Stressed doctorChildren’s doctors have expressed serious fears for the future of paediatric services as a new workforce survey shows gaps on rotas are increasing. Doctors say the service is at breaking point, sustained by existing junior doctors and consultants struggling to plug vacancies.

The annual ‘Rota Vacancies and Compliance Survey’, published today by the Royal College of Paediatrics and Child Health (RCPCH), found that paediatric services are not able to meet recommended staffing standards as 60% of tier 1 and 77% of tier 2 rotas, which are mainly made up of junior doctors, have not been able to attract the full complement of 10 full-time staff. The rise in junior doctor vacancies has led to an increase in the extent to which consultants are filling gaps in rotas at short notice; 38% of paediatric units report using consultants to fill junior doctor gaps in 2016 compared to 35% in 2015.

The RCPCH ‘Rota Vacancies and Compliance Survey’, which has been collecting evidence on the state of compliance with the Working Time Regulations (WTR) and extent of rota vacancies across the UK’s neonatal and paediatric units since 2009, reveals that:

  • There is now a 10% tier 1, and 20% tier 2 rota vacancy rate; averaged across both tiers there has been an increase in the vacancy rate from 12% in January 2015 to 15% in 2016
  • The rota vacancy rate is highest on tier 2 general paediatric rotas (28%), a rise from 18% in January 2015
  • 60% of tier 1 and 77% of tier 2 rotas comprise fewer than the recommended 10 staff per rota, the standard set in the RCPCH 'Facing the Future' report
  • 89% of clinical directors are concerned about how the service will cope in the next six months; up from 78% last year
  • Consultants are increasingly providing unplanned cover (35% in January 2015 rising to 38% in 2016), an average of 3.1 occasions over the 4 weeks preceding the survey compared to 2.4 in January 2015

Dr Simon Clark, Workforce Officer at the RCPCH, said: “The paediatric workforce is at breaking point and children’s healthcare is increasingly being compromised. There is no escaping the fact that an increase in junior and consultant posts is urgently needed, coupled with a radical re-design of services. It can take up to 8 years to complete paediatric training and just as long to implement a service redesign, so the RCPCH has made a number of immediate recommendations that we hope will help sustain services for children in the short-term. We call for managerial leadership to break down barriers to multi-disciplinary working, an increase in children’s nurses and immediate opportunities for our GP colleagues to access child health training.

“The NHS was designed in the 1940s when paediatric care took second place to the care of adults. Children are not small adults and paediatricians are proud to have helped focus attention on their needs. The RCPCH wants to see children’s healthcare move forward, not stand still, and now we fear things are starting to move backwards.

“Since the imposition of the highly damaging junior doctor contract, we have evidence from the College’s existing recruitment data that morale is at an all-time low. In a reversal of previous years’ figures, junior doctors are choosing to move out of England; 100% of posts at junior trainee level were filled in Wales, Scotland and Northern Ireland compared to 93% in England.”

Dr Clark says that continuing to deliver the service as it currently stands is not sustainable – a sentiment with which 89% of clinical directors agree. He said: “I urge decision-makers to increase trainee and consultant numbers, better map training places to demand, and plan emergency and non-emergency rotas well in advance. In the long term, more care should be delivered in the community by multi-disciplinary teams of paediatricians, GPs and nurses. Only one in three GPs have worked in a paediatric department; they deserve better opportunities to equip them with the skills they need to manage children’s health needs safely at home and to keep children out of hospital.

“We have rejected comments made recently suggesting that trusts do not need to provide staffing in keeping with standards set by regulators and royal colleges. Investment in children’s services is not only morally right, but necessary if they are to become healthy, productive adults. A healthier population will spend more time in work and less time needing health care; investment in children’s services are a win-win for everyone."