Evidence to include paediatrics on the Shortage Occupation List for the Migration Advisory Committee 2018 - consultation response

In June 2018, the Government commissioned the Migration Advisory Committee (MAC) to carry out a full review of the composition of the Shortage Occupation List (SOL) to ascertain what national shortages there were within the UK. We responded successfully making the case for paediatrics to be on the SOL.

The MAC invited evidence from all occupations and job titles to ascertain what national shortages there were within the UK. It did so by adopting a new approach to its call for evidence and engagement with stakeholders, focusing on specific job titles rather than broader occupations and requiring evidence that supports this approach by asking that all respondents to this call for evidence complete an online form that comprised their evidence to this review of the SOL.

Our response

We responded by compiling a document with supporting evidence for paediatric doctors to be in included on the Shortage Occupation List highlighting:

  • Workload pressures - Increase in paediatric emergency admissions nationwide, premature births and urgent deliveries, neonatal admissions, and of birth complications. General and neonatal paediatrics are shaping more and more in the form of an urgent care service requiring 24/7 medical rotas.
  • Recruitment - The fill rate for paediatric ST1 places in the UK has been close to 80% after each of the recruitment rounds in 2017 and 2018.  There is also concern about the geographical distribution of accepted places. In round 1 of specialty recruitment for 2018, Paediatrics has the lowest competition ratio amongst the medical specialties.
  • Rota gaps and vacancies impact - approximately 48% of paediatric trainees consider intensity of work heavy or very heavy, this is only exceeded by emergency medicine and medicine and approximately 65% of paediatric trainees feel somewhat, to a high degree or a very high degree burnt out by their work, placing it 4th of 11 specialties.
  • Community child health - demand has increased upon recognition and treatment of conditions such as ADHD, ASD, etc, yet the number of community paediatricians in the UK has declined significantly. In 2015 there were 17% less WTE doctors working in community paediatrics than in the previous 10 years.
  • Attrition, less than full time working and other workforce groups - There has been little development of other staff groups over recent years to support rotas. Staff, Associate Specialist and Specialty (SAS) doctors continued to decline in every RCPCH census since 2001.
  • Failure to meet staffing standards - Having fewer doctors and other staff on the rota inevitably means there is less time for trainees for teaching, research and carrying out audit and other quality improvement work.

Our recommendations

  • Between 2013/14 and 2016/17, emergency admissions rose in all nations (ranging from 13% to 18%). Only 48% of children admitted to the paediatric department with an acute medical problem are seen by a consultant paediatrician within 14 hours of admission. The level of admissions seen in some units mean that double rotas are increasingly needed (i.e. 2 consultants or two trainee doctors on call at the same time). Increases are needed in trainee numbers to ensure greater levels of less than full time working and mitigation of attrition from training. We need to increase the recruitment of trainees to ensure compliance with Facing the Future Standards  to alleviate rota shortages.
  • RCPCH is supportive of an increased skill mix where other types of appropriately trained and competent non-medical and other medical groups can support paediatric services. Our census shows that only (60.6%) of organisations employed Advanced Nurse Practitioners (ANPs) in 2017, unchanged from 60.3% in 2015. The RCPCH support ANPs so that they can use e-portfolio for their training at reduced membership rates. Only 3% of responding organisations (all in England), employ Physician Associates; the same number as in 2015. There was a total of 7.6 WTE Physician Associates recorded in 2017, down from 9 WTE in 2015.
  • In 2017, the College and the British Association for Community Child Health (BACCH) found that there was a need for substantial increase in the community child health medical workforce. This is necessary to meet the current and anticipated demand due to a rising number of co-morbidities, long delays in diagnosis for autism and ADHD, and growing safeguarding concerns.

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