Growing gaps in children’s doctor workforce revealed in new report

New figures published today by the Royal College of Paediatrics and Child Health (RCPCH) highlight an urgent and growing problem in the paediatric workforce. Prior to reaching consultant level, children’s doctors train for around eight years. The RCPCH study shows that almost 1 in 5 of paediatric trainee positions are currently vacant even though trainees themselves report high levels of enthusiasm for the speciality. Even more alarming is that this figure jumps to nearly 1 in 4 in more senior trainee positions and almost 90% of children’s units express concern over how they will cope over the coming six months.

The RCPCH annual ‘Rota Vacancies Survey’, now in its seventh year, involves a poll of clinical directors and workforce leads for paediatrics. This year the survey assessed paediatric units in England in relation to the impact of the 2016 Junior Doctors’ Contract. Of responders, 67% said that the contract is having a negative impact on recruitment and retention. One survey respondent said: “The impact of the contract is to make working hours and conditions less attractive and therefore likely to deter doctors from wanting to enter the speciality of paediatrics.’

Dr Simon Clark, RCPCH Officer for Workforce Planning, said:

“Large gaps in the paediatric workforce have a serious impact on doctors and vital hospital services. The shortages create very difficult working environments resulting in low morale amongst doctors and a lack of time for training and education. More senior doctors end up back-filling the gaps which, in turn also leads to cancelled services.”

Another survey respondent said: “Staff are regularly swapping into evening and night shifts to make the on-call safe …. leaving the department understaffed in the day. Numerous out-patient appointments [are] cancelled due to no available middle grade to help in clinics.”

Four out of every ten vacancies are being filled by locums, whose services are expensive compared to full time staff. Despite the ‘locum pay cap’ putting limits on pay, this is also putting strain on many units which are desperate to fill gaps. One service lead said “As a unit a long way from most locums… the cap means we can't offer a rate that is attractive to locums. They were difficult to attract without a cap and almost impossible with.” Another commented: “Caps have resulted in unfilled shifts, consultants stepping down and clinics cancelled the next day. Overall poor experience for patients.’

Dr Clark added:

“In an NHS, already stretched by budget cuts, the new figures shed further light on the pressures facing junior doctors. With more than 40% of positions filled by expensive ‘locum’ temporary staff, this can only add more pressure to strained hospital budgets. Whilst recognising the need to curtail costs, the pay cap was a simplistic short-term approach to a complex problem; it does not go to the root of the problem and as such is working for nobody.

“These figures should act as a wakeup call for Government to act now. Health Education England is responsible for training but has insufficient funding; NHS employers have insufficient funding; yet this problem is here and now. Efforts need to be coordinated across the now multiple components of a fragmented NHS. And with paediatric trainees excluded from the Home Office Shortage Occupation List in England, Wales and Northern Ireland, hospitals and doctors have been left in a difficult and unsustainable position.” 

The report also highlights the pressured paediatric workforce was stretched to breaking point through the 2016 winter with Dr Clark pointing out that “there is nothing so far to indicate 2017 will be any different.”

The RCPCH is calling for urgent action from Government to fix the growing crisis in the paediatric trainee workforce, through measures including:

  • Identifying a responsible body for integrated national and regional workforce planning, co-ordinated across all relevant agencies, identifying paediatric training, non-training, and consultant-level requirements, and aligning these projections with nursing and other child health workforce requirements.
  • Centrally funding an increase in the number of paediatric trainee places to 465 in each training year for the next 5 years in order to achieve an expansion in the consultant-level workforce by 752 WTE.
  • Committing to funding integrated primary/secondary care child health training for general practice and paediatric trainees.
  • Immediately placing paediatrics on the shortage occupation list, with exemption from the resident labour market test.


The full report can be read on the RCPCH website.

For further information, or to request an interview with Dr Clark, contact Tom Chappell, Senior Media & Campaigns Officer on, 020 7092 6067 or 07772 686022