Workforce Surveys

What was the survey?

As we all know, record waiting lists for Trauma and Orthopaedic procedures are impacting the quality of life for hundreds of thousands of patients across the country. Prior to the pandemic, waiting times were a key issue for the NHS, however the challenges imposed by Covid-19 have driven these to new heights.

The BOA undertook a survey of the workforce and of trainees, to help recognise the workforce factors involved in tackling waiting lists. We wanted to better understand their current work and training situations and future intentions to represent the views of our members at the highest levels driving strategies. The survey was distributed via member newsmails, on the BOA website and by social media. We also worked in partnership with BOTA to ensure the voices of trainees could be heard.

We received survey responses from 571 T&O consultants and locums (of an estimated 3,000 in the UK ~ 19%), 60 SAS surgeons, 409 trainees and 76 post-CCTs. This strong response represented all areas of T&O and every region of the country.

Current Workforce Capacity

  • T&O consultants and SAS surgeons in the NHS are not yet back to their pre-pandemic number of operating lists per week. On average they reported doing 28% fewer sessions of elective operating (from average of 2.5 pre-pandemic to 1.8 currently per week). We believe it must be a priority to get all surgeons back working at their full capacity for NHS work.
  • Almost half (48%) of T&O surgeons surveyed would take on extra work if asked, in order to help patients and assist the NHS through this difficult time. This additional capacity could be used to benefit patients, however we clearly appreciate that it is not only surgeons that are required to increase surgical capacity.
  • Sufficient beds, peri- and post-operative care, and the wider surgical team are vital to allow operations to continue. The President of the Royal College of Anaesthetists, Dr Fiona Donald, has expressed concerns that demands are becoming “beyond reasonable”. Long-term workforce and operational planning is necessary to ensure the people and resources are in place.

Future Projections

  • A potential workforce capacity gap could arise as consultant losses to retirement grow and recruitment bottlenecks occur.

Delays to Qualification

  • More than half (52%) of trainees continue to experience reduced training opportunities compared to pre-pandemic levels, despite over 80% reporting that they want to do extra to make up their numbers.
  • Trainees are not going on to consultant posts at the rate expected, due to delays (10%) or anticipated delays (45%) to CCT and difficulty securing consultant posts. We believe that every operation should be a training opportunity.

Retirement Intentions

  • Very concerningly, a quarter of consultants over 45 intend to retire in the next three years, which is double the rate seen in a 2019 survey by RCP, in which only 12% of consultants over 45 intended to retire in the subsequent 3 years. This is most pronounced in the 55-59 age group, the “backbone of the profession” who are experienced and skilled in both patient care and teaching.
  • 28% of those over 45 are saying they will retire earlier than intended due to the pandemic (with 4% saying they will retire later because of it).
  • The top three factors influencing retirement were: organisational culture & management, the pension taxation system and dissatisfaction with NHS culture. We believe it is imperative that NHS England urgently addresses these issues to retain talent.