Workforce census: Focus on Northern Ireland (2019)

This report, published in December 2019, focuses on the Northern Ireland findings form the workforce census 2017, and makes five key Northern Ireland-specific recommendations.

Introduction

This report is a workforce profile for Northern Ireland, supported by the Royal College of Paediatrics and Child Health (RCPCH) census 2017, and other data on the paediatric workforce and services collected by the RCPCH. It follows on from the Workforce Census Overview Report1 that provides a UK-wide analysis of the census data, and is part of a series of reports focusing on the devolved UK nations in turn23. A further report focuses on Specialty, Staff Grade and Associate Specialist (SAS) doctors4.

This report makes recommendations specific to Northern Ireland in five key areas:

  1. Planning the child health workforce
  2. Recruiting, training and retaining more paediatricians
  3. Incentivising the paediatric workforce
  4. Planning for and expanding the non-medical workforce
  5. Expanding paediatric training for the primary care workforce

The reports are supported by the following census resources on this website

  • An interactive dashboard of paediatric workforce data which allows users to apply filters and customise for their own use and interest
  • A set of detailed tables in Excel format for those who wish to see further breakdowns of the census data
  • An explanation of how we arrived at our estimate of consultant workforce demand and supply of trained doctors
  • The census data collection methodology and response rate

Executive summary

There are five Health and Social Care Trusts in Northern Ireland delivering acute, community and specialist (including neonatal) care for children and young people across 11 hospitals5. Northern Ireland has the highest proportion of the population under 18 of the UK nations, and 20.8% of the population are aged 0 to 15 years6.

Consultant whole time equivalent growth rate in Northern Ireland between 2015 and 2017 was 5.4%; lower than the England growth rate of 8.2% and the UK growth rate of 7.8%. Growth in Northern Ireland slowed compared to the findings of the 2015 census: the number of consultants grew by 17.9% between 2013 and 2015. Furthermore, 11.3% of the total career grade workforce (consultant plus SAS doctor) had posts vacant for longer than three months, higher than the overall UK rate of 4.1%.

The shortfall in paediatric trainees across Northern Ireland is also seen in rates of rota gaps and vacancies, which are higher than the UK for Tier 1 and Tier 3 medical staff. To meet the RCPCH standards set out in Facing the Future7, the number of WTE (whole time equivalent) consultants in Northern Ireland needs to increase by around half, to approximately 172 WTE. The actual increase between the previous census rounds was 5.4%.

There are particular concerns in Northern Ireland about workforce provisions to remote and rural areas. As in the rest of the health service, remote and rural areas face higher costs. Paediatrics faces issues of recruitment and retention, and a reliance on a small number of paediatricians in smaller centres8. The Rural Needs Act (NI) 2016 for Public Authorities places a statutory duty on local authorities to consider rural needs in their plans and policies9.

As in other specialties and healthcare professions, the number of paediatric trainees and consultants is unlikely to rise by the amount needed to meet demand any time soon10; especially as only 6% of Foundation Year 1 (F1) doctors consider specialising in paediatrics11. Therefore, workforce planners need to develop non-medical workforces, and see their potential in helping paediatric services meet standards and demand. Advanced Nurse Practitioners (ANPs) are employed across the Trusts in Northern Ireland, and this is a good first step towards diversifying the workforce.

The 2018/19 Draft Commissioning Plan from the Health and Social Care Board and the Public Health Agency sets out priorities for health and social care to improve the experience of people at all stages of their life and healthcare journey. According to the report, the child population is projected to decrease, but conclusions cannot be drawn about service demand based on population, as a decrease does not necessarily mean there will be a reduction in demand for child health services. As the burden of disease becomes more complex, and greater intervention is needed with the advent of technology (such as gene screening), there will continue to be a need for a highly trained workforce.

In Northern Ireland, compared to the rest of the UK, there is a higher ratio of people who obtained their Primary Medical Qualification (PMQ) in the UK compared to those who graduated overseas. Given that there are workforce shortages in the nation, it is important to further investigate this pattern and consider whether more could be done to attract overseas graduates.

The average number of Programmed Activities (PAs) in consultant full time contracts was higher in Northern Ireland compared to the rest of the UK. Furthermore, although the rate of less than full time (LTFT) consultants working in Northern Ireland increased compared to 2015, it was lower than the UK as a whole. Paediatrics in the UK has a trainee workforce which increasingly wishes to work LTFT12. Therefore, modelling will need to consider how the shift towards LTFT in trainees may extend into consultant LTFT working patterns in the future, as this could lead to a fall in the WTE workforce in Northern Ireland.

There is heavy reliance on Specialty, Associate Specialist and Staff Grade (SAS) doctors in Northern Ireland. The rest of the UK may be able to take lessons about how to effectively retain and reinvigorate SAS doctors in paediatrics. The number of SAS doctors in paediatrics has almost halved since the 2001 census across the UK. However, the NHS Long Term Plan13 contained a commitment to create a new associate specialist or equivalent grade. The RCPCH has recently released a workforce report focusing on SAS doctors in paediatrics using the latest census data4. We also welcome a recent report from Health Education England and NHS Improvement, Maximising the Potential14, which offers guidance to recognise and support SAS doctors.

The general paediatric workload is shifting, and we report a year-on-year upwards trend of admissions. A more effective way of working across primary and secondary care, as described in Facing the Future: Together for Child Health15, is needed to keep up with the upward trend in admissions. To further investigate this, RCPCH is conducting a project to determine the role of paediatricians and child health in the future called Paediatrics 204016. This project will develop a shared understanding of what the key issues are likely to be for paediatricians and to better understand what the future may hold for the profession in the UK in 2040.

While this report focuses on paediatricians, it is clear that many other doctors and healthcare professions contribute significantly to the delivery of child health and wellbeing. Therefore, it is vital that a holistic approach will be adopted to meet the gaps in addressing our current needs and concurrently to plan for an integrated child and family focused workforce for the future, as close to home as safely possible.

  • 1. Royal College of Paediatrics and Child Health, 2017 Workforce Census Overview. 2019.
  • 2. Royal College of Paediatrics and Child Health, 2017 Workforce Census: Focus on Scotland. 2019.
  • 3. Royal College of Paediatrics and Child Health, 2017 Workforce Census: Focus on Wales. 2019.
  • 4. a. b. Royal College of Paediatrics and Child Health, 2017 Workforce Census: Focus on Specialty, Associate Specialist and Staff Grade doctors. 2019.
  • 5. GMC, A workforce strategy to make sure the progress of the past 70 years does not stall. 2018/19.
  • 6. Health and Social Care Board and Pulbic Health Agency, Draft Commissioning Plan 2018/19.
  • 7. Royal College of Paediatrics and Child Health, Facing the Future: Standards for Acute General Paediatric Services. 2015.
  • 8. Nuffield Trust, Rural health care: A rapid review of the impact of rurality on the costs of delivering health care. 2019.
  • 9. The Department of Agriculture, Environment and Rural Affairs,, Rural Needs Act (Northern Ireland), Acts of the Northern Ireland Assembly, Editor. 2016.
  • 10. The Health Foundation, The King's Fund, and Nuffield Trust, Closing the gap: Key areas for action on the health and care workforce. 2019.
  • 11. UK Foundation Programme Office, F2 Career Destinations Report 2018. 2018.
  • 12. General Medical Council, The state of medical education and practice in the UK 2018. 2018.
  • 13. NHS, The NHS Long Term Plan. 2019.
  • 14. Health Education England and NHS Improvement, Maximising the Potential: essential measures to support SAS doctors. 2019.
  • 15. Royal College of Paediatrics and Child Health, Royal College of General Paediatrics, and Royal College of Nursing, Facing the Future: Together for Child Health. 2015: London.
  • 16. Royal College of Paediatrics and Child Health. Paediatrics 2040. 02/10/2019]; Available from: www.rcpch.ac.uk/work-we-do/paediatrics-2040.