Workforce Planning: is there an impending crisis in consultant posts available for neurology trainees?

The last two years have seen a significant expansion in the number of neurology registrar posts in response to the crisis caused by MMC. While this has been generally welcomed, there are concerns about whether there will be sufficient consultant posts for these trainees to move into, when they obtain their CCTs. In neurosurgery, trainees have predicted that there will be a deficit in consultant posts available for trainees finishing between now and 2012.

It is surprisingly difficult to find accurate information about the current numbers of neurology trainees and consultant posts. The most complete information for England comes from the NHS Workforce Review Team, who use data from Deaneries and a survey of Trust payrolls, but even this has proved to be inaccurate. Boyd Ghosh, ABNT Treasurer, has therefore undertaken a major piece of work to obtain more accurate information on the current numbers of neurology registrars in England. Boyd has combined data from the Workforce Review Team with information from Deaneries, programme directors, the Royal College of Physicians and individual trainees (including deferred posts). Boyd’s figures indicate that there are almost 100 more registrars due to complete training by 2014 than the Workforce Review Team were aware of. There is likely to be a “bulge” of trainees completing their CCT in 2011 due to expansion associated with MMC (red line in Figure 1).

According to Workforce Review Team data there were 539 NHS consultant posts in England in 2007. To make predictions about likely vacancies, they assume a net figure of 6 young consultants leaving each year, due to maternity leave or other movements, as well as assumptions about retirements. Boyd has extrapolated the consultant expansion of the last 10 years, 7% annually, to give a likely number of consultant posts in the future.

Using these assumptions (green line in Figure 1), the number of consultant vacancies should be sufficient for all registrars completing training until 2012. However, making slight changes to these assumptions changes these predictions substantially. For instance, if we were to gain 9 international consultants per year, as the workforce review team have assumed in their figures, and not have the predicted 6 young leavers, there would be insufficient consultant posts to accommodate the “bulge” of trainees completing in 2011 (black line in Figure 1).

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So what’s the bottom line? Based on the best data available, it doesn’t seem that there is a looming crisis in the number of consultant posts for neurology trainees as has been predicted in neurosurgery. However, accommodating all current trainees will certainly require ongoing consultant expansion in the specialty. Existing official sources of data on trainee numbers are worryingly inaccurate. The ABNT will try to maintain more accurate data, and will continue to make the case for ongoing consultant expansion in neurology. It may also be time for a wider debate about whether the role of consultant neurologists may need to broaden or change if we are to be successful in achieving this.