British Association of Urological Surgeons and The Specialist Advisory Committee in Urology Workforce Report November 217 Michael Palmer, Charlotte Taylor 1
Overall UK Consultant and Trainee Numbers 213 214 215 216 217 Consultant 886 963 989 148 183 Trainee 326 277* 322 31 319 UK Consultant Distribution 217 (216) Total 217 (216) Substantive 217 (216) Locums 217 (216) England 922 (889) 866 (848) 56 (41) Wales 5 (5) 46 (46) 4 (4) Scotland 86(85) 83 (81) 3 (5) Northern Ireland 25 (24) 24 (23) 1 (1) UK 183 (148) 119 (997) 64 (51) Republic of Ireland 44 39 5 2
Consultant Numbers by BAUS Region Region Regional Rep Substantive Locum Cons 217(216) England North East David Thomas 46(47) North West Max Mokete 124(124) 8 Yorks/Humberside Tony Browning 88 (9) 5 West Midlands Hemant Ohja 78(78) 7 East Midlands Simon Williams 49 (49) 3 East of England Bill Turner 11(92) 14 South East Coast Sri Sriprasad 71(63) 1 London North Giles Hellawell 14 (12) 9 London South Nick Watkin 53(53) 4 South Central Matt Hayes 75 (77) 4 South West Mark Stott 77 (73) 1 Wales Neil Fenn 46 (46) 4 Scotland Scotland West Mary Brown 45 (43) 1 Scotland East Ben Thomas 38 (37) 2 Northern Ireland John McKnight 24 (23) 1 UK Total 119 (997) 64 (51) Republic of Ireland Tom Lynch 33 4 3
UK SUBSTANTIVE Consultant Urologist: Population Ratios 27-17 UK England Wales Scotland N Ireland 27 1:88, 1:91, 1:9, 1:83, 1:11. 28 1:84, 1:85, 1:83, 1:72, 1:13, 29 1:8, 1:81, 1:78, 1:71, 1:93, 21 1:77, 1:78, 1:7, 1:7, 1:89, 211 1:74,121 1:74,31 1:71,581 1:69,613 1:89,97 212 1:72,189 1:72,36 1:7,455 1:69,142 1:82,39 213 1:71,312 1:71,349 1:68,76 1:68,771 1:86,232 214 1:7,33 1:69,99 1:75,61 1:68,831 1:85,714 215 1:69,457 1:69,95 1:74,171 1:66,512 1:84,286 216 1:65,769 1:65,116 1:67,826 1:67,25 1:81, 217 1:64,376 1:63,81 1:67,68 1:65,6 1:77,5 Total Consultant Numbers 26-17 12 1 8 6 4 2 26 28 21 212 213 214 215 216 217 There has been a 3.3% increase in total consultant numbers over the last 12 months and a 2.2% increase in substantive numbers. Increase in locum consultant numbers was 25% Chronological Rate of Annual Total Consultant Expansion (%) 4
1 9 8 7 6 5 4 3 2 1 8.9 8.7 6.9 5.9 6 5.5 5.4 5 3.3 4.2 3.7 3 2.7 1.3 3.3.5 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 16/17 The average annual rate of total consultant expansion over the last 16 years has been 4.6% Substantive UK Consultant: Population Ratios 217 UK 1: 64,376 (relative to 216) 65.6 million England 1: 63,81 55.26 million Wales 1: 67,68 no change 3.11 million Scotland 1: 65,6 5.4 million Northern Ireland 1: 77,5 1.86 million Republic Ireland 1: 127,27 216 data 4.7 million Comparison with Other Countries 5
Country Population Number of Urologists Pop ratio United Kingdom 65,648,1 117 1: 64,55 Australia 24,168,33 38 1: 63,5 France 64,811,43 135 1:48,8 New Zealand 4,565,185 12 1: 38,43 Denmark 5,69,75 253 (est) 1: 22,493 Sweden 9,851,852 48 1: 2,524 Spain 47,737,941 24 1: 19,89 Much of the data available online from sources such as EAU/ESRU is out of date. The above information was obtained directly from USANZ, Association Française de Urologie, Spanish Association of Urology, Danish Urological Society and the National Board of Health and Welfare Office (Sweden). The presence of office urologists in some countries makes comparisons difficult. Non-Membership of BAUS 8 7 6 5 4 3 Non-members in substantive posts 2 1 214 215 216 217 There has been a slight reduction in the number of consultants in substantive posts who are not members of BAUS. Unfilled posts 6
14 12 1 8 6 4 2 214 215 216 217 There has been an apparent reduction by 53% in the number of unfilled posts over the last twelve months. 216 217 Total posts (inc unfilled) Unfilled posts Total posts (inc unfilled) Unfilled posts North East 53 5 47 1 North West 137 4 134 2 York / Humber 12 9 1 7 West Midlands 95 14 89 4 East Midlands 59 7 52 East of England 112 14 117 2 South East Coast 76 12 78 7 London North 12 8 12 7 London South 65 1 61 3 South Central 87 9 84 4 South West 79 4 85 7 Wales 55 5 53 3 Scotland West 49 6 48 3 Scotland East 48 6 42 2 Northern Ireland 28 4 28 3 Totals 1165 117 1138 55 The reduction in unfilled posts cannot be explained simply by recruitment into them or replacement by locums. Overall, 27 less posts have been declared compared with last year, when filled and unfilled posts are added together. It is possible that posts which have not been filled have been withdrawn, but inaccurate returns are also an explanation. Gender Ratios 217 7
1% 8% 6% 4% Female Male 2% % Consultant Trainee Current consultant workforce (inc. locums) comprises 92 females and 991 males (8.5% female). Female trainee numbers are 16 of 319 (33%) a slight reduction compared to 216. Consultant Gender Ratio by Age Age range Male Female % Female < 4 66 15 19% 4-49 33 54 14% Over 5 447 16 3% Analysis of 928 consultants for whom date of birth is known Percentage of Female Consultants by Region 2 18 18 16 14 13 13 13 12 1 8 6 4 8 5 5 6 9 4 1 5 6 11 4 2 Consultant Retirements 8
Region Projected Retirements 218-222 North East 8 North West 3 York/Humber 18 West Midlands 19 East Midlands 13 East of England 19 South East Coast 22 London North 26 London South 1 South Central 12 South West 15 Wales 11 Scotland West 6 Scotland East 7 Northern Ireland 4 Based on number of consultants aged 62 or over during 218 222 Projected Retirements as % of Workforce by Region 218-222 35 3 25 2 15 17 24 2 24 27 19 31 25 19 16 19 24 13 18 17 1 5 Trainee Numbers 9
Deanery No of Trainees Northern 19 North West 18 Mersey 17 Yorkshire and Humber 3 West Midlands 25 East Midlands 16 East of England 2 Thames Valley 14 Wessex 11 South West 18 London/KSS 84 Wales 13 Scotland East 14 Scotland West 14 Northern Ireland 6 Total 319 Republic of Ireland 2 (not included in total) Recording the exact number of trainees remains difficult. Calculation was made more difficult this year due to JCST declining to release data to allow cross checking. The apparent increase from last year s total of 31 is mainly due to an increase in the return from London/KSS of 6 trainees. This appears to be due to inaccuracy in previous returns. There will always be variation due to trainees on OOP and in periods of grace, some of whom will have already been replaced at the time of the return, resulting in double counting. Number of Trainees (27-17) 35 3 25 2 15 1 27 29 211 213 214 215 216 217 Trainee numbers remain static (214 figures almost certainly incorrect) Percentage of Female Trainees by Programme 1
7 6 5 61 44 5 45 5 46 43 43 5 4 3 2 1 6 18 34 12 2 3 Certification Statistics GMC CCT Statistics 21-16 Year No of Trainees obtaining CCT (or CESR CP) 21 51 211 44 212 6 213 46 214 54 215 216 51 54 Average annual number of trainees completing training over the last 7 years is 51 11
Workforce Predictions do we have enough trainees? Number of projected Trainees awarded CCT against Consultant retirements 218-222 Assuming 4.5%, 2% and % expansion (Includes SAS Grade retirements) Year CCT Additional Posts (4.5%) Retirements Expansion 4.5% Expansion 2% No expansion 218 59 49 27-17 +1 +32 219 64 51 28-15 +14 +36 22 58 53 39-34 -4 +19 221 67 56 32-21 +12 +35 222 71 58 47-34 +1 +24 Projections are based on the number of consultants reaching 62 in each year. The consultants already over 62 at the time of compilation are excluded as it is assumed that they will be offset by some consultants retiring before age 62. CCT numbers are estimates based on all trainees completing training at their current expected CCT date. Due to lack of JCST figures for cross checking purposes, some data has extrapolated from 216 data. As in previous years, the figures demonstrate the importance of consultant expansion in the calculations. If the expansion continues at the same rate as the last 15 years we do not have enough trainees. A smaller expansion could be accommodated. Number of projected Trainees awarded CCT against Consultant retirements 218-222 using historical average CCT award numbers (Includes SAS Grade retirements) Year CCT Additional Posts (4.5%) Retirements Expansion 4.5% Expansion 2% No expansion 218 51 49 27-25 +2 +24 219 51 51 28-28 +1 +23 22 51 53 39-41 -11 +12 221 51 56 32-37 -4 +19 222 51 58 47-54 -19 +4 Using a more realistic number of CCT awards based on historical averages, these predictions show that even a very small expansion of 2% is not achievable in the medium term. The number of trainees required to expand at 2% over the next 5 years would be 288, based on these figures, but we are unlikely to produce more than 255 new CCT holders during that period. If the expansion continues at the same rate as the last 15 years there will be a significant shortfall. Longer Term Projections 12
An additional approach to estimating trainee numbers is to look at longer term trends. Using the following data a number of projections can be developed. Of 928 consultants whose date of birth is known, there are 463 aged over 5 years (5%). This number can be expected to retire over the next 12 years. The expected number of SAS retirements is not known but has been estimated in the past to be approximately 7 per year. There are a total of 319 Urology trainees on a 5 year training programme. If all trainees achieve CCT (or CESR CP) within the minimum time then the maximum average number of new consultants per annum we can achieve is 64. This will not be achieved due to periods of OOP, delayed progression, post CCT fellowships and some trainees not taking up UK consultant posts. Over the last 7 years the average number has been 51 per annum. Unfilled posts have not been included in this analysis. Historical consultant grade expansion has been 4.6% over the last 15 years. We do not know what it will be going forward, but it is highly unlikely to be % Scenario 1 Minimum requirement Assumptions Number over next 12 years Replacement of retired Known consultants only 463 Urologists SAS grades not included Expansion 2% 289 New consultants available Maximum possible 744 Outcome -8 Scenario 2 Realistic requirement Assumptions Number over next 12 years Replacement of retired Known consultants only, 463 Urologists SAS grades not included Expansion 2% 289 New consultants available Historical average (51 per annum) 612 Outcome -14 Scenario 3 Maximum requirement 13
Assumptions Number over next 12 years Replacement of retired SAS grades included at rate 547 Urologists of 7 per annum Expansion Historical average (4.6%) 772 New consultants available Historical average (51 per annum) 612 Outcome -77 These scenarios continue to provide evidence that we do not have enough trainees. The training programme can only deliver Scenario 1. This scenario uses an expansion rate that is half the historical average, ignores SAS retirements and has an unrealistic number of new consultants becoming available. The other scenarios are short by large margins. Although Scenario 3 might seem extreme, it uses the historical averages over the last few years. Using Scenario 2 as a guide we would need to produce 63 new consultants per year. Based on the recent CCT awards, the average is 82% of the maximum number. To produce 63 CCTs per annum we would therefore need 384 trainees 65 more than we have at present. This number is lower than quoted last year because unfilled posts have not been included in the analysis. Workload Data 14
Outpatient HES Data (England only) New Patients Follow Up 1,8, 1,6, 1,4, 1,2, 1,446,555 1,57,6551,533,491 1,34,953 1,125,9741,128,353 1,21,5211,256,2771,265,21 1,275,83 1,, 8, 6, 466,98 498,432 548,852 588,326 582,623 596,279 627,22 712,559 741,44 749,891 4, 2, 26/7 27/8 28/9 29/1 21/11 211/12 212/13 213/14 214/15 215/16 Outpatient attendance 215/16 Main Specialty New Patients Follow Up 3,, 2,5, 2,527,215 2,, 1,99,91 2,12,413 2,21,224 1,5, 1,533,491 1,579,36 1,, 749,891 938,228 891,174 5, 482,88 Urology General Medicine General Surgery Gastroenterology Gynaecology Procedures (HES England only) 15
45, 4, 35, 3, 25, 2, 15, 1, 5, TURBT 41,7 39,15239,33139,712 39,691 4,4514,26 39,373 35,33535,137 35,7135,535 36,434 34,16633,485 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, Flexi URS / PCNL 9,561 8,518 7,9 6,459 6,987 5,716 4,74 2,582 2,798 3,17 3,321 3,552 3,851 4,133 3,436 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 16
Partial Nephrectomy 1,8 1,6 1,516 1,579 1,713 1,4 1,2 1, 8 6 4 384 446 514 579 598 63 721 783 8 972 1,16 1,327 2 8, 7,5 7, 6,5 6, 5,5 5, 4,5 4, 3,5 3, 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 Nephrectomy 7,344 7,299 6,999 6,799 6,6 6,154 6,264 6,316 6,281 4,882 5,144 5,34 5,359 5,676 5,73 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 Cystectomy 2, 1,9 1,8 1,7 1,6 1,5 1,4 1,3 1,2 1,1 1, 1,89 1,889 1,92 1,922 1,927 1,81 1,654 1,67 1,564 1,588 1,489 1,475 1,479 1,51 1,396 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 17
8, Open Excision of Prostate 7,527 7, 6, 5, 4, 3, 2,53 2,916 2,984 3,413 3,537 3,487 3,582 4,26 4,846 5,52 5,576 5,318 6,122 6,554 2, 1, 3,8 3,6 3,4 3,2 3, 2,8 2,6 2,4 2,2 2, 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 Repair of Urethra 3,431 3,534 3,488 3,436 3,466 3,37 3,224 3,255 3,3 3,269 3,82 3,49 3,9 3,142 2,89 1/2 2/3 3/4 4/5 5/6 6/7 7/8 8/9 9/1 1/11 11/12 12/13 13/14 14/15 15/16 Acknowledgements. My thanks to: Charlotte Taylor who has collated and provided updates of the data tables Encarna Manzano, JCST/ SAC Urology for providing JCST data to help with verification. BAUS regional representatives for timely and accurate data submission. TPDs for updating the trainee information 18