New clinical oncology workforce figures highlight looming shortage of cancer doctors

Thursday 7 September 2017

NHS training leads must boost the number of clinical oncologists and invest in the oncology workforce as cancer prevalence grows, RCR says

New figures from The Royal College of Radiologists (RCR) reveal the UK’s clinical oncology consultant1 workforce remains under serious strain, with overworked doctors, difficulty filling vacancies and not enough trainees.

Released today, the RCR's Clinical Oncology UK Workforce Census Report 2016 – based on staff data from every UK cancer hospital2 – shows that during a time of growing need for non-surgical cancer treatment:

  • 5% of clinical oncologist posts sat vacant during the course of last year, up from a 3% vacancy rate in 2015

  • At least 78 extra clinical oncologists would be needed right now, just to make up for the overtime in contracted activities routinely worked by clinicians

  • 20% of clinical oncology training places were unfilled last year, with a predicted annual growth in new consultants of just 1% not enough to meet future needs

  • 6% of the UK's clinical oncology workforce qualified elsewhere in the EU, raising continuing questions over the impact Brexit might have on staff retention. In total, one-in-four practising clinical oncologists are from abroad

Figures show the number of full-time clinical oncologists in full-time permanent posts grew by 1.4% last year – with the equivalent of 822 consultants in substantive posts in 2016, compared to 811 in 2015. Meanwhile, locum numbers more than doubled, from 17 locum consultants in 2015 to 37 in 2016. 

Despite the apparent growth in numbers, our consultants are getting busier and busier, with patient numbers increasing as a result of the aging population on the one hand, and improvements in therapy on the other. As a result, many hospitals are struggling to recruit to meet demand.

Full-time hospital doctors are usually contracted to work ten sets of “programmed activities” (PA) periods during a working week3. In 2015, UK clinical oncologists worked 10.7 PAs on average, which rose to 11 PAs last year. To cover that overtime, at least 78 extra full-time consultants would need to be recruited.

Vacancy rates are also growing. In 2015, 3% of clinical oncology posts sat vacant (21 empty jobs). In 2016 the figure leapt to 5%, with 42 vacant consult jobs across the UK. South West England and the East Midlands were the most understaffed regional areas in 2016, with vacancy rates of 13% and 12% respectively.

In addition, the speciality is starting to see the knock-on effect of a previous drop in junior doctors going through core medical training (a pre-requisite for clinical oncology trainees) in 2012/13. Last year, one-in-five newly advertised clinical oncology training places sat unfilled.

Sadly, the College is not surprised by these most recent findings, which only reinforce those of previous years4. We are calling on Health Education England and its counterparts in the devolved nations to urgently invest in the cancer workforce and plan ahead.

Dr Jeanette Dickson, RCR Vice-President, Clinical Oncology, said:

"We know more about preventing and successfully treating cancer than ever, but the overall number of cancer patients is still set to grow three per cent every year5. Thanks to constant advances in non-surgical treatments and technologies more people are surviving the disease - but to continue to tackle new cases and manage patients surviving cancer it is brutally clear we need more doctors.

"If the Government does not help clinical oncologists, as well as the wider clinical oncology community, then patients will not receive the future care they deserve. Our figures make sobering reading and we are putting Health Education England and other NHS training bodies across the UK on notice; a cancer care crisis is looming if you do nothing to improve workforce planning and sustainability.

"The RCR is working hard to attract more trainees into clinical oncology, but the Government has to show some commitment to making the whole clinical oncology workforce sustainable, so tomorrow's healthcare workers actually want to work in cancer treatment. This means helping to fund more trainee doctors, nurses and therapeutic radiographers6 and ensuring we keep the overseas medical talent that, right now, is helping to keep our cancer services afloat.

"In addition, instead of the one-off cash injections of recent years, there also needs to be a proper rolling radiotherapy machine replacement programme – the equipment base must be kept up to scratch so that oncologists and radiographers can be confident they are working with the best kit to treat patients. This will ensure the best outcome for our patients and that clinical oncology remains an attractive, properly-resourced speciality for doctors to work in.” 

Cardiff-based clinical oncology trainee and co-chair of the RCR’s Oncology Registrars’ Forum Dr Caitlin Bowden said:

"The number of unfilled training places means an already depleted pool of trainees being spread more thinly. Opportunities for extra training and development, such as cancer research projects, are diminishing as time spent treating and advising patients has to take priority

"And it almost goes without saying that the growing demands we see being placed on what is a relatively small pool of consultant colleagues is not conducive to training the next generation of clinical oncologists.

"With constant advances in cancer treatments, it is more important than ever that registrars receive comprehensive training and it is daunting that we may be expected to start our first consultant job having received less teaching from senior colleagues who are themselves stretched to the limit."  

ENDS

References

  1. A clinical oncologist is a medical specialist who is trained in prescribing both radiotherapy and systemic therapies: chemotherapy, hormone therapy, biological therapy and the use of radioactive isotopes to treat patients with cancer.
  2. The RCR has been conducting an annual clinical oncology workforce report since 2008. Data for 2016 was collected between December 2016 and March 2017 as part of an online survey of hospital heads of service. Information was returned for each of the UK’s 62 cancer centres.
  3. Doctors’ working time is split into programmed activity (PA) units. In England, Scotland and Northern Ireland PAs are four-hour slots. In Wales, each PA unit is 3.5 hours.  
  4. RCR Clinical Oncology Workforce Census 2015: https://www.rcr.ac.uk/posts/latest-rcr-census-highlights-mounting-crisis-clinical-oncology-workforce
  5. Cancer incidence statistics from Cancer Research UK: http://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence#heading-Zero
  6. A therapeutic radiographer is a qualified radiographer who has undergone specific training in order to delivery radiotherapy to cancer patients. 

Notes to Editors

  • For further information and interviews, please contact Emma Cooper on 020 7406 5941 or email emma_cooper@rcr.ac.uk Out of office hours please call 07554 998197.
  • The Royal College of Radiologists has over 10,000 Fellows and members worldwide, representing the specialties of clinical oncology and clinical radiology.
  • The College sets and maintains the standards for entry to and practice in the specialties in addition to leading and supporting practitioners throughout their career www.rcr.ac.uk