UK’s most vulnerable children at risk of ‘falling through gaps’ say children’s doctors

Support for vulnerable children and families in need of community services covering obesity and mental health conditions are suffering as a new workforce survey, published today by the Royal College of Paediatrics and Child Health (RCPCH), reveals extreme shortages of newly qualified consultants.

The ‘CCT Class of 2016 – Where are they now?’ report, found that just 9.6% of newly trained paediatricians took up a consultant post in community child health – the specialty which is also responsible for assessing children for abuse or neglect and treating conditions like ADHD and obesity. This compares to the recruitment of 65% consultants in general paediatrics and 27.7% in specialist paediatrics such as neonatology, paediatric immunology and infectious diseases and paediatric neurology. However most newly qualified consultants entered the specialty they applied for.

In just one mental health trust in England, referrals went from an expected 6,545 to 11,500 in 2017-18, leading to more than 2,000 young people waiting for assessment or treatmentand pushing waiting times for routine appointments up to 19 months. The number of children who were the subject of a child protection plan (CPP) because they have suffered, or are at risk of suffering from, serious harm has also been increasing, with year on year rises of 126.7%. This sharp spike in demand is making doctors fearful that vulnerable children who need community paediatric services are going to ‘fall through the gaps’ unless a more doctors are recruited to the specialty.

Commenting on the findings, Dr Simon Clark, Workforce Officer at the Royal College of Paediatrics and Child Health (RCPCH), said:

“There’s no hiding the fact that all specialities need extra resourcing but as patient numbers increase along with the number of conditions they present with, services are going to become even more stretched. What’s striking about these latest workforce findings is the disparity between newly qualified consultants taking up positions in community paediatrics – a specialty that holds so much responsibility in managing growing 21st century problems – and general paediatric posts.  And with the average age of a consultant community paediatrician between 45 and 54, there is a risk this gap will widen further once they retire.

“If we are to reduce the pressure on services and support the most vulnerable children in society, more resources must be provided for community child health.”

The RCPCH believes that around 80 more community paediatricians are needed each year for the next five years to help sustain and improve these services. Without more support there is a threat of children falling through the gaps.

To make the specialty more appealing doctors say there should be a sustained plan to improve staffing. This plan must include giving trainees early exposure to community child health, the use of contract flexibility, opportunities to increase skill mix and support to develop and extend into other professional roles.

The CCT survey, which informs workforce planning to ensure the right support is available for new consultants, also highlighted that:

  • Of those working in the UK, 94.4% (167/177) are in a consultant post and of these, 92% (172/187) of respondents are employed by the NHS
  • 80% of respondents are in a permanent post. 29.8% (39/131) of female respondents and 9.3% (5/54) of male respondents are working less than full time
  • When asked how they found the transition from a non-consultant post to consultant, 26.8% (40/149) found it very easy or quite easy and 30.2% (45/149) found it either quite difficult or very difficult
  • Fewer doctors are working in a different region than the region they trained in after CCT – 27.7% of 2016 cohort respondents compared to 31.7% of 2015 cohort respondents
  • There has been an increase from 77% in 2015 to 89.2% in 2016 of those who are working in the same specialty as their specialist registration with the GMC

Dr Clark continued:

“Our survey also revealed that more newly qualified consultants are securing jobs in their chosen specialty and location.  Whilst this is great for doctors, this makes it harder to recruit in areas where filling consultant and trainee posts is already challenging such as remote and rural areas. This can also have an adverse impact on service delivery. The lack of competition for consultant jobs may also raise concerns about the quality of the future workforce.”