Key take-home messages

• The UK currently has a shortage of 1,400 anaesthetists.

• Most operations cannot take place without an anaesthetist.

• This shortage is estimated to cause 1 million operations to be cancelled each year.

• Demand for healthcare, in particular surgery, is rising due to factors such as the growing and ageing UK population.

• Supply of anaesthetists is constrained by inadequate training numbers, ageing workforce and poor retention.

• 39% of anaesthetists are aged 50+, an increase from 31% in 2007.

• Factors driving poor retention include increasing workloads, lack of flexibility in working hours and pension tax rules.

• The pandemic has had a major impact on the wellbeing and morale of the anaesthetic workforce.

• Due to the mismatch between supply and demand, the shortage of anaesthetic staff will reach 11,000 by 2040, which would prevent 8.25m operations taking place.

• There is an urgent need to address the anaesthetic workforce if the government is to achieve its goal of reducing elective surgery waiting lists.

• Solutions must include increasing anaesthetic training places, addressing the causes of poor retention and adopting a sustainable long term approach to workforce planning.

Background

Prior to the pandemic, the UK had a lower number of doctors per capita than most other developed countries (2.8 doctors per 1000 population, compared with 3.6 in comparable countries). 

Anaesthetists led on the frontline response to COVID-19 due to their unique skillset in looking after critically ill patients. This has led to high levels of mental ill health and burnout in the profession.

Increasing amounts of money are now being spent by anaesthetic departments on locums, bank staff and overtime to cover demand - this is not sustainable.

Anaesthetists are involved in the care of two thirds of hospital patients.

Higher training recruitment crisis

The number of applications to higher anaesthetic training is increasing - 758 in 2020, 1056 in 2021.

But the number of training posts is decreasing - 499 in 2019, 359 in 2021.

Each trainee carries out roughly 405 procedures per year.

Increasing training numbers by 100 would therefore mean 40,500 additional operations per year in Year 1, rising to 162,000 in Year 4 and, once all were fully qualified, 300,000 operations per year.

Retention crisis

1 in 4 consultants and 1 in 5 SAS doctors plan to leave the NHS within 5 years.

30% of anaesthetists think their workload will be unsustainable as they get older, while 60% think it would only be sustainable with adjustments.

Key issues include work life balance and flexibility - senior anaesthetists are choosing to leave or retire due to the unavailability of flexible working and appropriate job planning.

Pensions crisis

Consultants are facing extremely large tax bills due to annual and lifetime pension allowances being reached. This is largely a result of how the NHS pension is calculated.

In many cases this is leading consultants to reduce their hours or retire as it is not financially favourable to continue working full-time. In the 2020 RCoA Census, 14% of consultants had reduced their working hours due to the tax rules. 22% of consultants who had retired in the previous year said this was due to pensions tax.

In the March 2023 budget the Government made some changes to pension tax rules which should help alleviate some of these issues. These include:

• The Lifetime Allowance (LTA) Tax Charge on pension savings in excess of the LTA was removed in April 2023.

• The Lifetime Allowance is planned to be abolished completely from April 2024.

• Employees on the 1995 pension scheme can now build up further pension on the 2015 scheme.

• Employees on the 1995 scheme can start to draw down while still in work (more flexible than Retire and Return).

• Permanent removal of the “16 hour rule” limit on hours per week in the first month back at work after Retire and Return (this aligns the 1995 scheme with the 2008 and 2015 schemes).

• Annual allowance calculations now exclude growth due to inflation.

Less than Full Time (LTFT) Working

Flexible working is becoming more common across the NHS. One in ten consultants and SAS anaesthetists are currently working LTFT, and this could rise to one in three within five years. Meanwhile 30% of anaesthetists in training are considering working LTFT as consultants. 

The requirement to provide job plans that allow anaesthetists of all ages, genders and grades to stay in work will have an impact on workforce planning. Moreover, the decrease in participation rates will put additional pressure on an already overstretched workforce.

Increase in demand for services

The RCoA commissioned the York Health Economics Consortium (YHEC) to produce projections on the increasing demand for anaesthetists. These projections are based on the Centre for Workforce Intelligence (CfWI) projections from 2015.

There are three main underlying causes of the projected increase in demand for anaesthetic services:

• Growing and ageing population.

• Expansion of new surgical interventions.

• Expansion of the anaesthetist role, e.g. perioperative care pathways.

Overall, the demand for anaesthetists is projected to increase by 3.85% per year. However, the number of anaesthetists is only increasing by 1.54% per year.

This means that by 2040 the UK is projected to require 25,500 anaesthetists but at current rates will only have 14,500 - a shortfall of 11,000.

Impact on patient care

The average anaesthetist delivers 750 anaesthetics per year. The current shortfall of 1,400 anaesthetists therefore means 1,000,000 operations per year cannot take place. If, as projected, this shortfall increases to 11,000, it will mean 8,250,000 operations per year cannot take place.

There is an increasing use of locum anaesthetists to cover gaps in the workforce - this has risen by 16% between 2015 and 2020. Locums can cost up to £1760 per day.

Recommendations

The report concludes that a multifaceted approach is essential to put anaesthesia on a sustainable footing in order to meet demand, reduce the elective backlog and realise the government’s plans for the NHS.

Short to Medium Term

• Increase of ST4 training numbers by 100 per year - this will provide an immediate increase in capacity and will provide a foundation for a larger long term senior workforce.

• Consideration of the impact of the pandemic on wellbeing of anaesthetists, especially with respect to elective targets.

• Pension reforms (partially achieved).

• Increased flexibility with job plans, to allow more anaesthetists to stay in work.

Long Term

• A long term, sustainable approach to workforce planning is required.

• Boost to medical training places across the whole pathway, from medical school to higher training.

• Acceleration of legislation required to regulate anaesthesia associates.

• Transformation of the surgical pathway in line with recommendations from the Centre for Perioperative Care (CPOC) e.g. prehabilitation, shared decision making and improved discharge planning.

Further Reading

The Anaesthetic Workforce: UK State of the Nation Report

Centre for Workforce Intelligence: In-depth review of the anaesthetics and intensive care medicine workforce Final Report