Almost three quarters of consultant surgeons who took part in a national survey work more than their contracted hours and seventy per cent report they are expected to undertake elective operations while they are supposed to be on call for emergencies. These are the headline statistics from the first ever comprehensive survey of the surgical workforce published today (Thursday 27th Jan) by the Royal College of Surgeons (RCS).

The Surgical Workforce Report 2010 is the first edition of what will become an annual survey of surgical consultants working practices and is intended to provide the NHS with accurate figures to inform long term planning of the numbers of surgeons required to serve the UK. The report breaks down figures for each of the nine surgical specialties and was produced in collaboration with each of their associations*:

• Almost three quarters of respondents work above the standard NHS 10 sessions a week recommended by NHS Employers (called “programmed activities” or PAs in the NHS). This entails working significantly longer than the 48 hour European working time limit – however just twenty per cent of consultants have formally opted-out of the Working Time Regulation.
• Nearly 9 in 10 consultant surgeons who responded to the survey work on call at weekends and evenings providing 24hr care – this compares favourably with other hospital medical disciplines who currently struggle to provide consultant cover out-of-hours. Most of these surgeons work in on call rotas between 1 in 4 and 1 in 8.
• Overall, a small minority (six per cent) report working even more intensive rotas of 1 in 3 or less – however this figure is higher in some specialties (eg. rises to nineteen per cent of urologists).
• RCS guidelines state that time spent on call is intended to have a surgeon readily available to deal with emergencies – but seventy per cent of respondents report they are expected to undertake elective operating lists during on-call time. This is a significant barrier to improving emergency surgery in some specialties in the UK.
• A third of consultants who responded indicated a wish to work part-time at some point in their career – but less than ten per cent actually do.

John Black, President of the RCS, said:

“This survey demonstrates the high level of commitment to patients that exists in surgery. Our members routinely work far beyond what they are formally contracted to and patients should be reassured to learn that experienced consultant surgeons are routinely on call at night and at weekends if needed – the RCS believes that patient care is safest when led by consultants. It is a matter of concern that so many surgeons are being expected to undertake elective operations while on call – other studies have shown this leads to delays in them getting to emergencies as they cannot be in two places at once.

“The report also shows that women appear to be under-represented in surgery. Although there appear to be very few women consultant surgeons this reflects the fact that very few women went to medical school at the time the present generation of consultants entered specialty training. We expect to see far more female surgeons in the future.”

The report demonstrates the progress that still needs to be made in the gender balance within the surgical workforce. Despite the current graduate output from medical schools being 55 per cent female, only seven per cent of surgical consultants are women. This picture varies across the specialties with Oral and Maxillofacial (3.8 per cent) and Orthopaedics (4.6 per cent) reporting the lowest proportion and plastic surgery (13.1 per cent) and Paediatric Surgery (20 per cent) showing the greatest progress.

Bob Greatorex, RCS Council lead for the Workforce survey, said:

“For a long time there has been a boom-and-bust cycle in surgical service workforce provision in the NHS. Either there were acute shortages of skilled surgeons or an excess number who could not secure appropriate posts. Uneven distribution of workforce resources has repeatedly presented a significant obstacle to the delivery of the best possible care for the needs of the population so this new annual survey will provide all those planning for the future with the means to make sound decisions. This survey also shows that there is an opportunity for employer to offer flexibility for part-time working to lengthen NHS careers and retain the skills and experience of highly-trained consultants.”

The survey is available from the RCS website.

- Ends -

Notes to Editors:

1.  *The report was produced by RCS in collaboration with:
-The Association of Surgeons of Great Britain and Ireland
-The British Orthopaedic Association
-The British Association of Urological surgeons
-The British Association of Otorhinolaryngologists – Head and Neck Surgeons
-The British Association of Oral and Maxillofacial Surgeons
-The British Association of Plastic, Reconstructive and Aesthetic Surgeons
-The Society of Cardiothoracic Surgeons of Great Britain and Ireland
-The Society of British Neurological Surgeons
-The British Association of Paediatric Surgeons

2. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808.

If you have any queries please contact:
Matthew Worrall                    - Email: mworrall@rcseng.ac.uk; T: 020 7869 6047
Elaine Towell                         - Email: etowell@rcseng.ac.uk; T: 020 7869 6045
Heather Casey                       - Email: hcasey@rcseng.ac.uk; T: 020 7869 6042
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