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 workforce[i] 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 Plan[1]. 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 numberof 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.
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 consultants[2], 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 retirement[ii] 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 (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 FY2[iii].
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 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 and the data reveals that similar proportions of FY1 and FY2 doctors qualified within the UK.[iv]
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 surveys[3] 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 training grade doctors[v] 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’s[4] 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
1 year / 5 year / 10 yearConsultants / 3.0% / 14.8% / 41.1%
Associate specialist/staff grade/specialty doctor grades[vii],[viii], / 0.1% / 6.2% / 37.5%
Training grades / 1.0% / 8.9% / 39.8%
GPs (excl retainers) / -0.1% / 4.6% / 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 GPs[ix] 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 - no locum data - cannot illustrate change of contractual status
Table 2 – One, five and 10 year percentage growth rates in UK general practice workforce[x]
1 year / 5 year / 10 yearContractor GPs / -1.0% / -1.5% / -5.0%
Salaried GPs / 3.4% / 33.3% / 409.6%
GP Registrars / 7.4% / 30.4% / 90.4%
GP Retainers / -9.5% / -31.8% / -59.5%
Figure 5 – 10 year growth in contractor GPs versus salaried GPs
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).
Figure 6 - 2012 medical workforce by country
Table 3 – 2012 medical workforce by grade and country[xi]
England / Scotland / Wales / Northern Ireland / UKAll medical staff / 144,123 / 17,381 / 8,453 / 5,030 / 174,981
All Hospital career grades / 51,359 / 6,773 / 3,299 / 2,097 / 63,528
Consultant / 39,613 / 4,717 / 2,256 / 1,494 / 48,080
SAS grades[xii] / 11,746 / 2,056 / 1,043 / 603 / 15,448
Associate Specialist / 3,364 / 1,466 / 385 / 151 / -
Staff Grade / 6,535 / 474 / 288 / -
Other grades[xiii] / 1,847 / 590 / 184 / 164 / 2,785
All training grades / 56,659 / 6,186 / 3,085 / 1,777 / 67,701
Registrar Group / 38,866 / 3,983 / 2,012 / 1,247 / 46,108
GP Registrar / 4,426 / 447 / 202 / Not available / 5,075
FY2 / 7,022 / 764 / 526 / 530 / 8,842
FY1 / 6,215 / 992 / 345 / 7,552
GPs (excluding retainers) / 35,784 / 4,284 / 2,022 / 1,156 / 43,246
GP provider/performer / 26,886 / 3,745 / 1,762 / 1,156 / 33,549
Salaried/Other GP / 8,898 / 539 / 260 / Not available / 9,697
GP retainers / 321 / 138 / 47 / 506
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
Total[xiv] / Male / FemaleHeadcount / % / Headcount / %
All medical staff / 172,911 / 93,849 / 54.2% / 79,062 / 45.7%
All Hospital career grades / 63,244 / 40,913 / 64.7% / 22,331 / 35.3%
Consultant / 47,951 / 32,375 / 67.5% / 15,576 / 32.5%
SAS Grades[xv] / 15,293 / 8,538 / 55.8% / 6,755 / 44.2%
All training grades[xvi] / 67,119 / 30,696 / 45.7% / 36,423 / 54.3%
Registrar Group / 45,912 / 22,073 / 48.1% / 23,839 / 51.9%
GP Registrars[xvii] / 4,873 / 1,760 / 36.1% / 3,113 / 63.9%
FY2[xviii] / 8,785 / 3,757 / 42.8% / 5,028 / 57.2%
FY1 / 7,549 / 3,106 / 41.1% / 4,443 / 58.9%
GPs (excl retainers) / 42,548 / 22,240 / 52.3% / 20,308 / 47.7%
GP provider/performer / 32,392 / 19,190 / 59.2% / 13,202 / 40.8%
Salaried/Other GP / 9,697 / 3,045 / 31.4% / 6,652 / 68.6%
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 / UK / Rest of EEA / Outside EEA / UnknownHC / % / HC / % / HC / %
All medical staff / 151,631 / 102,973 / 69.8% / 9,124 / 6.2% / 35,378 / 24.0% / 21,570
All Hospital grades[xix] / 58,132 / 35,314 / 62.2% / 4,211 / 7.4% / 17,231 / 30.4% / 4,212
Consultant / 44,330 / 29,810 / 68.4% / 3,022 / 6.9% / 10,768 / 24.7% / 2,342
SAS grades[xx] / 13,802 / 5,504 / 41.8% / 1,189 / 9.0% / 6,463 / 49.1% / 1,870
All training grades / 57,972 / 40,160 / 72.7% / 3,298 / 6.0% / 11,750 / 21.3% / 9,058
Registrar Group / 42,849 / 28,099 / 67.8% / 2,808 / 6.8% / 10,550 / 25.4% / 2,901
FY2 / 7,786 / 6,115 / 83.2% / 333 / 4.5% / 903 / 12.3% / 1,117
FY1 / 7,207 / 5,843 / 93.1% / 150 / 2.4% / 280 / 4.5% / 319
GPs (excl retainers)[xxi] / 35,527 / 27,499 / 77.6% / 1,615 / 4.5% / 6,397 / 18.0% / 7,741
2012 UK medical workforce by age
Each of the career grades of doctors (consultants, SAS and GPs) has one-fifth 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 age[xxii]
Total / <30 / 30-34 / 35-39 / 40-44 / 45-49 / 50-54 / 55-59 / >60All medical staff / 171,922 / 30,022 / 25,420 / 27,118 / 23,460 / 21,837 / 19,142 / 13,540 / 9,341
All Hospital grades[xxiii] / 66,262 / 276 / 2,344 / 9,961 / 13,979 / 14,008 / 11,782 / 8,399 / 5,478
Consultant / 48,665 / 2 / 1,064 / 7,374 / 11,184 / 10,814 / 8,553 / 6,074 / 3,583
SAS grades[xxiv] / 17,530 / 271 / 1,280 / 2,586 / 2,785 / 3,176 / 3,210 / 2,310 / 1,891
All training grades / 63,828 / 29,311 / 18,579 / 10,964 / 3,467 / 1,028 / 335 / 91 / 46
Registrar Group / 46,450 / 14,882 / 16,848 / 10,231 / 3,186 / 905 / 289 / 73 / 35
GP Registrars[xxv] / 447 / 218 / 131 / 62 / 29 / 6 / 1 / 0 / 0
FY2[xxvi] / 9,322 / 7,368 / 1,107 / 496 / 190 / 91 / 35 / 18 / 11
FY1 / 7,609 / 6,843 / 493 / 175 / 62 / 26 / 10 / 0 / 0
GPs (excl retainers) / 41,832 / 435 / 4,497 / 6,193 / 6,014 / 6,801 / 7,025 / 5,050 / 3,817
Health Policy & Economic Research Unit 1
[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.
[ii] On 1 April 2012
[iii] Data is not available in this detail for Northern Ireland.
[iv]Data for Wales is not available by Country of qualification
[v]Registrars, specialist registrars, GP registrars, GP specialty training, SHOs, FTSTAs, FY2s, FY1/PRHOs.
[vi]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.
[vii]Not including ‘other grades’, or data for associate specialist/staff grade/speciality doctor grades in Scotland.
[viii]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.
[ix]Not including freelance/locum GPs.