SCOPING THE CURRENT PROBLEMS AND SOLUTIONS RELATING TO CONSULTANT by iiw15426

VIEWS: 6 PAGES: 85

									SCOPING THE CURRENT PROBLEMS AND
SOLUTIONS RELATING TO CONSULTANT
     PSYCHIATRIST VACANCIES,
 CONSULTANT RECRUITMENT AND THE
    USE OF LOCUMS IN ENGLAND
   NIMHE/SCMH Joint Workforce Support Unit.
 Supported by the Royal College of Psychiatrists.


                         February 2005



      Angela Hoadley, Malcolm Philip and Kamaldeep Dhillon
CONTENTS

Acknowledgements                                                           3

Reference Group                                                            3

Glossary                                                                   4

Executive summary                                                     To add

Introduction                                                               5

Context                                                                    6

Methodology                                                                13

Survey results 1

      Consultants in post
           England                                                         14
             By Specialty see Appendix A

      Vacancies
           Nationally by specialty                                         15
           By Region and specialty see appendix B

      Consultant recruitment                                               17

2003 Royal college of Psychiatrists Recruitment data                       26

Survey results 2

      Locum costs and usage                                                32

Survey results 3

      Ideas and solutions to shortages (stated in survey responses)        42

Survey results 4

      Impact of Consultant vacancies and locum use                         44

References                                                                 48

Appendix A         Consultants in post by specialty                        50
Appendix B         Vacancies by region and specialty                       56
Appendix C         Questionnaire                                           66




                                        2
ACKNOWLEDGEMENTS

Many thanks to all those who completed the questionnaire, agreed to telephone
interviews and provided further information requested.

Reference Group

A reference group was set up to provide advice on the survey and the final report.

Roslyn Hope                Director, NIMHE National Workforce Programme

John Allcock               Deputy Director, NIMHE National Workforce Programme

Dr Robin Arnold            Consultant, Avon and Wiltshire Mental Health Partnership
                           NHS Trust (British Medical Association)

Dr Jed Boardman            Royal College of Psychiatrists Regional Adviser

Dr. Maggie Corke           Chief Executive, Leicestershire Partnership NHS Trust

Stephen Dalton             Chief Executive, North Cumbria Mental Health and
                           Learning Disabilities NHS Trust, and representative on
                           the introduction of the consultant contract

Barry Foley                Changing Workforce Programme Mental Health Lead

Dr Peter Jarrett           Medical Director, Oxleas NHS Trust

Deborah Moon               Human Resources Director, East Kent NHS and Social
                           Care Partnership Trust

Dr Susan O’Connor          Medical Director, Avon and Wiltshire Mental Health
                           Partnership NHS Trust

Steve Partridge            Clinical Practice Placements Co-ordinator, Independent
                           Healthcare Association

Dr Sally Pidd              Deputy Registrar – Workforce, Royal College of
                           Psychiatrists

Graham Saxton              Service User

Hugh Stirling              MIND Carlisle

David Tombs                Service User

Dr Christine Vize          Director of Clinical Practice And Development, Avon and
                           Wiltshire Mental Health Partnership NHS Trust

Prof. Michael Wang         Head of Clinical Psychology, University of Hull


                                           3
GLOSSARY

Specialities of psychiatry

AC     Academic
CA    Child and Adolescent
FOR   Forensic
GA    General (Adult)
LD    Learning Disability
MAN   Management
OA    Old Age
OTH   Other
PTH   Psychotherapy


Sub-specialities of psychiatry

LIA Liaison
RHB Rehabilitation
SM Substance Misuse


Others

CAMHS       Child and Adolescent Mental Health Service/s
CCST        Certificate of Completion of Specialist Training
NCCG        Non-Consultant Career Grade
SpR         Specialist Registrar
DP          Discretionary Points
AAC         Advisory Appointments Committee
FT          Full Time
PT          Part Time
WTE         Whole Time Equivalent
CMHT        Community Mental Health Team
AO          Assertive Outreach
IELTS       International English Language Testing System

EEA

The European Economic Area (EEA) encompasses all the members of the European
Union, plus Iceland, Norway and Liechtenstein, and a range of other non-European
countries. There over 70 countries/territories around the world in the European
Economic Area.




                                        4
INTRODUCTION

In September 2003 the Sainsbury Centre for Mental Health (SCMH) and National
Institute for Mental Health, England (NIMHE) set up the Joint Workforce Support Unit
to support national developments, research and analysis on the mental health
workforce. One of the major pieces of work being undertaken nationally is looking at
key roles in psychiatry including the role of the consultant psychiatrist. The Joint
Workforce Support Unit was asked late in 2003 to carry out a national survey of
England on consultant psychiatrist posts, vacancies, recruitment of psychiatrists and
the use of locums.

The Royal College of Psychiatrists (RCP) carry out an annual survey of posts and
vacancies across the UK. For 2003 they decided not to do their own survey and
endorsed this survey, even though this survey work was for England only.

The survey was supplemented by:

    •   Gathering additional specific data from individual Trusts.
    •   Carrying out telephone interviews with Trust Chief Executives and Medical
        Directors.
    •   Analysing the returns made to the Royal College of Psychiatrists from each
        Advisory Appointment Committee (recruitment interview panel) arranged in
        2003, called AAC returns.

The report begins with an overview of the context and development of psychiatry,
some of the changes affecting consultant psychiatrists, and known issues from
previous research on recruitment and retention of psychiatrists. There is no known
recent research on the use of locum psychiatrists.

The work of the report is split into five main sections:

   •    The survey results on consultant numbers and vacancies.

   •    The analysis of the 2003 Royal College of Psychiatrists recruitment data.

   •    The costs and use of locums.

   •    Ideas and solutions to the shortages.

   •    The impact on services of the consultant vacancies and use of locums.

Interspersed in the report are any additional contributions from the telephone
interviews.

The final section is a summary of the key issues from the work and
recommendations for action or further research. In both the context and final section
on key issues and recommendations attention is drawn the NIMHE Workforce
Strategy (2004) and to the current projects underway by NIMHE, the Department of
Health, the Changing Workforce Programme and the Royal College of Psychiatrists
to address consultant shortages.


                                            5
CONTEXT

Whilst many people are familiar with the context and developments in mental health,
it is important to be aware of the full extent of the changes taking place across
mental health and social care. Services are being merged, modernised and
expanded, which is having a tremendous impact on the current service providers and
staff, as well as greatly transforming mental health for the future. Most of the recent
developments are broadly welcomed, although there is continuing concern over the
ability to staff an expanded service, with shortages of all types of mental health
professionals.

National Service Framework (NSF) and NHS plan

The largest impact has undoubtedly been the Adult Mental Health National Service
Framework (1999) and the additional factors included in the NHS plan (2000). These
together set out the Government’s programme of reform and investment to provide
comprehensive adult mental health services across the country. It was recognised at
the outset that this would require a major expansion in staffing for mental health and
significant investment has begun in expanding staffing and in training future staff in
the education system.

To implement the NSF and NHS plan, local implementation teams (LITs) were
created across the country and they were specifically charged with undertaking
multi-agency workforce planning to deliver the workforce required for the NSF and
NHS plan.

The Mental Health Policy Implementation guide (2001) gave more detail about the
services to be created, and other existing services to be improved, outlining staff and
service standards.

Mental health developments are now being taken forward within the NHS planning
and priorities framework 2003-6.

New clinical policy guidance

The National Institute for Mental Health England (NIMHE) have published the
Personality Disorder Services guidance, Personality disorder: No longer a diagnosis
of exclusion (NIMHE 2003), which outlines the appropriate clinical care and
management from specialist mental health services, and it will also ensure that
offenders with a diagnosis of personality disorder (PD) receive appropriate care from
forensic services.

New clinical guidelines

The National Institute for Clinical Excellence (NICE) with its National Collaborating
Centre for Mental Health are producing clinical guidance to improve service
provision. They have published a range of guidance already and a further seven sets
of clinical guidance are due by December 2006.




                                           6
Related developments

The Older People’s NSF was published in 2001 and this contains service
developments for psychiatry under standard seven - Mental Health in Older People.
Children’s mental health services have also been improving and expanding and the
Children’s NSF was published in 2004.

Draft revised Mental Health Bill

The draft Mental Health Bill was originally published by the Department of Health in
2002 and has since been the subject of much discussion. For Consultant
Psychiatrists and workforce planning, the main issue is about the potential expansion
in work under the responsibilities described in the draft Bill.

The European Working Time Directive

The European Working Time Directive (EWTD) currently applies in full to all health
and social care staff, with the exception of doctors in training who are covered by a
phased approach.

The EWTD has begun to cover doctors in training in a phased reduction of maximum
working hours, down to 58 from August 2004 and reducing to 48 hours per week in
2009. Much progress has already been made on junior doctors working hours with
the ‘New Deal’, but the EWTD imposes more stringent requirements in limiting junior
doctors’ hours. The impact is both on general hours and particularly on out of hours
working, mainly on-call.

The Sainsbury Centre for Mental Health surveyed a range of mental health Trusts in
2003 and found they were planning to bring working arrangements for junior doctors
in line with the provisions of the Directive without significant impact onto Consultants
work and thus numbers of consultants.

Restructuring of services

There has been huge upheaval in mental health service configurations in the last
four years, with Trusts merging, and Trusts and Social Services Departments
developing new working arrangements from closer collaboration to the creation of
Care Partnership Trusts.

Added to this there have been the changes at Regional Health Authority level and
changes at local level, with the introduction of Primary Care Trusts. In some cases
these now run mental health services, in many others they are responsible for
commissioning mental health services. Soon after their inception there was the
implementation of new business planning and contracting arrangements, centred on
the Local Delivery Plan (LDP). The service is now entering a further phase of change
with the NHS improvement plan. This includes more system reform with the
implementation of the new Health and Social Care (Community Health Standards)
Bill 2003, allowing the creation of NHS Foundation Trusts. There will be new
payment and contracting systems within the NHS, and proposed greater patient
choice from 2005 onwards.


                                           7
  New Consultant Contract

  As well as the accelerating pace of service change in the last few years a new
  consultants contract was negotiated over 2002/3 and introduced in 2003/4. The key
  changes to the existing consultant contract arrangements are:
     • Non emergency work during out of hours by agreement only.
     • Enhanced recognition for work done out of hours.
     • Agreed appeals procedure for pay progression and job planning.
     • Standardised approach to offering spare professional capacity.
     • Standardised number of sessions spent on direct clinical care.
     • Enhanced entitlement to annual leave.

  A review of the issues in implementation of the new contract is being undertaken by
  the Department of Health Changing Workforce Team and began in 2004.

  Consultant numbers

  The last figures published by both the Department of Health (DOH) and
  independently by the Royal College of Psychiatrists (RCP) were in 2001. The Royal
  College of Psychiatrists stated there were 2612. 91 WTE consultant posts filled,
  occupied by 2861 consultants, and a total of 3249 posts altogether (WTE 2900+).
  The corresponding Department of Health figures in the Hospital Annual Medical and
  Dental census in 2001 stated there were 2960 consultants, but gave no WTE figures.
  From previous years, WTE was about 90% of headcount, so 2960 consultants
  equated to approximately 2665 WTE. For March 2002 the DOH vacancy survey
  stated there were 250 vacancies for psychiatrists bringing the total number of posts
  to over 2900. (Note: The consultant numbers included the number of vacancies, as
  well as the number of posts filled by psychiatrists).

  From 1995 to 2001 the RCP census has shown steady growth in consultant
  psychiatrist positions, from 2684 posts in 1995 to 3249 in 2001, with consultants in
  post rising from 2356 to 2861. However it also shows that throughout that period
  there have been 300 plus vacancies, rising to 388 in 2001.

Department of Health figures 2003

The Department continues to do their Annual Medical and Dental Census and gather
quarterly vacancy information.

According to the summary data produced by the Department of Health the number of
Consultant Psychiatrists in post in the NHS has risen from 2960 in 2001 to 3224 in 2003.
This equates to an 8.9% increase over the two years. However it is worth noting that the
increase mainly happened in 2002-2003, with there only being a 0.5% increase in
consultants in post in 2001-2002. Of the current consultant psychiatrist workforce 36%
are female.

The DOH vacancy rate in March 2004 was 9.6% for consultant psychiatrists in the NHS
in England, showing a drop from the vacancy level of 11.3% in March 2003.




                                            8
Consultant Psychiatrist recruitment and retention

Problems recruiting to consultant posts are common and much work is being done
both nationally and locally to address the shortages of consultant psychiatrists.
Currently there are reported to be approximately 334 consultant psychiatrist
vacancies nationwide (DOH vacancy figures 2004), down from 364 vacancies in
2003. Levels of vacancies vary with speciality and by region, with the highest
vacancies, identified y the DOH figures in Manchester and Merseyside, Avon, West
Midlands, Durham, West Yorkshire, South East London and Essex.

There are a number of factors that are considered to contribute to these recruitment
difficulties, drawn from various studies. These include:

•   The current national shortage of trained psychiatrists that is attributed to poor
    earlier national workforce planning.
•   The lower popularity of psychiatry compared with other medical specialities.
•   Lack of access at some Trusts to good academic facilities.
•   The small size and/or rural location of some Trusts.

Similarly, there are problems related to retaining staff:

•   High attrition from training.
•   Trainees leaving posts earlier than expected.
•   The time taken to replace trainees leaving posts.
•   Locum cover being expensive and in short supply.
•   Psychiatrists feeling burnout and overburdened.
•   Bureaucracy and the requirements of management.
•   Lack of staffing/resources.

The morale of some consultants is low; they feel over-worked, emotionally over-
extended (‘emotional exhaustion’) and experience difficulties generating motivation
for inter-disciplinary working. The stress levels among consultants exceeded
clinically significant scores on well-validated questionnaires. This picture has
emerged from several recent studies (Onyett et al, 1997; Peck, 1997; Sainsbury
Centre for Mental Health, 1997; Pajak et al 2003).

Some contributory factors have been identified, including the following:

    a) Issues relating to clinical and managerial leadership - change to the roles of
       all hospital and community staff (e.g. the increase in team-based working) has
       raised questions about who has responsibility for clinical and managerial
       leadership and what is the effective relationship between these.
    b) The balance between responsibility and explicit authority - psychiatrists feel
       they are held clinically accountable for care but have little authority to secure
       the services necessary to meet needs.
    c) Large caseloads of people whom practitioners see relatively infrequently and
       thus may consequently not form positive personal relationships - working
       effectively with users is reported to be one of the major rewards of mental
       heath care work (Onyett et al, 1995; Harper and Minghella, 1997).



                                             9
   d) Widespread perceptions that consultants carry medical responsibility for all
      those referred to secondary care services, leading to unmanageable
      caseloads and unrealistic expectations of consultants (Department of Health
      National Steering Group Interim Report 2004).
   e) Assumptions that consultant psychiatrists should automatically be team
      leaders has led to confusion, stress for consultants, and irritation from other
      professionals (DOH National Steering Group Interim Report 2004).
   f) In general psychiatry, there has been a conflict, in some areas, between the
      implementation of the Care Programme Approach/Care Co-ordination by
      teams and the work of general adult psychiatrists in outpatient clinics. (DOH
      National Steering Group Interim Report 2004).

There are also concerns regarding the level of retirements amongst consultants in
recent years with the average age of retirement being 60. This premature retirement
is possibly contributing to a 5% reduction in their numbers, according to a Royal
College of Psychiatrists survey (2004). The average age of intended retirement was
60 and the responses showed that 59% indicated that they would take, or had
already taken, early retirement. Nearly three-quarters reported that they had Mental
Health Officer (MHO) status, which was found to be an important factor in early
retirement (Mears et al 2004).

Positive action

The shortages of consultant psychiatrists and the difficulties in recruitment and
retention have been recognised nationally and there is a broad range of work in
progress to improve the situation.

Recommendations about the recruitment and retention of psychiatrists were
published in 2004, based on the joint work of the Department of Health and the
Royal College of Psychiatrists. They recommended action to improve:

       The recruitment of medical graduates in specialty training in psychiatry.
       The retention of Senior House Officers in psychiatry and their uptake of
       Specialist Registrar posts.
       The retention of Specialist Registrars in psychiatry and their uptake of
       consultant psychiatrist posts.
       The retention of non-consultant career grades in psychiatry and encourage
       their uptake of consultant posts.
       The retention of consultants, particularly those considering retirement.
       International recruitment.

This fits with the broader NHS programme of filling consultant posts in shortage
specialties called the Filling Consultants Posts: Toolkit (2004). This offers help on:
   o Consultants working flexibly.
   o Flexible retirement and extending working lives.
   o Consultants returning to practice.
   o Assisting and supporting new consultants.
   o International recruitment.
   o Utilising the international fellowship scheme.



                                           10
   o Managed placements to allow consultants to sample life as an NHS
     consultant.

The International Fellowship Scheme offers qualified medical specialists from
outside the UK the opportunity to undertake a two-year Fellowship working as a
consultant in the NHS (England only). These Fellowships are for fully trained
independent specialists who wish to obtain valuable experience of living and working
for a short while in a different country.

The managed placement scheme aims to attract consultant-level doctors who wish
to sample work in the NHS before applying for a long term post. Managed Placement
doctors fill a vacant permanent post on an initially temporary basis. They are
appointed for a period of six months and seconded to Trusts with consultant
vacancies in the relevant specialty. All doctors on the scheme are on the specialist
register, have undertaken a linguistic assessment and undergone full employment
checks. The trust is represented on the interview panel, and the doctor is assigned
an independent mentor.

There is also the global recruitment scheme. Interest amongst potential candidates is
generated through advertising in the international medical and national press, and
seminars are arranged in countries where there is agreement to hold them.
Expressions of interest are compiled in a database of those on the specialist register,
or doctors entitled to be on the specialist register by virtue of European Directive.

The Flexible Career Scheme (FCS);

• For doctors in the training grades the FCS provides an alternative to flexible
training, although it is important to note that time spent on the scheme will not be
accredited for training because doctors will be working less than 50% full time. It is
however possible for doctors on the scheme to keep their National Training Number
(NTN). Trusts that employ doctors in the training grades on the FCS receive 100%
central funding to cover their employment costs.
• For career grade doctors (consultants or non-consultant career grades) it provides
a route into permanent or temporary part time work by providing central funding for
the creation of suitable part time posts. Trusts that employ career grade doctors on
the FCS receive central funding to cover up to 50% of their employment costs.
• For returnees the scheme provides a clear re-entry pathway back into the NHS
with fully funded refresher training, and the option to work full or part time during this
period. After completing refresher training there is the option to return to a part time
post supported by the FCS.
• For doctors nearing retirement it gives central funding to support them in reducing
their hours in their final years of service. Trusts that employ doctors close to
retirement on the FCS receive central funding to cover up to 50% of their
employment costs.




                                            11
New ways of working for consultant psychiatrists

Through a partnership between NIMHE and the Royal College of Psychiatrists there
is a review underway of the role of consultant psychiatrists and their work with other
professionals in mental health. A national steering group was set up in 2003 with two
sub-groups aiming to explore the professional role of psychiatrists in multi-
disciplinary care and review their own role to produce recommendations for more
effective and satisfactory modern roles and career paths.

This work has produced an interim report in 2004 of guidance on new ways of
working for psychiatrists in a multi-disciplinary and multi-agency context (DOH 2004).
The themes of the report point towards considering new ways of working for
psychiatrists drawing on research and projects that are continuing on exploring new
roles. Recent research Mears et al (2004) argues that psychiatrists working in a
more progressive way seem to suffer less stress/occupational pressure than their
more traditional colleagues. The progressive way of working was drawn from
Kennedy and Griffiths (2001) and was characterised by effective delegation amongst
the team, well managed referrals, protection of non-clinical time, low numbers of
fixed contract sessions and progressive multi-disciplinary working.

Further work is underway and planned to look at new ways of working for
psychiatrists, clarification of their legal and professional responsibilities, and the
development of new roles across the different professions in psychiatry. Changes to
the psychiatrist role must be set within the multi-disciplinary context and within the
on-going redesign and modernisation of services in primary and secondary care.




                                          12
METHODOLOGY

The Joint Workforce Support Unit, a joint Sainsbury Centre for Mental Health
(SCMH) and National Institute of Mental Health (NIMHE) initiative, developed a
questionnaire with the project being supported by the Royal College of Psychiatrists
(RCP).

The questionnaire asked for information about numbers of consultant psychiatrist
funded posts, vacancies of consultant psychiatrists, difficulties in recruitment to
consultant posts, the use, cost and impact of locum usage, and any innovative
solutions to problems of shortages of psychiatrists. The questionnaire used both
closed and open ended questions in order to provide quantitative data and more in
depth qualitative information.

An up to date list of NHS trusts providing mental health services was compiled in
November 2003 and rechecked at the beginning of January 2004. Independent
providers of psychiatric care were also contacted via the Independent Healthcare
Association. Only 2 responses were forthcoming from this sector.

Questionnaires were sent out on the 12 January 2004 with a closing date of the 6th
February. However, due to an initially low response rate, non-responders were
contacted by phone and email with final response levels achieved of 59 Trusts from
83 Trusts in England providing data (71%). This compares favourably with the last
Royal College of Psychiatrists survey that also achieved a 71% return rate. In order
to increase response rates in the latter stages of the process, Trusts were asked to
complete only four pages of the questionnaire, the quantitative sections regarding
numbers of Consultants in post, numbers of vacancies, cover arrangements and
financial information on expenditure on locums.

Following analysis of the qualitative data, topics were identified to follow up with
Medical Directors and Chief Executives. Medical Directors and Chief Executives of
Trusts who had returned questionnaires were approached to participate in a 20
minute telephone interview. In the end only a small number of interviews were
carried out as it was found they added little to the data already gained in the survey.

Additionally the Royal College of Psychiatrists suggested that their returns on all
advisory appointment committees in 2003 be analysed. It was agreed to do this and
the RCP provided access to the relevant returns, which were analysed by both
specialty and region.

A reference committee was formed to support the survey work, provide advice and
comment on the report.




                                           13
SURVEY RESULTS 1

TOTALS FOR ENGLAND, CONSULTANTS IN POST

Introduction

This section provides data about consultant psychiatrist posts in England, vacancies
and consultant recruitment issues. A breakdown of consultant posts by specialty is
provided in appendix A and details of vacancies by specialty and region is provided
in appendix B. The figures provided should be by head count; however some Trusts
provided Whole Time Equivalent (WTE) figures only.

Table 1. Consultant psychiatrists in post, England (not including vacancies)

Speciality          Total               Total FT           Total PT            Extrapolation
                    substantive                                                to 100% of
                    posts, both FT                                             Trusts both
                    and PT*                                                    FT and PT*
GA                  1035.18             854                181.18(6 PT         1458
                                                           posts)
OA                  357.92              320                37.92 (16 PT        504.11
                                                           posts)
CA                  258.92              205                53.92               364.68
LD                  148.66              126                22.66               209.38
FOR                 178.18              146                32.18               250.95
PTH                 64.11               32                 32.11               90.3
SM                  71.24               56                 15.24               100.33
RHB                 49.91               39                 10.91               70.3
LIA                 22.08               15                 7.08                35.32
AC                  45.96               37                 8.96 WTE (11        80.22
                                                           PT posts)
MAN                 29.98               20                 9.98                42.23
OTH                 25.94               12                 13.94               36.54
TOTAL               2288.08             1862               426.08              3222.71
*Some Trusts did not give funded posts or PT posts by WTE. The PT posts not by WTE have been
ignored in producing the totals.

The Consultants in post figure extrapolated from the 71% return up to an
approximate figure for England is 3223, which is very close to the Department of
Health figure for 2003 of 3224 (see page 9). The largest figure is for general adult
services accounting for 45% of all those in post, with the other large service
providers of Older Adults and Children and Adolescents accounting for 15.5% and
11% respectively.

The returns identify 1237 male consultants and 818 female consultants The figures
complied by the Royal College of Psychiatrists since 1995 show a steady move
towards more female consultants, moving at about one percent per year. In 1995
there were 2481 consultants of whom 71% were male. By 2001 there were 66%
male consultants. Our survey records there being 62.5 % male consultant
psychiatrists.


                                              14
The breakdown of full-time to part-time working is 84% full-time. 16% of male
consultants work part-time, whereas 42% of female consultants work part-time.
In comparison with the general population, in January 2004 in the UK 26% of
everyone in employment were part-time and 10% of men were part-time, as opposed
to 44% of women (Labour Force survey 2004).

VACANCIES ALL CONSULTANTS ENGLAND (all vacancies full and part time)

General Adult Total vacancies across England                                175.48
(81.7% of vacancies covered by locums).

Old Age Total vacancies across England                                      55.545
(75% of vacancies covered by locums).

Child and Adolescent Total vacancies across England                         40.35
(47.5% of vacancies covered by locums).

Learning Disability Total vacancies across England                          38.4
(45.6% of vacancies covered by locums).

Forensic Total vacancies across England                                     20
(38.5% of vacancies covered by locums).

Psychotherapy Total vacancies across England                                2.77
(90% of vacancies covered by locums).

Substance Misuse Total vacancies across England                             13.43
(74% of vacancies covered by locums).

Rehabilitation Total vacancies across England                               6.6
(53% of vacancies covered by locums).

Liaison Total vacancies across England                                      1.38
(27.5% of vacancies covered by locums).

Academic Total vacancies across England                                     0.6
(100% of vacancies covered by locums).

Management Total vacancies across England                                   0.8
(75% of vacancies covered by locums).

Other Total vacancies across England                                        7.03
(69% of vacancies covered by locums).

Locum cover percentages exclude new posts or staff acting up.

Total                                                                       362.385

Note: This is again based on the 71% return. If we were to extrapolate this figure to
100% the total vacancy figure for England would be 510.4 vacancies.




                                                15
The DOH vacancy rate in March 2004 was 9.6% down from 11.3% in March 2003.
The DOH vacancy data only applies to posts vacant for over three months that
Trusts are actively trying to fill. This survey asked for all vacant posts whether or not
they were being or had ever been advertised. It was suggested in the survey
preparation that not all posts were advertised because of the workforce shortages,
and others with locums had not been advertised for some time and were not actively
being recruited to.

The vacancy level on the returns for the survey is 362. This approximates to the
previous levels quoted by the Royal College of Psychiatrists from their surveys of
370-390 vacancies per annum. However if the actual return figure is extrapolated for
the whole of England this produces a vacancy level of 510 posts. These are whole
time equivalent posts and the full-time to part-time split is not known.

A full England vacancy level of 510 on a total number of posts of 3238 extrapolated
for England from the returns (see page14), gives a vacancy rate of 15.75%. This is
significantly higher than the DOH vacancy survey and could support the assumption
that some posts were not being advertised/actively recruited to. The England figure
makes the current shortages even more acute.

The planned expansion of consultant psychiatrist posts is 400 for the period 2003 to
2006, and a further 400 for 2007-2009, SCMH (2003). Add to this current estimates
for the requirements of the draft revised Mental Health bill of a further 200
psychiatrists and there is a very serious problem.

Overall there are estimated to be 500 plus vacancies now and a requirement for
another 1000 psychiatrists by 2009.

The highest vacancy rates are across the North-East and North-West, with specific
specialty vacancy levels apparent both across the country and in particular regions.

Table 14. Vacancy rates in percentages of all funded posts by national
(England) and regional figures and by speciality.

Region       National NW NE           WM LON SW EAST                SE     EM
Speciality (England)
GA           16.95% 39% 24% 8% 6%                13% 15%            22%    23%
OA           15.52% 16% 18% 23% 5%               13% 11%            16%    0*
CA           15.6%     4% 30% 17% 6%             9% 21%             21%    15%
LD           25.8%     49% 45% 11% 19% NA              15%          23%    29%
FOR          11.2%     15% 27% NA           11% NA     7%           6%     12%
PTH          4.3%      4% 17% NA            5%   11% NA             NA     NA
SM           18.6%     58% NA        14% 9%      NA    25%          17%    20%
RHB          13.2%     42% 17% NA           NA   NA    50%          18%    0
LIA          6.25%     NA     NA     NA     NA   NA    NA           28%    0
AC           1%        NA     NA     40% NA      NA    NA           NA     0
MAN          2.67%     NA     NA     NA     NA   NA    NA           10%    0
OTH          27.1%     NA     87% NA        18% 50% NA              27%    55%
* Data from two Trusts only, neither having OA vacancies.



                                           16
 CONSULTANT RECUITMENT

 This section provides a summary of the responses to qualitative questions on
 Consultant vacancies and recruitment. Overall the response rate on the qualitative
 part of questionnaire was 53. Some of the late returnees of the survey were not
 asked to complete the qualitative questions in the survey.

 Please note XXX has been inserted as appropriate, to protect anonymity and confidentiality.

         Table 31. Summary of quantitative responses, questions 1 – 10.
         Question Number                               Yes No Missing

         1. Vacancies covered other than by locums?                     26     27    0
         2. Known local factors impacting on recruitment ?              28     25    0
         3. Geographical factors ?                                      27     26    0
         4. Known factors with specific posts?                          31     24    0
         5. Problems with individual posts ?                            14     39    0
         6.Problems with approval of job descriptions ?                 20     33    0
         7. Problems with response to adverts?                          42     11    0
         8. Difficulty with AACs?                                       13     40    0
         9. NCCG job?                                                   2      50    1
         10. Terms and Conditions                                       24     29    0

 Q1. Do you have any consultant psychiatrist vacancies covered by other
 arrangements than locums?

 Almost 50% of Trusts replied with a range of responses:

 - Four Trusts are using SpRs as locums.
 - Nine Trusts are using staff in acting up roles.
 - 19 Trusts have substantive staff are covering, there are some acting up staff
 whose position in turn, is being covered by Locums.
 - One Trust had a Nurse Consultant covering an Assertive Outreach post.

Selected Comments

We have always been able to recruit to any post advertised. Local factors are: Medical influence in
management, small catchment areas, nice rural location, friendly, keen, enthusiastic consultants.

Regional SpR scheme based on neighbouring Trust who have majority of posts. Many SpRs put
down roots within area of neighbouring Trust (hours purchase, children in school, partner’s work) and
therefore, look to this Trust first in search of consultant posts.

Not enough SpRs in training to fill vacant posts over next few years.

Poor reputation of precursor Trust.




                                                    17
Q2 Are there known local factors impacting on recruitment of Psychiatrists to
the organisation?

Responses were received from 25 Trusts.

National Factors.

Pay was mentioned by four Trusts, three in particular noting locums could earn more
money working via agencies. Additionally due to national shortages competition from
other Trusts was mentioned. This was seen by two Trusts as due to a lack of SpRs
doing their CCST. National shortages of psychiatrists were also impacting in other
ways, e.g. a lack of substantive people in post put potential candidates from
applying, which can lead to a Catch 22 situation.

Additionally a lack of funding has led to catchment areas being over RCP limits was
noted by a number of sites (five) as a factor impacting on local recruitment.

Whilst a smaller number of Trusts mentioned the limited number of applicants,
limited number of good quality candidates, the figures and comments in later
questions surrounding problems with locums also point to a shortage of suitable
candidates. The feeling is candidates, both substantive and locums, can pick and
choose their jobs as a result of the national shortages.

Local Factors.

There are a number of reasons Trusts gave as impacting on recruitment of
psychiatrists. The main reason given was geographical location, four trusts in
particular mentioned the high levels of deprivation in their area. Housing costs
werementioned by four Trusts.

SpR training based in neighbouring Trust/isolation from main teaching area or lack of
academic posts/connections was mentioned by 10 Trusts. Many Trusts relied on
home grown SpRs to become their future consultants so felt at a disadvantage if
SpRs were not trained locally as many SpRs would have already settled in a
particular area and were felt, by Trusts further away to be reluctant to move.

On call frequency was mentioned by four Trusts. This was linked to having no middle
grade tier and busy demanding posts by two Trusts.

Poor Trust/previous Trust reputation was mentioned twice. Individual Trusts also
mentioned proximity to London Teaching hospitals, being Primary Care Trust (PCT)
based and limited size and range of services.

Selected Comments

In the past we have received very little funding to expand our medical workforce. As a consequence
our catchment sizes are higher than in neighbouring Trusts and above Royal College norms. We
have lost a number of consultants to local Trusts due to this. It is only in recent years that funding of
new posts has been supported and the situation is slowly now improving.




                                                    18
Selected Comments (continued)

Workload (sector) of one post is too high, which prevents post being advertisable. We are bidding to
PCTs for a second consultant post, however, this is not high on the PCT priority list (Adult LD post).

The Trust made offers to five candidates via the International Fellowship Scheme in March 2003.
Due to the many and various delays, we are still awaiting start dates to be confirmed for the four
who have accepted. We are in regular contact with the people at the DOH International Fellowship
Scheme.

Potential candidates have stated that posts should be advertised with inducements, dedicated time
for academic pursuits as well as special payments for lead roles.

Strict adherence to Whitley guidance in the past has meant the terms and conditions did not
compare favourably with other providers. Some providers have the financial flexibility to offer a more
attractive rate and conditions.



Q3 Does the geographical location of the Trust/Provider cause difficulties in
recruitment ?

54% of Trusts provided additional comments:

       -    Issues such as Transportation difficulties (nine Trusts).
       -    Distance to the centre/teaching centre (four Trusts).
       -    Remote location (seven trusts).
       -    Infrastructure issues (two Trusts).
       -    Expensive housing (16 Trusts).
       -     Costs of living (five Trusts).
       -     Deprived area (four Trusts), this is a repetition of the above answers in
            Q2. (However specifically the high morbidity was mentioned by an
            individual Trust; the impact of these reasons on other factors such as poor
            schools was mentioned).

Selected Comments

“High accommodation costs and costs of living. Our experience is that potential candidates are
now looking to the North and West Country for jobs. There appears to be more highly resourced
Trusts particularly in the North.”

“XXX is a pleasant rural county but its rurality puts off “townies”. For schooling, environment etc
we are A+ and the house prices are reasonable. However training schemes that are city-centric
create psychiatrists with a city-centric mindset who would never see the advantages of the better
quality of life a rural or semi–rural environment could offer.”

“Poor historic access to SpR posts – SpR’s ‘breed’ Consultants.”

“Availability of suitable candidates in local training schemes.”

“Regional SpR scheme based on neighbouring Trust who have the majority of posts. Many SpRs
put down roots within the area the of neighbouring Trust (house purchase, children in school,
partner’s work) and therefore, look to this Trust first in search of consultant posts.”




                                                   19
Q4 Are there known factors relating to individual posts/specialties?

Comments on this question were received from 35 Trusts. 25% stated that
workload/population/catchment areas were above Royal College recommended
norms, which resulted in the posts not being advertised. These problems would
continue unless additional funding emerges or the Royal College of Psychiatrists
norms change. In the interim considerable quantities of money may be spent on
locums, substantive colleagues will have to provide cover and a reduced service
offered.

Related difficulties stated were: Agreeing transition arrangements with adult
psychiatrists; agreeing mutually acceptable working arrangements; and limited time
available for special interests.

Trusts said all specialities were difficult to recruit for them (three Trusts) and specific
specialities highlighted were Forensic (four Trusts), Learning Disabilities (four
Trusts), Older Adults (five Trusts), General Adult (nine trusts), Substance Misuse
(three Trusts), and Children and Adolescents (four Trusts).

Higher salaries offered by competing trusts were a difficulty for one Trust, and two
Trusts highlighted long delays on the international fellowship scheme.

Selected Comments

“Posts in XXX could not be filled unless enhanced salaries were offered.”

“Certain sectors have higher population sizes than the Royal College Norms. There are difficulties in
persuading PCT’s of the need for additional funding for new posts in competition with large acute
trusts.”

“The Trust covers a mix of urban, suburban and semi rural areas. It is more difficult to recruit to posts
within the more urban borough, i.e. XXX and XXX. This position is compounded by the particular
need to reprovide/improve in-patient facilities in these boroughs. Where services in a particular
specialty or location are currently provided by a substantial proportion of Locum staff, it is more
difficult to recruit substantive consultants.”




Q5 Are there problems with the terms of employment related to individual
posts?

There were16 responses to this question. Salary and pay were mentioned by five
trusts and a further five Trusts mentioned a lack of staff including a middle tier and
lack of sub specialities.

The large catchment area for five trusts created difficulties with heavy workloads and
frequent on call and high patient morbidity, and two Trusts mentioned the specific
speciality of forensic/prison work.




                                                   20
Selected Comments

“Forensic Posts; two applicants were interviewed for two posts. Both were offered posts. One
candidate declined the offer because of the rotational aspects of the Forensic post. The Job
Description was being revisited.”

“I think a general problem with recruitment was lack of another SIZ approved tier. We all loathe
being on call for the “hassle” factor if nothing else. I feel employing a middle tier of NCCGs
(Associate Specialists) has helped fill remaining vacancies.”


Q6 Are there problems with approval of job descriptions?

Problems were mentioned with the Royal College of Psychiatrists job description
approval process by 15 Trusts including changing the norms too frequently and the
norms not being flexible enough.

Specialist services not being funded was a problem for three Trusts, nine Trusts
mentioned the time taken to approve positions. One trust felt its unique situation was
not considered.

Selected Comments

“During our last recruitment campaign there was a delay of over nine weeks whilst we waited for the
Royal College to approve our job descriptions. After this period of time we received a response
stating that they were approved. We do not understand why it took nine weeks for that reply to be
sent.”

“The Trust has a historical low level of investment in medical staffing. The established posts are
well outside "College Norms”. The financial situation makes it hard to immediately move to "norm"
level posts. There is therefore a debate with the Regional Adviser (including Regional
Representatives) about what will be agreed. Different Regional Representatives vary on how strictly
they apply the "College Norm" rule as to whether to recommend approval to the Regional Adviser.
As a Trust the most difficult area has been in Old Age Psychiatry where the local arrangement of
good Primary Care and Community Hospitals gives a significant resource that means, we believe,
the population figures could be higher per WTE Consultant.”

“Within older adult services the guidance regarding job descriptions from the Royal College
classifies these positions as not compliant due to number of Consultants per catchment area. Job
descriptions awaiting approval from the Royal College appears to be a lengthy process and may
result in loss of applicants. The Royal College of Psychiatrists still apply the traditional population
requirements to posts which do not take into account the development of the National Service
Framework Services which have reduced Consultant workload.”



Q7 Have there been difficulties with the response to adverts?

80% of trusts replied identifying poor responses or lack of responses to adverts. For
26 Trust there was no response to adverts, 18 stated a limited response to adverts,
and six Trusts said they had to advertise more than once for a position.

Poor quality candidates were mentioned by four Trusts and people applying and then
withdrawing from the process was stated by four Trusts.




                                                    21
The international fellowship scheme as a way of filling posts was mentioned by six
Trusts, headhunting agencies were used by two Trusts, and trying to recruit directly
from abroad independent of the international fellowship scheme was stated by three
Trusts.

A number of Trusts commented that they were reliant on SpRs covering or filling
consultant posts.

Selected Comments

“We ran an advertisement for Consultants and Staff Grades in October 2003. We had no
confirmed candidates for our Appointments Panel on the 5th February. The Recruitment Agency
feedback is as follows:

    •   500 Doctors have been contacted by the Recruitment Consultant’s research team.
    •   On average it takes a researcher a week to connect with a Doctor.
    •   Apart from ‘blind’ advertisements in the British Medical Journal and the telephone
        activity as above, the Agency has run extensive email and SMS-based marketing
        campaigns which they estimate will have reached an audience of approximately 700
        more people. From an initial list of 504 substantive doctors, plus 350 locums who were
        also contacted, 229 have declined our positions. Of the remaining 262 substantive
        doctors, contact is still to be made or their interest confirmed.
    •   The main reason the roles have been declined is due to lack of interest in moving from
        an existing post or refusal to relocate .
    •   Many doctors expressed an interest if the Trust offered a significant financial incentive.
    •   Locum doctors have opted to remain in their roles for financial reasons or due to
        registration status.
    •   There is no negative perception of the Trust.
    •   The Agency is feeling frustrated that, despite their best efforts, they have been unable
        to provide doctors who want to join XXX Trust.
    •   The Agency is now going to advertise for doctors in Sweden and Switzerland.”


“Few candidates so limited choice. Have to advertise 2/3 times on occasions before
appointment.”

“No response to Elderly/Learning Disabilities/Adult Posts. Normal recruitment process
undertaken on a targeted basis with SpRs who have approached the Trust with a view to
working with the Trust. Potential Applicants are often ‘Home Grown.”



Q8 Have there been difficulties with Advisory Appointments Committees?

The main issue raised was the time taken to convene appointments committees
according to 25% of respondents.

Selected Comments
“It is always difficult to co-ordinate diary commitments for such a broad spectrum of panel
members, despite scheduling dates months ahead. This will continue to be an on-going issue.
One suggestion at our Trust is to schedule panel dates bi-monthly or quarterly so dates are
agreed to in advance.”

“The availability of Royal College representatives can cause delays to the recruitment process.”

“The length of time it takes to convene committees. Number of Representatives from
Universities and Royal College is small.”


                                                  22
Q9 Have there been applicants who could be appointed to Consultant level but
they preferred to take a NCCG level job instead?

Only three Trusts commented on this> One SpR opted to work as a Staff Grade due
to the high catchment areas that our consultants cover and in two trusts there were
instances of appropriately qualified Doctors with CCST who preferred to remain as
locums (one trust giving the reason for this as financial).

Q10 Have terms and conditions on any posts been offered outside standard
terms and conditions of service in order to attract permanent consultants?

57% of trusts responded to this question. The majority of trusts had offered
consultants extra financial benefits in a variety of formats; retention premia,
discretionary points and setting the starting salary at the top of the scale. Trusts
identified specific reasons including:
competition - neighbouring Trusts had offered enhancements.
service priorities - To enable the trust to develop services (Forensic/Prison).
Recruitment and retention - Extra sessions paid to recruit/retain.

The extent of the problem facing Trusts is illustrated by one Trust which claimed that
a trust near to them had offered a newly qualified consultant the top of the salary
scale, four additional sessions, two Discretionary points making a salary greater than
greater than £105k (see below). [It has not been possible to verify this claim].

Other incentives mentioned by individual Trusts were;
- offering additional on call or no on call as applicable,
- offering enhanced travel expenses,
- paying for three years accommodation and removal costs for a Consultant from
  Europe,
- paying relocation expenses,
- creating an individual Trust local pay package.

Selected Comments

“Maximum of scale is viewed by applicants as the starting norm. Sums equivalent to discretionary
points are often quoted. Further payments (sessions) are normally linked to additional
responsibilities.”

“Recruitment and retention package £14,000 and appointment at the top of scale.”

“But clearly not enough considering the incentives offered by Trusts to the north of XXXX. E.g.
newly qualified consultant offered top of the salary scale, four sessions two DPs i.e. greater than
£105k!! clinical tutor post in the NE of England.”

“Extra sessions (two-three) paid to adult psychiatrists to recruit/retain consultants in one
geographical location.”




                                                   23
Q11 If you have answered YES to any of the above questions, please use the
space below to explain what, if any action is planned/has been initiated to
improve recruitment of consultant psychiatrists. E.g. recruiting from abroad,
using the international fellowship scheme, changing posts to make them more
attractive.

      27 Trusts had used the International Fellowship Scheme (IFS) with varying
      degrees of success (9 Trusts mentioned long delays between appointment
      and Consultants actually commencing work, whilst 4 Trusts had used the IFS
      with no success). Additionally 12 Trusts had attempted to recruit themselves
      from abroad.

      Nine trusts mentioned word of mouth as one means of recruiting Consultants.

      10 Trusts were making the job more attractive, individual trusts specified
      offering dedicated CPD time and another offered good level of support staff.

      Six Trusts were offering/negotiating to offer a recruitment premium whilst 3
      Trusts had lobbied their PCT for more funding to reduce catchment sizes to
      make the job more attractive/comply with RCP norms.

      Five Trusts were reviewing their medical staffing requirements.

      Two Trusts had introduced a tier of Associate Specialists.

      Three Trusts had introduced NCCGs.

      Three Trusts were developing other services, e.g. Assertive Outreach, Liaison
      Psychiatry etc.

      One Trust was developing Nurse led services.

      Three Trusts were relying on local SpRs to become Consultants locally.

      Two Trusts were actively encouraging locums to take substantive posts whilst
      another was encouraging a part time Consultant to work full time.

      Three Trusts were working with other local Trusts so they did not compete
      with each other for Consultants (1 Trust was offering a joint post in
      conjunction with a neighbouring Trust).

      Four Trusts used headhunting agencies, three Trusts advertised nationally,
      two Trusts mentioned career fairs.

      Two Trusts suggested more training places for SpRs.

      Two Trusts said no action was necessary as there were fully recruited or a
      very low level of vacancies.

      Eight trusts were using the Managed Placement Scheme.


                                         24
     Four Trusts were using Flexible Career Scheme (FCS).

     One Trust was using the Global Scheme.


Selected Comments

“We have recruited five doctors through the international fellowship scheme and one
doctor through the global scheme. Unfortunately we have experienced significant delays
with these doctors commencing in post. At appointments made in March 2003 the first
has commenced in post this month. One is due to start in March 2004 and one in April
2003 (13 months after the interview). We have had to withdraw the offer made to one
fellow after he failed the IELTS test for the fourth time. With each IELTS failure there is a
three month delay before the test can be taken again. In the meantime we have had to
sustain locum costs waiting for these doctors to commence.”

“With regards to the NHS Consultant workforce targets, posts cannot be counted as
recruited to until the appointee commences in post. Although we have made a number of
appointments this year we are unable to count them in our targets. This has placed our
SHA area on ‘red alert’ due to a failure to meet the targets. The ability to meet the targets
is beyond the control of the Trust when appointees through the DoH scheme do not have
GMC registration when they are interviewed. Because of these experiences we are
unlikely to attempt to recruit from overseas again.”

“We’ve always had some trouble recruiting. This means one –two vacancies in various
posts out of a complement of 14 –16 consultants in adult psychiatry, rehabilitation, Older
Adults and substance misuse.
In the last few years we’ve increased the number of consultants to 16 and have just
appointed a tier of Associate Specialists to help on call and medical input into NSF
developments. This may have led us to be successful at recruiting to our last two
vacancies. Mind you we had two applicants for two posts so it was hardly overwhelming.”




                                                 25
2003 ROYAL COLLEGE OF PSYCHIATRISTS RECRUITMENT DATA.

Introduction

The Royal College of Psychiatrists receive returns on every vacancy advertised
across England, Scotland, Wales and Northern Ireland. Is was agreed that to add to
the information on consultant vacancies and recruitment their returns for 2003 would
be made available and the analysis of those returns is provided below.

Table 32. Posts advertised in 2003 and the reasons for the vacancy.

Posts          GA    OA     CA      LD     FOR    PTH     SM     RHB     LIA    Overall
Advertised     192   70     85      22     31     14      25     8       4      451
FT             131   50     63      15     29     6       20     8       3      325 85%
PT             22    6      18      4             8              0       1      59 15%
Vacancy
Reasons
New Post       64    35     57      7      18     4       8      4       3      200 53%
Retirement     29    5      7       8      2      6       6      0       1      64 17%
Consultant     46    8      11      1      7      4       4      3       0      84 22%
move in
NHS
Consultant     2     4      3       1      1      0       0      1       0      12     4%
move to
non-NHS
Other          5     2      3       2      1      0       1      0       0      14   4%
Advertised     25    10     11      2      9      1       3      2       0      63
more than
once

There were 451 posts advertised in 2003, of which 85% were full time. This shows
little change from the last Royal College of Psychiatrists published analysis from
2001, which had 441 posts being recruited to. According to the 2003 returns 55% of
these were new posts, although it is not clear if they are completely new posts with
new funding for them, or redesigned posts funded by existing money for a consultant
psychiatrist post. The largest area of recruitment is in General Adult Psychiatry
where there were 192 posts advertised, 42.5% of the total posts advertised. This
level of recruitment is followed as expected by Older Adults 15.5% and Children and
Adolescent services

Retirements accounted for 18% of the vacancies. This needs to be put in the context
of the total number of consultants in post, extrapolated to 3223, thus retirements took
place on 2% of posts. Very small percentages are recorded as leaving the NHS. The
level of retirements is an increase on the last recorded Royal College of Psychiatrists
figures, again from their 2001 report, when the retirement level was approximately
12-13%.

There is a high degree of concern over the filling of posts and the consultant
shortages, however only 14% had been advertised more than once. This though
may hide the fact that some posts are advertised once, the employer has no success


                                          26
in recruiting and thus does not advertise again and either fills the post with a locum
or some other arrangement, such as an SpR acting up, or makes no further attempt
to fill the post.

Overall whilst applicants for posts are in low numbers, see table 33 over the page,
the success rate at filling posts is high in the circumstances with 79% of posts being
filled. This is significantly lower than the last published figures from 2001 when over
92% of posts were filled. The specialties suffering the greatest decreases in
successfully filling posts were General Adults (10% reduction in success), Older
Adults (13% reduction), Children and Adolescent (12% reduction), Forensic
(7%reduction) and Substance Misuse (28% reduction in success).

The average number of applicants per post in 2003 was 1.44, with never more than
two applicants per post except for Psychotherapy, although it should be noted that
this was against recruitment to only 14 posts. Learning Disabilities struggled for
candidates with only 24 applications for 22 posts over 2003. The level of applications
is lower than the 2001 position from the last report by the Royal College of
Psychiatrists when the average level of applicants was 1.63 per post.

Table 33 Applicants for posts in 2003 and the number of posts filled.

               GA    OA     CA     LD     FOR PTH        SM     RHB     LIA     Overall
Posts          192   70     85     22     31  14         25     8       4       451
Advertised
Applicants     280 87    129       24   40       39      29   11        7       646
Average        1.51 1.24 1.5       1.09 1.29     2.78    1.16 1.37      1.75    1.44
no.
Applicants
per post
Male           72% 58% 41% 54% 65%               63%     64% 37%        71%     58%
applicants
Female         28% 42% 59% 46% 35%               37%     36% 63%        29%     42%
applicants
Shortlisted    83%   91%    90%    87%    92%    92%     93%    82%     100%    90%
Interviewed    72%   76%    75%    87%    77%    77%     79%    82%     71%     77%
Number of      146   53     67     18     27     14      18     8       4       355
posts filled   76%   76%    79%    82%    87%    100%    72%    100%    100%    79%




                                           27
Table 34 Primary medical Qualification of the applicants and percentage
holding the professional qualification.

                  GA        OA        CA       LD        FOR      PTH       SM        RHB      LIA
UK                40%       62%       65%      54%       81%      79%       64%       80%      57%
EIRE              2%        5%        6%       0%        14%      0%        7%        0%       0%
EEA-other         12%       7%        10%      0%        0%       13%       14%       20%      0%
Non-EEA           45%       26%       19%      46%       5%       8%        14%       0%       43%
% holding         64%       72%       78%      75%       77%      56%       72%       64%      100%
professional
qualification
Note: Not all forms returned to the Royal College of Psychiatrists contained complete data on
primary medical qualification, so these percentages are calculated from the Regional Advisers
returns that did provide the data, which is the majority but not a full return.

The professional origin of the applicants in 2003 showed a broad spectrum, with
significant numbers of non-European Economic Area (EEA) applicants, the highest
percentages of non-EEA applicants being in General Adults (45%), Learning
Disabilities (46%) and Liaison Psychiatry (43%).

The percentage of applicants already holding a professional qualification was
generally around three quarters, except for General Adults (64%), Psychotherapy
(56%), Rehabilitation (64%) and Liaison Psychiatry (100%).

Table 35 Appointments to posts of consultant psychiatrist.

                  GA      OA      CA         LD        FOR PTH SM            RHB LIA          Overall
Male              111     26      25         12        17  8   12            3   2            63%
Female            32      26      41         6         9   5   3             5   2            37%
Primary
qualification
 UK               46%     71%     62%        50%       92%   92%     72%     71%      75%     61%
 EIRE             4%      4%      4.5%       0%        8%    8%      5%      0%       0%      4%
 EEA-other        13%     2%      12.5%      0%        0%    0%      5%      29%      0%      9%
 Non-EEA          37%     23%     21%        50%       0%    0%      8%      0%       25%     26%
Percentage        73%     70%     80%        72%       73%   71%     88%     63%      75%     -
holding
Specialist
qualification
Note not all forms gave complete information on successful recruits to posts, therefore the total males
and females for example may not equal the total number of posts filled.

The level of male and female applicants being recruited into post accords with the
general trend towards more female consultants identified, with current posts held by
males 62.5% and by females 37.5% (see page 14).

The level of non-EEA recruitment has increased from 2001.The biggest increases in
non-EEA appointments was in General Adult Psychiatry increasing from 25% to
37%, Learning Disabilities increasing from 23% to 50%, and Rehabilitation dropping
from 45.5% in 2001 to 0% in 2003. As General Adult posts accounted for 43% of all
posts recruited to in 2003, the increase in non-EEA applicants shows a much greater


                                                  28
use of global recruitment to try to fill vacancies. How much that is a reflection of the
international fellowship and other international recruitment schemes is difficult to tell.

As General Adult services are the largest single specialty a breakdown of their
recruitment in 2003 has also been done using the geographical breakdown by the
Deaneries of the Royal College of Psychiatrists. This is provided over the following
two pages. It is clear that there are wide variations across the country regarding the
ability to attract candidates to apply and subsequently recruit them. South West and
North West London only filled 50% of their posts in 2003, with the South West and
Oxford only succeeding in filling 57% of their posts. However it does not follow that
these areas had the lowest numbers of average applicants per post, only the South
West stands out having 0.86 applicants per post. Also there is no clear correlation
that those with the highest vacancies receive fewer applicants and fill a lower
percentage of posts.




                                            29
Table 36 General Adult Services Recruitment data 2003.

                London   London    London   London       Eastern   Kent   Wessex
                South    South     North    North                  Surrey
                East     West      East     west                   Sussex
Post            18       6         7        16           14        20     6
Advertised
Full-time       14       2         6        9            10        16      5
Part-time       1        1         1        3                      2       1
Vacancy
Reasons
New Post        8        1         3        6            7         7       1
Retirement      3                  1        3            2         4       1
Consultant      1        2         2        3            1         4       5
move in NHS
Consultant                                                         2
move to non-
NHS
Other                              1                               1
Advertised      1        1         2        1            3         3       0
more than
once

Posts           18       6         7        16           14        20      6
advertised
Applicants      40       8         12       36           18        27      10
Average no.     2.2      1.33      1.71     2.25         1.3       1.35    1.6
Applicants
per post
Male            75%      66.6%     58%      68%          91%       81%     80%
Female          25%      33.3%     42%      32%          9%        19%     20%
Shortlist       78%      75%       66%      69%          77%       92%     80%
Interviewed     60%      50%       58%      42%          77%       81%     80%
Number of       14       3         6        10           10        18      6
posts filled    77%      50%       86%      50%          71%       90%     100%

Appointments
Male            9        2         3        5            7         13      4
Female          3        1         2        4            2         3       2
Primary
qualification
 UK             42%      33%       20%      63%          50%       40%     33%
 EIRE           17%      0%        0%       0%           0%        0%      0%
 EEA-other      8%       0%        20%      25%          12.5%     6.6%    0%
 Non-EEA        33%      66%       60%      12%          37.5%     53.3%   66%
Percentage      83%      66%       80%      44%          89%       69%     83%
holding
Specialist
qualification


                                       30
                     South       Oxford     West      Trent   North   Northern Totals
                     West                   Mids              West
Post                 14          7          19        30      12      23       192
Advertised
Full-time            8           3          13        21      11      13       131
Part-time            1           1          2         3               6        22
Vacancy
Reasons
New Post             1           2          8         7       6       7        64
Retirement           2           2          1         6       1       3        29
Consultant           4                      5         6       4       9        46
move in NHS
Consultant                                                                     2
move to non-
NHS
Other                                       1         2                        5
Advertised           2           1          2         8       0       1        25
more than
once

Posts                14          7          19        30      12      23       192
advertised
Applicants           12          11         29        39      16      22       280
Average no.          0.86        1.57       1.53      1.3     1.33    0.95     1.51
Applicants
per post
Male                 66.6%       73%        81%       58%     62%     82%      72%
Female               33.3%       27%        19%       42%     38%     18%      28%
Shortlist            100%        91%        93%       95%     69%     100%     83%
Interviewed          92%         73%        86%       77%     69%     95%      72%
Number of            8           4          15        22      9       21       146
posts filled         57%         57%        79%       73%     75%     91%      76%

Appointments
Male                 6           4          13        18      6       17       77%
Female               2                      2         4       3       4        23%
Primary
qualification
 UK                  61%         75%        33%       29%     62%     62%      46%
 EIRE                13%         0%         0%        5%      13%              4%
 EEA-other           13%         0%         8%        14%     25%     14%      13%
 Non-EEA             13%         25%        59%       52%     0%      24%      37%
Percentage           75%         75%        85%       82%     78%     66%      73%
holding
Specialist
qualification
Note; not all forms were fully completed.




                                                 31
SURVEY RESULTS 2

LOCUM COST AND USAGE

Introduction

This section provides information on the costs of using locums across mental health
in the NHS in England and qualitative information on the experience of the use of
locums by Trusts.

Q 12. Locum Costs
NB Some trusts only completed reduced information for the following sections

2000- 2001                                                               Total £ 4,519,161
18 Trusts provided information
 (Some Trusts did not provide
 information and some were not in
 existence in 2000 – 2001).



2001-2002                                                                Total £12,272,643
29 Trusts provided information
(Some Trusts did not provide
 information and some were
 not in existence in 2001 – 2002).



2002 –2003                                                               Total £ 26,115,834
39 Trusts provided information
(Some Trusts did not provide
information).



April 2003 – Sept 2003                                                   Total £15,254,361
37 Trusts provided information



If the expenditure is extrapolated to 100% of Trusts over the full year, 2003-
2004, this equates to an estimate expenditure on locums of £70,339,553.
Note;
1.We have not attempted extrapolations for previous years due to the complications of differing
numbers of trusts each year with mergers and changing configurations of organisations at local level.

2. One Trust whilst not hiring locum consultants spent £105225 over three years on locum staff
grades and SHOs. Other Trusts may have done the same but it is not possible to split this out from
the returns.




                                                 32
Q14. Hourly rates charged by agencies for Locums

The range across the country was £35.00 to £93.00. The average was £69.12.
NW average £68.34
NE average £68.66
WM average £66.18
LONDON average £67.28
SW average £72.13
EAST average £77.31
SE average £66.36
EM average £71.14

The highest were agency rates, the medium levels were agency rates negotiated by
Trusts to a better level or the locums became independent contractors and cut out
the agency costs, and the lowest figures were doctors doing locum work on NHS
rates (few are able to employ locum doctors this way). One Trust claimed the agency
charges were prohibitive, whilst 5 other Trusts employ locums direct mainly due to
financial reasons, arguing it is cheaper to employ locums direct than pay agency
fees on top of locum salaries. For example one Trust stated that 3 locums became
independent contractors and the hourly rate reduced from £85 per hour to now £67.

Example 1 Locum expenditure

Costs for Dr A employed at Trust ‘X’.
Hourly rate £77.70 including commission, employers’ national insurance and Working Time
Directive.

Annual payment for basic hours                                      £ 150432
On call payments                                                    £ 108955
Total                                                               £ 259387
                                                    Anonymous breakdowns provided by Trust



Table 37. Summary of quantitative responses to questions 13 and 14.

Questions 13 and 14                                      Yes           No        Missing
Are your locums recruited from NHS                       15 (25%)      39       5
agencies? (i.e. NHS Professionals)
Are locums recruited from agencies?                      46 (78%)      8        5


Q13 Are your locums recruited from NHS agencies? i.e. NHS Professionals
(NHSP)

69% Trusts replied (41 out of 59 giving qualitative comments). For 16 Trusts supply
issues were discussed, commenting that NHSP could not supply any locums or
those of a suitable calibre; four Trusts would use NHSP where possible but still
required locums from other sources; one Trust used an agency with a good
understanding of their needs as NHSP was relatively new; nine Trusts were currently
in the negotiation process with NHSP; for one Trust NHSP did not operate in that
area; and five Trusts use the national framework of approved agencies.


                                               33
Selected Comments

“We get locums from wherever we can. We can’t afford to rely on just one agency or source
otherwise we will rapidly come unstuck.”

“Where possible we use NHSP but locums are not always registered with NHS Professionals as
they can achieve better rates of pay with commercial agencies.”

“We have approached them in the past but they had no applicants.”

“NHSP have not, in the past, been able to meet our requirements.”



Locums are covering 11% of all psychiatrist posts in England, and the majority of all
vacant posts (see table 34 over the page), 69% of all vacancies are covered by
locums. Note these figures are based on the 71% return of questionnaires and are
not extrapolated to give a full England estimate. 11% of all psychiatrist posts in
England being covered by locums is a very substantial level and would give support
to the estimated costs of locums across England being over £70 million.

The level of posts covered by locums is very variable across England with the best
areas for locum cover being those with the largest vacancies, North West, North
East and South East. However there are still 31% of posts that are not covered by
locums, which means over 100 posts not covered. They may of course be covered
by other arrangements, e.g. employing staff grades or associate specialists, which
may not show up in the survey. The East Midlands manages to cover 41% of posts
with locums, although it should be noted that this amounts to 15.14 posts uncovered.

Table 38. Percentage of vacancies covered by locums.

 Specialty North        North     West       East      East      South       South      London
           West         East      Mids       Mids                West        East
 GA        95%          91%       78%        41%       73%       63%         89%        75%
 OA        75%          84%       66.6%      -         70%       75%         71%        100%
 CA        33%          79%       54%        53%       2 4 . 5 % 0%          55%        57%
 LD        35%          34%       42.5%      50%       70%       -           75%        50%
 FOR       40%          75%       -          36%       20%       -           25%        0%
 PTH       100%         72%       -          -         -         0%          -          100%
 SM        79%          -         100%       0%        50%       -           81%        50%
 RHB       100%         100%      -          -         100%      -           0%         -
 LIA       -            -         -          -         -         -           28%        -
 AC        -            -         100%       -         -         -           -          -
 MAN       -            -         -          -         -         -           75%        -
 OTH       -            89%       -          -         -         0%          82%        48%
 Total     76%          78%       67%        41%       60%       58%         75%        66%
 WTE       63.12        42.24     21.43      10.56     26.44     9.00        55.86      22.8




                                                34
Table 39. Summary of quantitative responses, questions 15 – 25.

Question number                                                    Yes            No    Missing
                                                                                        or N/A
Q15. Are any locums employed directly by the                       43 (73%)       11    5
Trust/Provider
Q16. Are locums given any other benefits as well as                40 (68%)       14    5
salaries?
Q17. Do locums demand other terms and conditions?                  45 (76%)       8     6
Q18. Are locums employed required to cover the full                39 (66%)       14    6
duties of the post?
Q19. Does the Trust/provider have difficulty in recruiting         26 (44%)       27    6
locum consultant psychiatrists?
Q20. Has the Trust/provider had any restrictions with              24 (41%)       28    7
regard to employing locums?
Q21. Has the Trust/provider had any problems through               38 (64%)       14    7
employing locums?
Q22. Are any of the locums consultant psychiatrists who            19 (32%)       34    6
have taken early retirement?
Q23. Are the locums used eligible to be considered for             29 (49%)       22    8
employment as Consultant Psychiatrists
Q24. Has the organisation advertised for locums in the             19 (32%)       32    8
hope of that they will accept a permanent position in the
longer term?
Q25. Have there been any examples of individuals                   20 (34%)       33    6
requesting locum posts themselves instead of seeking
permanent employment?

Q15 Are any locums employed directly by the Trust/Provider or under other
arrangements?

There were 30 Trust responses. However 23 Trusts did not respond and this may
account for the discrepancy between the quantitative and qualitative answers. Some
Trusts use a mixture of methods so the categories are not mutually exclusive:

- One Trust uses retired Consultant to cover sickness.
- Four Trusts use locums though agencies.
- 21 employ Locums on Trust contracts (but may have been introduced through an
agency and NHS rates of pay may not apply).
- Six Trusts use self employed Locums.
- Two Trusts have Associate Specialists acting up.
- One Trust uses Specialist Registrars (SpRs) acting up.

  Selected Comment

  “We have in the past employed one of our SpRs who had completed his training and obtained a
  CCST on a ‘self employed’ basis. The doctor would not work unless we paid him agency rates.
  Our options were to either agree to this or pay an unknown doctor from an agency with the agency
  fees in addition. Many doctors request agency rates on a NHS contract which we do not agree to.
  The NHS consultant hourly rate is approx. £34 per hour. We have had requests to pay as much
  as £100 per hour.”



                                                35
Q16 Are locums given any other benefits as well as salaries?

On this question 39 Trusts responded.

A large number of trusts (36) are supplying locums with accommodation, with one
Trust quoting their costs at up to £300 per week.

Additionally a majority of Trusts commenting provided some payment/recompense
for travel. Travel expenses were paid by 15 Trusts, car hire is provided by eight
Trusts, taxis were used by one Trust and pool cars are provided by one Trust. An
individual trust provided an example of their travel provided; Agency locum
consultants were given one return journey home per week and accommodation or
daily travel mid week.

Trust employed locums were given Continuous Professional Development by two
Trusts, and one Trust provided study leave. Both of these measures are what might
be termed positive costs, professional development is updating and/or maintaining
locums with current practice.
 Selected Comments

 “Free hospital accommodation for up to 6 months.”
 “Free taxis (home to base) Free accommodation”
 “Accommodation, Travel Expenses”
 “Free accommodation.”



Q17 Do locums demand other terms and conditions?

Despite the generous salary locums are able to earn, Trusts have to pay for
additional benefits in order to attract locums. Budget overspends are therefore
unsurprising. On this question 43 Trusts responded.

For the majority of respondents, locums demanding a guaranteed or extra on call
was mentioned by 39 Trusts. Four Trusts mentioned payment of travel costs, an
increased hourly rate/guaranteed payment and accommodation or upgrade of
accommodation. In one Trust a locum requested payment for a Bank Holiday even
though it was not worked.

Part time working with no on -call covering a full time job where on-call was required
was agreed by one Trust.

Selected Comments

“All agency locums demand 1:5 minimum on-call. Some demand all sorts of other perks – home to
Trust travel, upgrade of accommodation. Taxis, car hire, increased hourly rate etc.”

“1:5 on-call has caused us problems at times (in addition to high costs), e.g. what do you do if you
have greater than 5 locums on the rota?”




                                                  36
Example 2 Locum Expenditure

Locum B employed with Trust Y.
Annual salary costs                                                              £238,202
On call costs                                                                    £ 29,203
Travel expenses (home and work related)                                          £ 3,511
Accommodation expenses                                                           £ 15,600

Total                                                                            £ 286516

Example 3 Locum Expenditure

Locum Doctor C was employed via an agency that charged an hourly rate of £78.90. This
amounted to £243,643 for 2003/2004. No on call commitment was required or paid for this doctor.
                                                  Anonymous breakdowns provided by Trusts.


Q18 Are locums employed required to cover the full duties of the post?

Replies came from 20 Trusts. Of these 14 Trusts said none of their locums had
management duties, whilst another three Trusts stated that their locums covered
only basic clinical work. A small number of Trusts mentioned that roles such as
leadership, service development, planning and teaching of junior doctors were the
responsibility of substantive consultants.

A single Trust mentioned their locums would only work in the day time and do no on
call. The same trust said that some locums would only cover outpatient or
community based work. A further two trusts commented on the limited role their
locums worked in the areas of reduced working hours, and locums would not cover
specialisms such as Learning Disabilities or Substance Misuse.

 Selected Comments

 “Some locums have negotiated or demanded reduced hours, covering only outpatient/community
 services, but not inpatient, no management responsibilities and no on call.”

 However usually locums will not be involved in the Trust management issues and therefore work
 less hard than permanent consultants.

 Locums are employed to cover all duties of the post. However some locums have either been
 reluctant or incompetent to carry out management tasks or educational supervision of junior doctors.


Q19 Does the Trust/provider have difficulty in recruiting locum consultant
psychiatrists?

24% of Trusts responded to this question. The majority of comments related to
difficulties finding good quality locums. Some Trusts mentioned a general lack of
locums, whilst other Trusts discussed the unreliability of locums and their clinical
competence/incompetence.

The tactics Trusts employed to find suitable locums reflected these difficulties. They
used word of mouth to identify potential suitable locums and employed retired
psychiatrists who had previously worked in the Trust, as locums.



                                                37
A number of Trusts mentioned specific difficulties in recruiting locums for Older
Adults, Forensic, Learning Disabilities and Children and Adolescent Mental Health
Services (the latter being the most frequently mentioned by Trusts). Children and
Adolescent service difficulties are borne out by the data on locum cover, which
showed that apart from the North West vacancies were less than 60% covered by
locums (page 42).

Selected comments
Some locums have been dreadful clinically incompetent. Occasionally do not turn up. One locum
left after working about 4 hours just said ill and went to another job!!

Quality of agency locums often poor and patchy availability. Locums often go back on their word at
the last minute prior to starting. A number have left at short notice usually when offered a better
deal elsewhere.

There is a general shortage of competent and reliable consultants. The standard of some locum
consultants is questionable.



Q20 Has the Trust/provider had any restrictions with regard to employing
locums?

42% Trusts replied. The majority of comments (23) received related to the financial
implications of paying locums and the impact this was having. One Trust mentioned
they had now reached the position of refusing to pay agencies for locums and
substantive colleagues had to cover vacancies.

The quality of locums, their on call payment demands and age of candidates (in one
case 80+) were all raised as issues.


Selected Comments

Financial pressures - despite Trust knowledge of severe difficulties and high risk the care group
has received no additional funding from either our PCT or the wider Trust. The requirement on
the Care Group to meet these additional costs has created significant pressures in other staffing
groups as recruitment to vacancies have needed to be delayed, unacceptably.

Due to the need for financial control, manpower authorisation controls are in place requiring
executive team level approval for expenditure.

Financial constraints will preclude agency locum use in the future. Overspend on locums in
region of £1 million last year.



Q21 Has the Trust/provider had any problems through employing locums?

On this question 36 (61%) of Trusts responded. From 41 Trusts comments arose
from a range of issues regarding performance, both personal and professional, from
locums.

There were 26 Trusts that specifically made comments about performance
issues/quality of work. According to six Trusts locums generated more complaints


                                                  38
than substantive colleagues. One Trust stated that one locum made inappropriate
advances to a young female patient.

Information was provided by eight Trusts regarding their referrals to the GMC about
locums. Referrals to the GMC included:

   •   Two locums were referred to GMC for sexual misconduct.
   •   One locum was referred to GMC with dementia.
   •   Two Locums were referred due to problems with performance and behaviour.
   •   Two were referred regarding both personal and professional conduct.
   •   Two trusts mentioned not being informed of a locums’ previous GMC hearing.
   •   One locum was referred for fraudulent behaviour.
   •   One agency locum “made rash decisions and after one week was asked to
       leave and reported to GMC.”

The impact of using locums in services creating a lack of continuity of care and
budget overspends were the next most frequent comments Trusts provided. Lack of
continuity of care is further highlighted in responses to Q28.

Two trusts observed the negative impact locums had on both teams and the ill
feeling it created from substantive colleagues.

 Selected Comments

 One or two locums generate a number of complaints. Some were lazy and did not do the work
 required leaving more problems and responsibilities for other members of the MDT.

 Often despite being very expensive they are very poor quality. There have been performance
 management problems.

 One locum (the most expensive) was RMO for a patient who subsequently killed his own son.
 He was criticised in both the internal panel inquiry and the root cause analysis.

 Ability, Standard, Commitment, Costs, Demands.


Q22. Are any of the locums, consultant psychiatrists who have taken early
retirement?

31% of Trusts replied and all were employing psychiatrists who had taken early
retirement.

Where specialty was stated:
- Six Trusts were employing them in GA.
- One Trust was employing them in Rehabilitation.
- Two Trusts were employing them in CAMHs.
- Two Trusts were employing them in OA.
- One Trust was employing them in an academic post.
- One Trust was employing them in a managerial role to do job planning for the new
consultant contract.




                                               39
Selected Comments

“Four of the GA psychiatrists used in the last 30 months had taken early retirement.”

“One CAMHs consultant working 0.4 wte is retired. We have had others in the past. “

“Consultant took early retirement at 64. He returned for a short-term contract, but is still with us
due to the delays in the International Fellowship appointee still not having joined. “

“At least half have already retired. Three fulltime in GA , one in an academic post at 0.6 wte.”


Q23. Are the locums used eligible to be considered for employment as
Consultant Psychiatrists?

31 Trusts provided responses. 22 of the Trusts said that their some of their locums
did not have the necessary qualifications to be substantive Consultants. Of these 22
Trusts, 14 Trusts said some of their locums were qualified but preferred to do locum
work mostly due to financial reasons and two Trusts said their locums preferred to
have no managerial responsibility.

Another two Trusts stated their locums were retired Consultants and one Trust said
that their locums were not capable/competent of being a Consultant Psychiatrist.

Selected Comments

“Some would have got substantive posts but preferred to do locum work, some have been
consultants and retired. Some would never have been successful in substantive posts because they
didn’t have qualifications and were not capable.”

“Most are not able to get on specialist register, a number have gone on register and moved into
substantive posts.”

“Mixed picture: - Some have non-recognised qualifications, e.g. DPM, MD. Some are part trained
SpRs, and some are aged over 65 years.”

“Most are eligible with CCST but find locum work more lucrative with less demands.”

“Our remaining locum has not got his Part 2 and despite many years involvement with a specialist
provider. He has also applied to NHS fellowship but been unsuccessful. Very disappointing for our
service users and clinical colleagues.”

“Some have CCST and are eligible to work as Consultants some are already substantive
consultants doing locums during their annual leave but most agency locums we have employed
would not be eligible to be considered for a substantive post as Consultant as no CCST.”


Q24. Has the organisation advertised for locums in the hope of that they will
accept a permanent position in the longer term?

This gained replies from 17 Trusts. There were eight Trusts stating that they had
tried this, with two Trusts adding locums had become substantive psychiatrists that
way. Additionally two Trusts had offered locum position to SpRs who did not have
CCST and another Trust stated they had employed a locum whilst awaiting Royal
College of Psychiatrists approval of posts and prior to advertising the post.


                                                   40
A single Trust answered that they had not specifically tried this, however there was
the possibility that qualified locums would enjoy the post and apply for the
substantive post.

A further two Trusts were using The International Fellowship scheme and one Trust
was hoping to make use of the New Consultant entry scheme.

 Selected Comments

 “We have done this twice, one led to substantive recruitment and other is on-going. Both
 candidates were already known to the Trust. We would not do this if we did not know of a
 candidate.”

 “We have an NHS fellowship locum in Older Adults psychiatry (two year fellowship contract)
 STILL awaiting College approval since last Easter.”



Q25. Have there been any examples of individuals requesting locum posts
themselves instead of seeking permanent employment?

Responses to this question came from 18 Trusts. There were eight Trusts that said
locums wanted the higher salaries locums were offered, five Trusts mentioned that
the locums had wanted to see if they liked the post/service first before committing,
whilst three trusts said locums were unsure of their future intentions. As mentioned
previously two Trusts employed SpRs who acted up three months prior to obtaining
their CCST.

 Selected Comments

 “Some do this to see if they like the post. Some ask for it as a form of recruitment premium, e.g.
 first few weeks on agency rates.”

 “Some SpRs wish to work as locums when they obtain their CCST for financial reasons and also
 to decide on their future.”

 “They want the extra money.”

 “One who has already been offered an attractive position when service eventually opens. One
 who wanted to earn “big money”. One who has yet to decide what or where he settles.”

 “Yes, locum posts seem to be much more of a short term, lucrative option for medics with limited
 responsibility.”




                                                  41
SURVEY RESULTS 3

Introduction

Trusts were asked for their views on ideas and solutions to reduce the level of
vacancies for consultant psychiatrists and the use of long term locums.

Q26. Do you have any examples of ideas/alternative solutions that you feel
may reduce the vacancy numbers of consultant psychiatrists and use of locum
consultant psychiatrists?

Recruitment Issues.
  • Increasing numbers of SpRs/SHOs was mentioned by 12 Trusts.
  • One Trust discussed having flexible SpR criteria whilst another Trust
      discussed discouraging dual training of SpRs.
  • Two Trusts mentioned providing sufficient support to new consultants/junior
      doctors (one each).
  • One Trust mentioned improving their Trust’s reputation.
  • Three trusts mentioned a more flexible approach to locums who are
      sufficiently experienced and competent being able to work as substantive
      staff. These types of comments are also reflected in responses to Q 28.
  • Three Trusts mentioned making the job more attractive, a factor that could
      also impact on retention and which may encourage locums into becoming
      substantive consultants.
  • Five Trusts mentioned improving the Royal College of Psychiatrists (RCP)
      approval process and ending the RCP blocking or delaying recruitment.
  • One Trust suggested all Trusts should recruit on national terms and
      conditions.
  • Two Trusts mentioned promoting psychiatry from medical school age.
  • Two Trusts complained about the time delays they had encountered using the
      International Fellowship scheme, whilst another Trust suggested an active
      recruitment campaign concentrated on particular countries in Europe and
      Asia, different to the current IFS.

Retention Issues.
   • Two Trusts suggested allowing consultants at age of 55 retiring under RMO
      scheme to return to full time employment without reducing their pension and
      allow them to continue with any Merit Award. This would not cost the NHS
      anything, could persuade consultants to stay on and avoid use of locums.
   • 12 Trusts suggested steps to improve the working life of Consultants
      including: reducing Consultant’s workload, reducing bureaucracy, improving
      working conditions of Consultants, fitting the job to the individual and
      changing Consultant’s roles. Another Trust recommended a campaign to
      make consultants feel that their services are both recognised and
      appreciated.
   • One Trust suggested having adequate numbers of other staff in teams.
   • One Trust mentioned making liaison psychiatry an acute speciality in the
      limelight of hospital doctors.




                                          42
     •     One Trust discussed improving the proposed Mental Health Bill whilst another
           Trust mentioned reducing the numbers of reforms.

Other Suggestions.
   • Nine Trusts mentioned capping locum pay.
   • Three Trusts mentioned increasing funding.
   • Four Trusts discussed flexible arrangements.
   • Five Trusts mentioned using other staff.
   • One Trust mentioned clarifying locum roles.

 Selected Comments

 “I believe the NHS should ban the use of commercial agency locums, this would reduce the
 Trusts financial deficits and bring the pool of permanent agency locums back into potential
 substantive employment. Flexible packages to retain consultants after retirement, or from early
 retirement – especially annualised hours, sabbaticals, academic sessions, part time working.”

 “We have worked over a number of years to make Consultant jobs that fit individuals that are
 interested in working for us. As a result we have a high number (one third) of posts that are
 flexible/part time, and a very low vacancy rate. We were commended by the mental health Trust
 for this recently.”
 “We have good support for newly appointed consultants, including strong PDP peer groups. I
 personally see all new appointees on a monthly basis for perhaps a year to offer
 support/guidance and this helps retention rates. We have resisted the move to place consultants
 into CMHTs (as their base) and all have rooms adjacent to each other on the central site. This
 improves consultant cohesion and I believe is one reason we have a strong consultant body.”

 “Stop the Royal College ability to block/delay recruitment. Stop them blocking creativity in
 developing jobs. Stop them setting unrealistic expectations on small non-specialist trusts.
 Implement a national locum tariff set by DoH (we have been gazumped by Trusts offering more)
 its obscene having to barter when loyal substantive consultants continue to carry the risk and
 work excessive hours.”

 Trusts recruiting on national terms and conditions and not advertising posts with salaries in
 excess of £30,000 above Whitley rates. Hopefully this will reduce with the new contract.

 Royal College of Psychiatrists responding quickly to requests for approval. We have lost
 potential candidates because of the delays we have experienced.

 Recruiting from overseas only once a doctor is on the Specialist Register.”

 “Make the job something people want to do:
 - Reduce the blame culture.
 - Dispel the idea we can take control of people’s behaviour 24/7.
 - Dispel the belief risk assessment is anything other than a paper exercise to leave an audit trail
   when things go wrong.
 - Reduce form filling.
 - Provide adequate junior support.
 - Give us time to do what’s expected of us.

 •       More linkages and joint working with the educational institutes (from schools through to
         universities).
 •       More overseas options.
 •       Strong educational programmes to encourage consultants in the “national shortages” e.g.
         CAMHs, SM.
 •       Learning best practice from other countries.
 •       Promotion and awareness of mental health professions to all ages and social groups.
 •       Clearer career pathways into mental health.”


                                                    43
SURVEY RESULTS 4

Introduction

The last section of the survey concentrates on the impact of consultant psychiatrist
vacancies and covering posts with short and long term locums. Trusts were asked to
gather responses from line managers, other staff and service users.

Q27. WHAT IMPACT HAVE THE CONSULTANT PSYCHIATRIST VACANCIES
AND/OR USE OF LOCUMS HAD ON THE CLINICAL SERVICES?

There were 24 Trusts that responded to this question and commented on the impact
on service users, other staff and related issues about locum use.

Impact on people using services.

This area was the most commonly reported by Trusts. The most frequent
observation was the impact of locums on service users. These include:
a lack of continuity of care for service users, an increase in complaints from service
users and carers, service users having to repeat the same information to different
locums. One Trust mentioned service users finding it difficult to talk to a new face.

Additionally concerns were expressed about poor care for individuals, delays and
cancellations of appointments due to a shortage of Consultants, increased waiting
time for appointments due to a lack of consultants, unnecessary changes to
medication and that length of stay had increased.

Impact on other staff.

The majority of Trusts responses related to increased pressure on substantive
colleagues (psychiatrists). Additionally a number of Trusts recognised the use of
locums resulted in increased pressure on other professional groups who were
“plugging the gaps” and 12 Trusts thought they were relying on the goodwill of staff,
both psychiatrists and other professionals to deliver the service.

Due to covering for vacant posts etc. a number of psychiatrists were having difficulty
in conducting CPD activities/remaining up to date with clinical practice/latest
developments. 10 Trusts mentioned a lack of support/or teaching time available to
junior doctors. Given that these are the Consultants of the future, not getting the
quality and quantity of support required, and seeing their Consultants workload may
have a negative impact on their future career choices.

Six Trusts mentioned the time taken to induct new locums to the service. A number
of Trusts discussed the effect of locums on creating uncertainty/distress/anxiety for
other professional team members, whilst four Trusts mentioned that locums were
unable to work with teams/did not make an effort to create good working
relationships.

Three Trusts mentioned that the use of locums created a straining of relationships
between primary and secondary care (GPs were mentioned in all three cases).


                                          44
Multiple difficulties arising from the use of Locums

12 Trusts mentioned the lack of service development, which was due to the lack of
time of substantive psychiatrists and/or budget overspends on locums. As a single
issue 12 Trusts mentioned the expense of locums leading to budget overspends.
The issue of the quality of locums was mentioned by 11 different Trusts and a lack of
leadership of teams due to the use of locums was also mentioned. Further factors
impacting on service users came from having to prioritise work against staff
shortages resulting in delays, e.g. medication reviews were significantly delayed.
Contradictory approaches to care resulting from the use of locums were raised by a
smaller number of Trusts.

A number of Trusts mentioned locums were not up to date with latest clinical
practice/evidence, and two Trusts mentioned locums patients occupied more beds
and locums appeared to be reducing risk taking, whilst a further two Trusts
mentioned unnecessary admissions of service users.

Lack of flexibility to appoint competent staff as Consultants due to lack of
qualifications.

There were two Trusts that mentioned staff grades:

 “Some of the most successful locums have been valued Staff Grade doctors already
employed by the Trust but who are not eligible to apply for a substantive post. In the
long term their career progression is not well served by this situation.”

“In our Trust we have gone, in some instances, for long-term locums, that is
psychiatrists who, for whatever reason, are not eligible to be on the Specialist
Register, and therefore cannot be appointed substantively, but who have shown
themselves to be competent and reliable practitioners, and able to work at
Consultant level. Obviously, such colleagues would have been able to earn
substantial sums of money working as agency locums but we have offered them the
Trust’s remuneration package, which is generally seen to be attractive. We have
thus avoided the unreliability of external agency locums and frequent change of
Consultants that often comes with this. We have also, incidentally, avoided the
excessive expense of agency locums.”

Selected Comments

“I am lead GP for XXX for mental health. We have had difficulties attracting consultant psychiatrists
in the past and had numerous locums. This had lead to a straining of relationships between primary
and secondary care and complaints from users about a lack of continuity of care. The Community
Mental Health Team have had to cope with changing locums. Thankfully, the situation has
improved and we have more permanent consultants in our locality sectors now. The patients, GPs
and CMHT members are much happier and we have established a GP/Consultant Clinical Forum
which meets every 6 months to share good practice and improve relationships, all leading to an
improvement in patient care.”

Views canvassed from Service users and clinical colleagues.
“Team morale was at an all time low during period of high vacancies and when we could only attract
short (2 –3 week) locums. Team members and service users were dissatisfied with quality of
experience, lack of “ownership”, disgust at the high costs for often poor performance, and
unreliability. Having to see a different consultant each time. Having to recount history each
occasion. Other team members having to carry unacceptable risk. Extended length of stay in In-
                                                     45
patient. Unnecessary admissions, reduced risk taking, unnecessary changes to medication.
Increased complaints.”
Selected comments continued

Views canvassed from Service users and clinical colleagues.
“Team morale was at an all time low during period of high vacancies and when we could only
attract short (2 –3 week) locums. Team members and service users were dissatisfied with quality
of experience, lack of “ownership”, disgust at the high costs for often poor performance, and
unreliability. Having to see a different consultant each time. Having to recount history each
occasion. Other team members having to carry unacceptable risk. Extended length of stay in In-
patient. Unnecessary admissions, reduced risk taking, unnecessary changes to medication.
Increased complaints.”


Feedback from other staff and service users on the impact of consultant
psychiatrist vacancies and/or use of locums had on the clinical services.

  Concerns

   1. Considerable variations in diagnostic clarification due to lack of consistency of
       care – leading to problems in the patient’s care and ongoing treatment.
   2. A number of patients have complained about inconsistencies and having to
       repeat their history and personal details. Often patients feel unable to talk to
       a new face.
   3. Different psychiatrists have different approaches, particularly with Personality
       Disordered clients who need a consistent approach to their care.
   4. Locums are unprepared for out patient consultations.
   5. A number of appointments have been cancelled due to the absence of a
       doctor. The lack of doctors compromises waiting lists and has meant that
       other healthcare professionals need to keep the service operating.
   6. A great deal of managerial time is spent co-ordinating placements which is
       particularly difficult when a locum can only undertake 2 weeks work (often
       whilst they take leave from their substantive employer).
   7. Substantive Consultants have helped to provide cross cover in the absence of
       locums but become exhausted and demoralised. Their workload is already
       significantly higher than the recommended level. Many have left which has
       created more vacancies.
   8. Some locums have been excellent but they do not contribute to the wider role
       in the same way as a substantive consultant, such as with education and
       service planning.
   9. Some of the most successful locums have been valued Staff Grade doctors
       already employed by the Trust but who are not eligible to apply for a
       substantive post. In the long term their career progression is not well served
       by this situation.
   10. Often locums do not drive which escalates costs with funding taxis for them.
   11. Deficits in forensic awareness when dealing/working with the Criminal Justice
       Service system leading to increased risk with certain users.
   12. Poor quality of medical input to assessment, conducted by the Multi-
       Disciplinary Team.
   13. Little investment in achieving acceptable relationships with other clinicians. At
       times considerable conflict and unacceptable behaviour.
   14. Different clinical styles. Lack of medical advice.
   15. Knock on effect on placement of junior doctors. As Senior house Officers
       cannot be placed with Locum Consultants because they are not recognised
       by the Royal College as approved trainers, this creates the situation of having


                                                46
       no junior support in some localities. As a result the Trust had to employ ‘Trust
       Doctor’ SHOs for these areas. Some flexibility by the Royal College with
       regards to the supervision of SHOs would be helpful in this context.
   16. Users who are difficult to engage are exploiting the lack of consistency within
       the medical input.
   17. Users advising of their concerns re: changes/lack of consistency.
   18. Increased complaints from patients and confusion from staff when the locum
       turnover is high.
   19. Increased pressure on nurses who are left holding high risk patients on their
       caseload.
   20. Patients loose faith in the service, feel unsettled with lots of changes in staff
       and some have stopped their treatment.

   How Trusts have responded to the workforce shortages

       •   Empowerment of other disciplines.
       •   Opportunities created to review traditional practice and make changes.
       •   Giving Service Managers more clinical directions in cases.
       •   Enabling key Managers to provide clinical direction in cases.
       •   Closer/more organised MDT meetings valuing/utilising a collective
           responsibility.
       •   The Team have matured to a more ‘adult’ approach in their dealing with
           conflict, not displacing issues onto the issue of lack of medical input.
       •   Improved the profile of Psychology/OT/SW’s.
       •   More holistic approaches towards treatment.
       •   Better engagement of users through ensuring their involvement.

Selected comments

“I am not convinced we have managed. High locum use and excessive workloads on remaining
consultants appear to have been main strategy, Looking at alternative consultant role but that hasn’t
become anything practically useful yet.”

“More generally, the fact that for much of the past 2 years XXX CAMHS has had only 2 out of a total of 5
psychiatry posts filled by substantive Consultants* and there has been such difficulty securing
experienced locums has meant: -
   1. some undesirably differing, even occasionally contradictory approaches to cases.
   2. high medical staffing costs.
   3. slower pace in implementing projects particularly key waiting list projects.
   4. an erosion of goodwill and capacity by the substantive consultants because of the pay relatives
        and repeated calls on them to provide cover between locums. Wider clinical management roles
        are not filled e.g. Social Services residential homes liaison, Child Protection, and even clinical
        leadership in because there are so few substantive consultants left to undertake them.
   5. An erosion of good will and capacity among all professions.
   6. A substantial opportunity cost in terms of scare management time lost in continuous search for,
        evaluation of suitability, induction and support of new locums especially those not familiar with
        UK legislative framework etc. This has slowed down many initiatives, e.g. recruitment of other
        disciplines, developing an ASD service, user involvement, standardisation across XXX.”

“The Trust has poor information systems that have caused difficulties in making these returns. Medical
staffing is coming back in to the Trust from XXX Shared Services which has to date provided poor
service. GPs do not like having locums as it reduces continuity of care and they have do not build up a
close relationship with them.”




                                                  47
REFERENCES

Mears A., Etchegoyen A., Stormont F., Kendall T., Katona C. and Pajak S. (2004a)
Female psychiatrists’ career developments after flexible training.
Psychiatric Bulletin (2004) 28: 201 –203

Mears A., Kendall T., Katona C., Pashley C. and Pajak S. (2004b)
Retirement intentions of older consultant psychiatrists.
Psychiatric Bulletin (2004) 28:130 –132

Mears A., Pajak S., Kendall T., Katona C., Medin J., Huxley P., Evans S. and Gately
C. (2004). Consultant psychiatrists working patterns: is a progressive approach the
key to staff retention?
Psychiatric Bulletin (2004) 28:251-253

National Statistics (2004). Labour Workforce Survey, Full-time/Part-time and Second
Jobs (SA). www.statistics.gov.uk/statbase/xsdataset.asp?More=Y.

National Working Group on New Roles for Psychiatrists. (2004). New Roles for
Psychiatrists.

Onyett S., Pillinger, T. and Muijen, M. (1995) Making Community Mental Health
Teams work: CMHTs and the people who work in them.
SCMH: London.

Pajak S., Mears A., Kendall T., Katona C. and Medina J. (2003) Workload and
Working Patterns in Consultant Psychiatrists; An investigation into occupational
pressures and burdens.
College Research Unit, Royal College of Psychiatrists, London. June 2003.

Pidd S.A. (2003) Recruiting and retaining psychiatrists.
Advances in Psychiatric Treatment (2003) vol. 9 405- 413

Royal College of Psychiatrists (2002) Annual Census of Psychiatric Staffing 2001.
Occasional Paper 54, October 2002.
Royal College of Psychiatrists, London.

Sainsbury Centre for Mental Health (2003) Psychiatrists in Demand
Sainsbury Centre for Mental Health, London.


Department of Health Publications

Department of Health, National Steering Group interim Report (2004). Guidance on
New ways of working for Psychiatrists in a multi-disciplinary context.

Department of Health (2004) website. NHS Workforce Vacancies Survey March
2004. (http://www.publications.doh.gov.uk/public/vacancysurvey.htm)




                                         48
Department of Health (2003) Getting the right start: National Service Framework for
Children, Young People and Maternity Services. Part 1: Standard for hospital
services.

Department of Health (2003). Hospital, Public Health Medicine and Community
Health Services Medical and Dental staff in England: 1993-2003.

Department of Health (2003) Guidance on implementing the European Working Time
Directive (EWTD) for Doctors in Training. ww.doh.gov.uk/workingtime/guidance.htm

Department of Health, National Assembly for Wales, the NHS Confederation and the
British Medical Association (2002) Guidance on Working Patterns for Junior Doctors.
www.doh.gov.uk/workingtime/guidance.htm

Department of Health (2002) Draft Mental Health Bill.

Department of Health (2001). National service framework for older people.

Department of Health (2001) The Mental Health Policy Implementation Guide.

Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform.

DOH (1999) National Service Framework for Mental Health.




                                         49
APPENDIX A          CONSULTANTS IN POST BY SPECIALTY

GENERAL ADULT PSYCHIATRY

    Table 2 General Adult Consultant Psychiatrists in post, by WTE and
    headcount England and extrapolation to 100%.

    GA                      Figures from survey (71% of MH             100%
                            NHS Trusts, number 59)                     extrapolation*
    Total FT WTE            854                                        1203
    Total PT WTE            181.18 WTE & 6 PT posts                    255 WTE + 8 PT
                                                                       posts
    Total FT Male           532                                        749
    Head count
    Total PT Male           89                                         125
    Head count
    Total FT Female         224                                        315
    Head count
    Total PT Female         130                                        183
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 175.48 WTE to 854 FT WTE and
    181.18 PT WTE, extrapolated to 100% = 1705.15

OLD AGE PSYCHIATRY

    Table 3 Old Age Consultant Psychiatrists posts, England

    OA                       Figures from survey (71% of               100%
                             MH NHS Trusts n=59)                       extrapolation*
    Total FT WTE             320                                       451
    Total PT WTE             37.92 WTE & 16 PT posts                   53.4 + 22.53 PT
                                                                       posts
    Total FT Male Head       206                                       290
    count
    Total PT Male            15                                        21
    Head count
    Total FT Female          83                                        117
    Head count
    Total PT Female          49                                        69
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 55.545 WTE to 320 FT WTE and 37.92
    PT WTE, extrapolated to 100% = 582.35




                                           50
CAMHS (CHILD AND ADOLESCENT MENTAL HEALTH)

     Table 4 Children and Adolescent Consultant Psychiatrists posts,
     England

     CA                 Figures from survey (71% of MH                   100%
                        NHS Trusts n=59)                                 extrapolation*
     Total FT WTE       205                                              289
     Total PT WTE       53.92                                            75.94
     Total FT Male Head 97                                               137
     count
     Total PT Male Head 24                                               34
     count
     Total FT Female    76                                               107
     Head count
     Total PT Female    67                                               94
     Head count
     *rounded to whole person where necessary. Gender headcount figures may be different to
     the WTEs as not all returns gave male/female breakdowns.

     Note - If vacancy figures are included 40.35 WTE to 205 FT WTE and 53.92
     PT WTE, extrapolated to 100% = 421.51


LEARNING DISABILITY

     Table 5 Learning Disability Consultant Psychiatrists posts, England

     LD                 Figures from survey (71% of MH                   100%
                        NHS Trusts n=59)                                 extrapolation*
     Total FT WTE       127                                              179
     Total PT WTE       21.67                                            30.52
     Total FT Male Head 72                                               101
     count
     Total PT Male Head 9                                                13
     count
     Total FT Female    23                                               32
     Head count
     Total PT Female    16                                               23
     Head count
     *rounded to whole person where necessary. Gender headcount figures may be different to
     the WTEs as not all returns gave male/female breakdowns.

     Note - If vacancy figures are included 38.4 WTE to 127 FT WTE and 21.67 PT
     WTE, extrapolated to 100% = 614.74




                                            51
FORENSIC

    Table 6 Forensic Consultant Psychiatrists posts, England

    FOR                Figures from survey (71% of MH                   100%
                       NHS Trusts n=59)                                 extrapolation*
    Total FT WTE       146                                              206
    Total PT WTE       32.18                                            45.32
    Total FT Male Head 96                                               135
    count
    Total PT Male Head 7                                                10
    count
    Total FT Female    31                                               44
    Head count
    Total PT Female    13                                               18
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 20.0 WTE added to 146 FT WTE and
    32.18 PT WTE, extrapolated to 100% = 279.13


PSYCHOTHERAPY

    Table 7. Psychotherapy Consultant Psychiatrists posts, England

    PTH                Figures from survey (71% of MH                   100%
                       NHS Trusts n=59)                                 extrapolation*
    Total FT WTE       32                                               45
    Total PT WTE       32.11                                            45.22
    Total FT Male Head 18                                               25
    count
    Total PT Male Head 14                                               20
    count
    Total FT Female    10                                               14
    Head count
    Total PT Female    29                                               41
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 2.77 WTE added to 32 FT WTE and
    32.11 PT WTE, extrapolated to 100% = 94.2




                                           52
SUBSTANCE MISUSE

    Table 8. Substance Misuse Consultant Psychiatrists posts, England

    SM                 Figures from survey (71% of MH                   100%
                       NHS Trusts n=59)                                 extrapolation*
    Total FT WTE       56                                               79
    Total PT WTE       15.24                                            21.46
    Total FT Male Head 37                                               52
    count
    Total PT Male Head 14                                               20
    count
    Total FT Female    10                                               14
    Head count
    Total PT Female    5                                                7
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 13.43 WTE to 56 FT WTE and 15.24 PT
    WTE, extrapolated to 100% = 119.25



REHABILITATION

    Table 9. Rehabilitation Consultant Psychiatrists posts, England

    SM                 Figures from survey (71% of MH                   100%
                       NHS Trusts n=59)                                 extrapolation*
    Total FT WTE       39                                               55
    Total PT WTE       10.91                                            15.37
    Total FT Male Head 24                                               34
    count
    Total PT Male Head 9                                                13
    count
    Total FT Female    11                                               15
    Head count
    Total PT Female    9                                                13
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note -If vacancy figures are included 6.6 WTE to 39 FT WTE and 10.91 PT
    WTE, extrapolated to 100% = 79.59




                                           53
LIAISON PSYCHIATRY

     Table 10. Liaison Psychiatry Consultant Psychiatrists posts, England

     LIA                Figures from survey (71% of MH                    100%
                        NHS Trusts n=59)                                  extrapolation*
     Total FT WTE       15                                                21
     Total PT WTE       7.08                                              10
     Total FT Male Head 13                                                18
     count
     Total PT Male Head 6                                                 8
     count
     Total FT Female    4                                                 7
     Head count
     Total PT Female    7                                                 10
     Head count
     *rounded to whole person where necessary. Gender headcount figures may be different to
     the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 1.38 WTE to 15 FT WTE and 7.08 PT
    WTE, extrapolated to 100% = 33.04


ACADEMIC

     Table 11. Academic Psychiatry Consultant Psychiatrists posts, England

     AC                       Figures from survey (71% of            100% extrapolation*
                              MH NHS Trusts n=59)
     Total FT WTE             37                                     52
     Total PT WTE             8.96 & 11 PT posts                     12.63 WTE +15.5 PT
                                                                     posts
     Total FT Male            34                                     48
     Head count
     Total PT Male            16                                     23
     Head count
     Total FT Female          1                                      1
     Head count
     Total PT Female          10                                     14
     Head count
     *rounded to whole person where necessary. Gender headcount figures may be different to
     the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 0.6 WTE to 37 FT WTE and 8.96 PT
    WTE, extrapolated to 100% = 65.58.




                                            54
MANAGEMENT

    Table 12. Management Psychiatry Consultant Psychiatrists posts,
    England.

    MAN                Figures from survey (71% of MH                   100%
                       NHS Trusts n=59)                                 extrapolation*
    Total FT WTE       20                                               28
    Total PT WTE       9.98                                             14.05
    Total FT Male Head 11                                               15
    count
    Total PT Male WTE 12.6                                              17.74
    Total FT Female    3                                                4
    Head count
    Total PT Female    7                                                10
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 0.8 WTE to 20 FT WTE and 9.98 PT
    WTE, extrapolated to 100% = 43.35.


OTHER

    Table 13. Other Psychiatry Consultant Psychiatrists posts, England.

    OTH                Figures from survey (71% of MH                   100%
                       NHS Trusts n=59)                                 extrapolation*
    Total FT WTE       12                                               17
    Total PT WTE       13.94                                            19.63
    Total FT Male Head 6                                                8
    count
    Total PT Male Head 4                                                6
    count
    Total FT Female    2                                                3
    Head count
    Total PT Female    10                                               14
    Head count
    *rounded to whole person where necessary. Gender headcount figures may be different to
    the WTEs as not all returns gave male/female breakdowns.

    Note - If vacancy figures are included 7.03 WTE to 12 FT WTE and 13.94 PT
    WTE, extrapolated to 100% = 46.44.




                                           55
APPENDIX B            VACANCIES BY REGIONAL DEVELOPMENT CENTRE AREA
                      (FULL AND PART TIME) AND SPECIALTY

NORTH WEST

(Six Trusts of the nine in the region provided information, 66.6% response rate by
region and 10.2% of the total sample of 59 Trust responses.)
NB Percentages have been rounded

Table 15. North West region psychiatrists by speciality and vacancy rate

Speciality Total       Total Total   Vacant       Numbers by         Vacant posts
           Posts       FT    P/T     posts by     wte and %          as a % of
                                     wte          covered by         funded posts
                                                  locums
GA           111.9     98    13.9    43.9         41.7 wte 95%       39%
OA           55.7      54    1.7     12           9 wte     75%      16%
CA           23.56     19    4.56    3            1 wte     33%      4%
LD           23.41     20    3.41    11.5         4 wte     35%      49%
FOR          34        32    2       5            2 wte     40%      15%
PTH          7.43      5     2.43    0.27         0.27 wte 100%      4%
SM           8.25      6     2.25    4.75         3.75 wte 79%       58%
RHB          5         3     2       2.1          2.1 wte 100%       42%
LIA          2         2     0       0            -                  -
AC           13        11    2       0            -                  -
MAN          3         2     1       0            -                  -
OTH          0.8       0     0.8     0            -                  -
TOTAL %      288.05    252   36.05   82.52        63.12 wte 22%      25%
are
averaged

Table 16. North West substantive consultants by speciality and gender

Speciality   FT Male    FT Female    PT Male    PT Female   TOTAL
GA           54         17           7          11          89
OA           25         10           1          2           38
CA           12         4            1          5           22
LD           7          3            2          2           14
FOR          17         6            0          2           25
PTH          3          1            0          3           7
SM           3          1            1          0           5
RHB          2          1            2          1           6
LIA          1          1            0          0           2
AC           11         0            1          3           15
MAN          2          0            0          1           3
OTH          0          0            1          1           2
Total        137        44           16         31          228




                                         56
NORTH EAST

(Nine Trusts of the 15 in the region provided data, 60% response rate for the region
and 15.25% response rate from the total sample).
t* Figures may not add up as one Trust did not provide complete information

Table 17. North East region psychiatrists by speciality and vacancy rate

Speciality Total       Total   Total      Vacant     Numbers by        Vacant
           posts       FT      P/T        posts by   wte and %         posts as a
                                          wte        covered by        % of funded
                                                     locums            posts
GA        92.51     84      8.51          22.55      20.55wte 91%      24%
OA        51.8      48      3.8           9.545      8wte*     84%     18%
CA        15.8      12      3.8           4.8        3.8wte    79%     30%
LD        19.75     14      5.75          8.9        3wte      34%     45%
FOR       15        15      0             4          3wte      75%     27%
PTH       6         5       1             1          0.72wte 72%       17%
SM        3         3       0             0          -                 -
RHB       6         5       1             1          1wte     100%     17%
LIA       4.55      4       .55           0          -                 -
AC        2.64      2       .64           0          -                 -
MAN       2.87      2       .87           0          -                 -
OTH       2.5       0       2.5           2.45       2.17wte 89%       87%
TOTAL % 222.42 194          28.42         52.245     42.24wte 52%      60%
are
averaged
*NB 1 WTE covering the 0.545 post.

Table 18. North East substantive consultants by speciality and gender

Speciality   FT Male   FT Female       PT Male   PT Female   TOTAL
GA           71        20              4         8           103
OA           34        15              1         2           52
CA           9         3               3         5           20
LD           6         5               1         4           16
FOR          13        1               0         0           14
PTH          1         3               0         0           4
SM           2         1               0         0           3
RHB          2         1               2         2           7
LIA          4         0               0         3           7
AC           0         0               0         0           0
MAN          0         0               5         3           8
OTH          0         0               0         0           0
Total        142       49              16        27          234




                                           57
WEST MIDLANDS

(12 Trusts of the 15 in the region returned data, 80% response rate for the region
and 20.33% response rate from the total sample).

Table 19. West Midlands region psychiatrists by speciality and vacancy rate

Speciality Total posts Total       Total    Vacant       Numbers by         Vacant
                       FT          P/T      posts by     wte and %          posts as
                                            wte          covered by         a % of
                                                         locums             funded
                                                                            posts
GA          119.74         108     11.74    11.81        9.18 wte 78%       8%
OA          39.6           32      7.6      9            6 wte    66.6%     23%
CA          32.14          28      4.14     5.5          2.95 wte 54%       17%
LD          35.10          29      6.10     4            1.7 wte 42.5%      11%
FOR         9              9       0        0            -                  -
PTH         3.86           3       0.86     0            -                  -
SM          7.14           7       0.14     1            1 wte     100%     14%
RHB         4.3            4       0.3      0            -                  -
LIA         0.5            0       0.5      0            -                  -
AC          1.5            1       0.5      0.6          0.6       100%     40%
MAN         0              0       0        0            -                  -
OTH         3.6            3       0.6      0            -                  -
TOTAL %     256.48         224     32.48    31.91        21.43wte           12%
are                                                      73.52%
averaged


Table 20. West Midlands region, substantive psychiatrists by speciality and
gender
Speciality FT Male FT Female PT Male PT Female TOTAL
GA         70        21          3        15           109
OA         26        4           2        4            36
CA         10        14          0        5            29
LD         23        3           2        4            32
FOR        8         1           0         0           9
PTH        3         0           0         2           5
SM         5         2           0         0           7
RHB        3         1           1         0           5
LIA        0         0           0         1           1
AC         1         0           0         1           2
MAN        0         0           0         0           0
OTH        3         0           0         1           4
Total      152       46          8        33           239




                                           58
EAST MIDLANDS

(Two Trusts of the five in the region returned data, 40% response rate for the region
and 3.4% response rate from the total sample).

Table 21. East midlands region psychiatrists by speciality and vacancy rate

Speciality   Total      Total      Total        Vacant   Numbers by         Vacant
             funded     FT         P/T          posts    wte and %          posts as
             posts                              by wte   covered by         a % of
                                                         locums             funded
                                                                            posts
GA           48.47      44         4.47         11.2     4.6 wte   41%      23%
OA           19.46      16         3.46         0                           0
CA           20.27      17         3.27         3        1.6 wte 53%        15%
LD           13.73      12         1.73         4        2 wte     50%      29%
FOR          44.28      36         8.28         5.5      2 wte     36%      12%
PTH          5.64       4          1.64         0        -                  -
SM           5          5          0            1        0 wte     0%       20%
RHB          9          9          0            0        -                  -
LIA          4          4          0            0        -                  -
AC           14.82      9          5.82         0        -                  -
MAN          2          2          0            0        -                  -
OTH          1.82       1          0.82         1        0.36 wte 36%       55%
TOTAL %      188.49     159        29.49        25.7     10.56wte 43.2%     14%
are
averaged


Table 22. East Midlands region, substantive psychiatrists by speciality and
gender.

Speciality   FT Male   FT Female    PT Male     PT Female    TOTAL
GA           22        8            11          7            48
OA           10        6            0           5            21
CA           6         8            2           3            19
LD           8         1            0           2            11
FOR          25        7            1           5            38
PTH          3         0            0           4            7
SM           3         0            0           0            3
RHB          5         3            0           1            9
LIA          2         1            1           0            4
AC           8         1            9           3            21
MAN          1         1            0           0            2
OTH          0         0            2           1            3
Total        93        36           26          31           186




                                           59
EAST

(Seven Trusts of the eight in the region returned data, 87.5% response rate for the
region and 11.86% response rate from the total sample).

Table 23. Eastern region psychiatrists by speciality and vacancy rate

Speciality Total       Total    Total     Vacant     Numbers by        Vacant
           Posts       FT       P/T       posts      wte and %         posts as
                                          by wte     covered by        a % of
                                                     locums            funded
                                                                       posts
GA           130.82    118      12.82     20         14.54wte 73%      15%
OA           45.55     41       4.55      5          3.5 wte   70%     11%
CA           47.27     40       7.27      9.8        2.4 wte 24.5%     21%
LD           26.18     26       0.18      4          2.8 wte   70%     15%
FOR          14        14       0         1          0.2 wte   20%     7%
PTH          2.71      1        1.71      0          -                 -
SM           8.13      7        1.13      2          1 wte     50%     25%
RHB          4         4        0         2          2 wte     100%    50%
LIA          0.45      0        0.45      0          -                 -
AC           0         0        0         0          -                 -
MAN          5.22      4        1.22      0          -                 -
OTH          0.55      0        0.55      0          -                 -
TOTAL %      284.88    255      29.88     43.8       26.44wte 58.2%    15%
are
averaged


Table 24. Eastern region, substantive psychiatrists by speciality and gender

Speciality   FT Male   FT Female    PT Male      PT Female   TOTAL
GA           68        29           6.5          5.2         108.7
OA           29        7            3            8           47
CA           16        8            8            9.3         41.3
LD           14        4            0            1           19
FOR          7         6            0            0           13
PTH          0         1            2            1           4
SM           4         1            1            1           7
RHB          2         0            0            0           2
LIA          0         0            0            1           1
AC           0         0            0            0           0
MAN          1         0            0            1           2
OTH          0         0            0            0           0
Total        141       56           20.5         27.5        245




                                         60
SOUTH WEST

(Three Trusts of the eight in the region returned data, 37.5% response rate for the
region and 5.08% response rate from the total sample).

Table 25. South West region psychiatrists by speciality and vacancy rate

Speciality           Total   Total    Total    Vacant      Numbers by      Vacant
                     posts   FT       P/T      posts by    wte and %       posts as a
                                               wte         covered by      % of
                                                           locums          funded
                                                                           posts
GA                   47      41       6        9.5         6 wte 63%       13%
OA                   30      29       1        4           3 wte 75%       13%
CA                   11.4    5        6.4      1           0 wte 0%        9%
LD                   2.7     2        0.7      0           -               -
FOR                  6       6        0        0           -               -
PTH                  4.5     2        2.5      0.5         0 wte 0%        11%
SM                   2.2     2        0.2      0           -               -
RHB                  6.3     5        1.3      0           -               -
LIA                  0       0        0        0           -               -
AC                   0       0        5        0           -               -
MAN                  6       6        0        0           -               -
OTH                  1       0        0        0.5         0 wte 0%        50%
TOTAL % are          117.1   98       23.1     15.5        9wte 69%        13%
averaged


Table 26. South West region, substantive psychiatrists by speciality and
gender

Speciality   FT Male   FT Female     PT Male   PT Female     TOTAL
GA*          35        7             3         3             48
OA           19        10            1         0             30
CA           5         1             2         5             13
LD           2         0             1         0             3
FOR          5         1             0         0             6
PTH          1         1             1         0             3
SM           1         0             0         0             1
RHB          3         2             1         1             7
LIA          0         0             0         0             0
AC           0         4             0         1             5
MAN          4         2             0         0             6
OTH          0         0             0         0             0
Total        75        28            9         10            122

* FT figures do not add up




                                          61
SOUTH EAST

(13 Trusts of the15 in the region returned data, 86.66% response rate for the region
and 22% response rate from the total sample).

Table 27. South East region psychiatrists by speciality and vacancy rate

Speciality Total       Total     Total     Vacant     Numbers by        Vacant posts
           Posts       FT        P/T       posts      wte and %         as a % of
                                           by wte     covered by        funded
                                                      locums            posts
GA           176.19    161       15.19     38.02      33.8 wte 89%      22%
OA           80.81     65        15.81     13         9.2 wte 71%       16%
CA           47.44     35        12.44     9.75       5.4 wte 55%       21%
LD           17.19     15        2.19      4          3 wte    75%      23%
FOR          33.35     20        13.35     2          0.5 wte 25%       6%
PTH          11.82     5         6.82      0          -                 -
SM           16.03     10        6.03      2.68       2.18wte 81%       17%
RHB          8.31      5         3.31      1.5        0         0%      18%
LIA          4.95      2         2.95      1.38       0.38 wte 28%      28%
AC           14        0         0         0          -                 -
MAN          8.36      3         5.36      0.8        0.6      75%      10%
OTH          3.67      1         2.67      0.98       0.8 wte 82%       27%
TOTAL %      422.12    322       86.12     74.11      55.86wte          18%
are                                                   64.6%
averaged



Table 28. South East region, substantive psychiatrists by speciality and
gender

Speciality   FT Male   FT Female    PT Male    PT Female    TOTAL
GA           120       27           11         16           174
OA           43        13           3          16           75
CA           13        16           1          17           47
LD           8         5            1          1            15
FOR          17        2            1          2            22
PTH          3         2            5          3            13
SM           7         2            6          1            16
RHB          3         2            1          2            8
LIA          1         1            4          2            8
AC           14        0            0          0            14
MAN          1         0            6          2            9
OTH          0         0            1          1            2
Total        230       70           40         63           403




                                         62
LONDON

(Six Trusts of the 10 in the region returned data, 60% response rate for the region
and 10.16% response rate from the total sample).

Table 29. London region psychiatrists by speciality and vacancy rate

Speciality     Total      Total     Total        Vacant   Numbers by      Vacant
               Posts      FT        P/T          posts by wte and %       posts as a %
                                                 wte      covered by      of funded
                                                          locums          posts
GA          314.55     200          114.55       18.5     13.8 wte 75%    6%
OA          57         41           16           3        3 wte 100%      5%
CA          63.14      49           14.14        3.5      2 wte 57%       6%
LD          10.6       8            2.6          2        1wte    50%     19%
FOR         22.55      14           8.55         2.5      0 wte 0%        11%
PTH         22.15      7            15.15        1        1wte 100%       5%
SM          21.49      16           5.49         2        1 wte 50%       9%
RHB         7          4            3            0        -               -
LIA         6.63       4            2.63         0        -               -
AC          4          0            4            0        -               -
MAN         1.53       0            1.53         0        -               -
OTH         12         6            6            2.1      1 wte 48%       18%
TOTAL %     542.64     349          193.64       34.6     22.8wte         6%
are                                                       68.6%
averaged
* Some PT WTE were not given

Table 30. London region, substantive psychiatrists by speciality and gender

Speciality   FT Male   FT Female    PT Male      PT Female TOTAL
GA           92        95           53           64          304
OA           20        18           4            12           54
CA           26        22           7            17           72
LD           4         2            2            2            10
FOR          4         7            5            4            20
PTH          4         2            6            16           28
SM           11        3            5            2            21
RHB          2         2            1            2             7
LIA          3         1            3            0             7
AC           0         0            2            2             4
MAN          0         0            2            0             2
OTH          3         2            0            6            11
Total        169       154          90           127         540




                                            63
APPENDIX C. THE SURVEY QUESTIONNAIRE




                              64
SCOPING THE CURRENT PROBLEMS AND SOLUTIONS RELATING
  TO CONSULTANT PSYCHIATRIST VACANCIES, CONSULTANT
    RECRUITMENT, AND THE USE OF LOCUMS IN ENGLAND
                                NIMHE/SCMH Joint Workforce Support Unit.
                              Supported by the Royal College of Psychiatrists.
                                                                     January 2004



The Royal College of Psychiatrists undertake an annual survey of Consultants and Junior Medical Psychiatric posts. The eleventh annual survey relating
to psychiatric staffing in England, Scotland, Wales and Northern Ireland 2002 is to be published shortly. The Royal College are not undertaking their
annual survey in the autumn of 2003, and are fully endorsing this survey for the National Institute of Mental Health England, and providing access to their
own data. It is essential that this survey is completed for all mental health services to provide the best data for current analysis and future national
planning.
Notes

        The survey is being sent to the Medical Directors of all Trusts in England and to private sector mental health services.

        The survey deadline is 6 February 2004. A copy of the analysis will be loaded onto the SCMH website, www.scmh.org.uk,
        for comment in April 2004 and you and colleagues will be welcome to comment online about the results.

        No Trust or provider will be individually identified in the final report, the results will be aggregated. However where individual
        examples have been provided that it would be helpful to use and they could be attributed back to the individual provider, they
        will only be used where permission has gained from that provider.

        The final report will be available on the SCMH website in June 2004.

        Further information regarding completing this questionnaire can be obtained from;

        Malcolm Philip/Angela Hoadley                                                       Tel: 0207 827 8300
        The Sainsbury Centre for Mental Health                                              Fax: 020 7403 9482
        134 –138 Borough High St                                              Email:        malcolm.philip@scmh.org.uk
        London SE 1LB                                                                       a.hoadley@scmh.org.uk

        There is a section at the end of the questionnaire where we are interested in the impact of any recruitment difficulties about
        Psychiatrists on the clinical services. This will need to be photocopied and sent to a few colleagues and service user
        representatives for their response. We are keen to gather both organisational and user perspectives on any difficulties.
        Please ensure this is done in good time so their response can be gathered. Photocopied responses from colleagues/user
        representatives should be attached to the main questionnaire.

        Please complete and return this questionnaire in the freepost envelope provided by
        6th February 2004. If you would prefer to complete a version sent and returned via e-mail please contact Malcolm Philip or
        Angela Hoadley by e-mail, addresses as above, and a word version will be sent out to you.




                                                                    66
Name of Trust/Provider:

Name and job title of person                                               Name of Medical Director:
completing questionnaire:



Postal address:                                                                     Postal address:




Telephone number:                                                          Telephone number:

Fax number:                                                                Fax number:

Email address:                                                                      Email address:

The questionnaire refers to data about psychiatrist positions as at:
(Please state to what date the data provided is applicable to).


  It is important that we have full contact details so we can contact the person completing the questionnaire, or supervising it’s completion, if
  there are any queries, and/or contact the Medical Director for further information. Contact details will be kept confidentially by the Sainsbury
  Centre for Mental health.




                                                                               67
1. CONSULTANT PSYCHIATRIST POSTS

                   Establishment     Establishment    Number of      Number of     Number of    Number of
                    - funded full-   -funded part-    male           male          female       female
                   time posts in     time posts in    consultant     consultant    consultant   consultant
                   WTEs              WTEs             staff Full     staff part    staff full   staff part
                                                      time (1)       time (1)      time (1)     time (1)
General Adult
Psychiatry
Old age
Psychiatry
Child and
Adolescent
Psychiatry
Psychiatry of
Learning
Disability
Forensic
Psychiatry
Psychotherapy
Substance
Misuse
Rehabilitation
Liaison
Psychiatry
Academic
Management
Other
Total

Notes.
1. Please state numbers of staff by headcount, do not attempt to translate into WTEs.


                                                                68
2. CONSULTANT PSYCHIATRISTS VACANCIES
                                                                                                                     Index
Specialism Funded          Length       Does a      What is      How long         How long        Is the vacant      GA -General
            vacant         of time      locum       the WTE      has the          has this post   post being         Adult Psychiatry
(see index) post in        vacant       cover       of the       locum been       been            covered in         OA - Old age
            WTE (1)        (in          this        locum?       employed?        covered by      some other         Psychiatry
                           months)      vacancy?    (3)          (in months)      locums? (in     way? If so         CA - Child and
                           (2)                                                    months)         please state       Adolescent
                                                                                                  over page          Psychiatry
                                                                                                                     LD - Psychiatry
                                                                                                                     of Learning
                                                                                                                     Disability
                                                                                                                     FOR - Forensic
                                                                                                                     Psychiatry
                                                                                                                     PTH -
                                                                                                                     Psychotherapy
                                                                                                                     SM - Substance
                                                                                                                     Misuse
                                                                                                                     RHB -
                                                                                                                     Rehabilitation
                                                                                                                     LIA - Liaison
                                                                                                                     Psychiatry
                                                                                                                     AC - Academic
                                                                                                                     MAN –
Notes.                                                                                                               Management(4)
                                                                                                                     OTH - Other
Please include all posts vacant, even if they have never been advertised, are filled by locums, or covered by other grades.
                                                                                                                     l
   1. WTE means whole time equivalent. A full-time post is designated 1 WTE, others are less e.g. a half-time post is 0.5 WTE.
   2. Please specify the length of time vacant since either the last substantive/permanent consultant or the length of time post
      established but not filled. For this column please ignore any locum or other temporary appointment to the post.
   3. A locum may not be covering the full hours of the post. E.g. they may be half-time in a full time post, in which case they are
      0.5 WTE. Please state their WTE against a full-time position, even if the post they are covering is part time.
   4. Management posts are only those ESTABLISHED as management posts and vacant as such.


                                                                 69
Consultant Psychiatrists vacancies (continued)                                                              Index
                                                                                                            GA -General
Specialism Funded         Length     Does a      What is     How long       How long        Is the vacant   Adult Psychiatry
             vacant       of time    locum       the WTE     has the        has this post post being        OA - Old age
(see index) post in       vacant     cover       of the      locum been     been            covered in      Psychiatry
             WTE (1)      (in        this        locum?      employed?      covered by      some other      CA - Child and
                          months) vacancy? (3)               (in months)    locums? (in way? If so          Adolescent
                          (2)                                               months)         please state    Psychiatry
                                                                                            over page       LD - Psychiatry
                                                                                                            of Learning
                                                                                                            Disability
                                                                                                            FOR - Forensic
                                                                                                            Psychiatry
                                                                                                            PTH -
                                                                                                            Psychotherapy
                                                                                                            SM - Substance
                                                                                                            Misuse
                                                                                                            RHB -
                                                                                                            Rehabilitation
                                                                                                            LIA - Liaison
                                                                                                            Psychiatry
                                                                                                            AC - Academic
                                                                                                            MAN –
                                                                                                            Management(4)
Notes.                                                                                                      OTH - Other
                                                                                                            l
Please include all posts vacant, even if they have never been advertised, are filled by locums, or covered by other grades.
1. WTE means whole time equivalent. A full-time post is designated 1 WTE, others are less e.g. a half-time post is 0.5 WTE.
2. Please specify the length of time vacant since either the last substantive/permanent consultant or the length of time post
   established but not filled. For this column please ignore any locum or other temporary appointment to the post.
3. A locum may not be covering the full hours of the post. E.g. they may be half-time in a full time post, in which case they are
   0.5 WTE. Please state their WTE against a full-time position, even if the post they are covering is part time.


                                                                  70
4. Management posts are only those ESTABLISHED as management posts and vacant as such.

Do you have any consultant psychiatrist vacancies covered by other arrangements than locums?

YES     NO      Please state which post(s), and the arrangements for cover. Give details for each post.




The following questions relate to the main difficulties in recruiting permanent/substantive consultant psychiatrists to
your organisation.

Please circle YES or NO to the following questions, as appropriate and provide details where possible.

Are there known local factors impacting on recruitment of Psychiatrists to the organisation?                YES NO
This covers general factors relating to attracting candidates to the organisation, factors relating to individual posts please specify in
the next question.
Please give details.




                                                                   71
Does the geographical location of the Trust/Provider cause difficulties in recruitment?              YES NO
For example transport difficulties, poor local environment, poor schooling, high accommodation costs. Please give details.




Are there known factors relating to individual posts/specialties?                                           YES    NO
Please state which posts and give details




                                                                    72
Are there problems with the terms of employment related to individual posts?   YES   NO
For example, out of hours commitment, number of sessions.
Please state which posts and give details




Are there problems with approval of job descriptions?                          YES   NO
For example from the Trust/provider, Royal college (regional adviser).
Please state which posts and give details




                                                                 73
Have there been difficulties with the response to adverts?                  YES   NO
For example cannot shortlist? No response to advert.
Please state which posts and give details




Have there been difficulties with Advisory Appointments Committees?   YES   NO
Please state which posts and give details




                                                              74
Have there been applicants could be appointed to Consultant level but preferred to take a NCCG level job instead?
                                                                                             YES NO
Please state which posts and give details




Have terms and conditions on any posts been offered outside standard terms and conditions of service in order to attract
permanent consultants? YES NO
For example offering higher salaries than NHS national salary scales. Please state which posts and give details




                                                                75
If you have answered YES to any of the above questions, please use the space below to explain what, if any action is planned/has
been initiated to improve recruitment of consultant psychiatrists. E.g. recruiting from abroad, using the international fellowship
scheme, changing posts to make them more attractive.
Continue on the next page if required.




                                                                76
Actions planned/initiated continued.




                                       77
3. USE OF LOCUMS


How much was spent in 2000-2001 on locums for consultant psychiatrists?         £

How much was spent in 2001-2002 on locums for consultant psychiatrists?         £

How much was spent in 2002-2003 on locums for consultant psychiatrists?         £

How much has been spent in first half of the current financial year?       £        April 03-Sept 03


Are your locums recruited from NHS agencies? (i.e. NHS Professionals)               YES   NO
If NO can you give reasons?




Are locums recruited from agencies?                                                       YES    NO
If Yes please state which agencies, and basic hourly rates charged, where known.

Agency                                     Basic hourly rates for consultants




                                                                 78
Are any locums employed directly by the Trust/Provider or under other arrangements?                 YES NO
For example directly employed by the organisation or self employed, or via own business. Please give details.




Are locums given any other benefits as well as salaries?                                                 YES NO
For example car hire, accommodation paid for. Please give details.




                                                               79
Do locums demand other terms and conditions?                                                               YES NO
For example the locum may demand a guaranteed 1 in 4 on-call even if the post does not require it. Please give details.




Are locums employed required to cover the full duties of the post?                          YES NO
If no please state what the arrangements are for each locum on lower commitments. E.g. reduced hours, no management
meetings, only covering for some of the patients/users.




                                                                80
Does the Trust/provider have difficulty in recruiting locum consultant psychiatrists?        YES NO
If yes, please give details and state any for particular specialities.




Has the Trust/provider had any restrictions with regard to employing locums?                 YES   NO
If yes please give details. For example financial, contractual issues on duties performed.




                                                                  81
Has the Trust/provider had any problems through employing locums?                           YES NO
If YES, please give details.




Are any of the locums consultant psychiatrists who have taken early retirement?           YES NO
If YES please state how many, what speciality they are working in and what WTE they work?




Are the locums used eligible to be considered for employment as Consultant Psychiatrists?   YES   NO
If not, please give reasons. For example they do not have the required qualifications.




                                                               82
Has the organisation advertised for locums in the hope of that they will accept a permanent position in the longer term?
                                                                                               YES NO
If YES please state the arrangements. For example a six-month locum offered to candidate
so they can see if they like the post.




Have there been any examples of individuals requesting locum posts themselves instead of seeking permanent employment?
                                                                                              YES NO
If YES please state reasons if known. For example the individual decides to seek a locum position initially
to see if they like the post.




                                                                 83
Do you have any examples of ideas/alternative solutions that you feel may reduce the vacancy numbers of consultant psychiatrists
and use of locum consultant psychiatrists?




                                                               84
4. WHAT IMPACT HAVE THE CONSULTANT PSYCHIATRIST VACANCIES AND/OR USE OF LOCUMS HAD ON THE
CLINICAL SERVICES?
Please specify how the services have been run in the absence of a permanent Psychiatrist. Note we are not attempting to ‘catch
anyone out’, nor looking to ‘discover bad practice’, we are interested to know how the services have coped in the absence of a
Psychiatrist. This will need to be completed by someone other than the principal person completing the form. Please photocopy
this page and send to colleagues and user representatives. We will accept handwritten responses from others and individual
responses will be confidential as per the rest of the survey. However it would help if they could add a name, job title as appropriate
and contact number in case we need to contact them.




Note.
We would be very interested to hear of any innovative response to the difficulties posed by being unable to recruit a
Psychiatrist. For example re-organising teams, changing work roles of others to deliver services without a Consultant
Psychiatrist or with reduced locum hours of support.


                                                                  85

								
To top