Annual workforce figures released today by The Royal College of Radiologists (RCR) reveal the continuing struggle to staff cancer centres.
Clinical oncology leaders have questioned how the NHS will be able to rollout cutting-edge life-saving innovations – such as immunotherapy drugs and high energy proton beam radiotherapy – without more investment.
The RCR’s Clinical Oncology UK Workforce Census Report 2018 details the current staffing crisis among clinical oncologists (1).
Oncology trainee numbers need to at least double
Based on data from every UK cancer hospital (2), the report reveals:
- One-in-six UK cancer centres now operates with fewer clinical oncology consultants than five years ago
- Vacancies for clinical oncology posts are now double what they were in 2013 – with more than half of vacant posts empty for a year or more
- The UK’s clinical oncology workforce is currently 18 per cent understaffed – without investment the shortfall is predicted to grow to at least 22 per cent by 2023
- To close the gap between supply and demand for cancer doctors, oncology trainee numbers need to at least double. Even with that investment, the gap would not be closed until 2029.
The RCR report shows there were 922 clinical oncology consultants working across the UK’s 62 cancer centres in 2018.
This equates to 863 doctors working full-time – an increase of 46 full-time consultants in practice compared to 2017.
Although the number of consultant clinical oncologists in the UK is growing, the increase is not keeping up with the needs of hospitals and patients. Nearly 1,000 people are diagnosed with cancer every day (3), and demand for radiotherapy and chemotherapy services are going up by two (4) and four (5) per cent a year respectively.
The UK is now short of at least 184 clinical oncologists
The UK is now short of at least 184 clinical oncologists – the minimum number needed to fill vacancies and cover the extra hours doctors are working to treat patients. This compares to shortfalls of 144 doctors in 2017 and 78 in 2016.
While 53 new UK-qualified consultants are set to enter the workforce in 2019, these new recruits will not be enough to fill the 70 posts left empty in 2018.
With not enough consultant clinical oncologists being trained, cancer centres are reporting increasing difficulties with recruitment.
Last year, there were 70 funded vacancies for clinical oncology consultants, compared to 33 empty posts in 2013. However, this number only gives an indication of the real need for more doctors, as it is based on how many jobs centres were able to fund and advertise.
One cancer centre admitted to having no new job applicants since 2015, stating “the situation is dire”, and others stated they could not fund, let alone recruit to, much-needed extra posts.
Meanwhile, attempts to recruit from abroad have been patchy, with only five centres successfully hiring overseas doctors last year. Reported issues included not having the resources to support consultants trained overseas, as well practical problems with remote job interviews and needing more hospital HR expertise to deal with complex overseas recruitment issues.
The RCR’s workforce report estimates that by 2023, the NHS will need a bare minimum of 1,214 full-time clinical oncology consultants to look after cancer patients. However, based on current trends, there will only be 942, meaning the UK will be 22 per cent short of the number of consultants it needs.
The report forecasts that we can close the gap between supply and demand if the number of trainee placements is doubled – from 64 placements a year to around 138.
However, it would still take another decade before consultant numbers catch up.
Dr Tom Roques, the RCR’s Medical Director of Professional Practice for Clinical Oncology and lead author of the workforce report, said:
“The UK is seeing more and more fantastic innovations in cancer treatment – from the introduction of new immunotherapy drugs to the NHS’ first high energy proton beam radiotherapy centre.
“Clinical oncologists are vital to the rollout of these new therapies but we do not have enough of them and our workforce projections are increasingly bleak, which begs the question, what kind of service will we be able to provide for our patients in future?
“Today’s RCR workforce figures and forecasts show our cancer hospitals under immense strain – some centres have seen a reduction or stall in consultant numbers and many are desperate but failing to recruit, predominantly because we do not have enough consultants in training.
“We predict that by 2023 the workforce will be more than 20 per cent short-staffed, and we are really concerned that it is people with cancer who will suffer, with less clinical oncologists’ expert time to go around.
“Central and devolved governments and their related health workforce agencies must face up to these findings and act on them now to boost clinical oncologist numbers, as well as improving working practices to help keep them in the NHS, for the sake of all current and future cancer patients.”
- A clinical oncologist is a doctor who is specially trained in prescribing both radiotherapy and systemic therapies: chemotherapy, hormone therapy, immunotherapy and the use of radioactive isotopes to treat patients with cancer.
- The RCR has been conducting an annual clinical oncology workforce report since 2008. Data for 2018 was collected between October and December 2018 as part of an online survey of hospital heads of service. Information was returned for each of the UK’s 62 cancer centres.
- Public Health England. Radiotherapy activity across England. National Cancer Registration and Analysis Service (NCRAS). London: Public Health England, 2017.
- National Audit Office. Progress in improving cancer services and outcomes in England. London: National Audit Office, 2015.