNI. Northern Ireland Health and Social Care Workforce Census 2012.
Available
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http://www.dhsspsni.gov.uk/workforce_census_march_2012__web.pdf
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TICAL_REPORT_2007-08.pdf
Health Policy & Economic Research Unit
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