Royal College of Surgeons UK Surgical Workforce Census Report: Addressing Challenges in the UK Surgical Workforce

13 February 2024

The surgical landscape in the UK has never been more challenging. A recent Royal College of Surgeons of England report painted a stark picture of a stressed and struggling workforce. Lack of access to operating theatres, extended hours, and stressful working environments are leading to burnout, a situation which is simply not viable long-term. Furthermore, half of the census respondents are considering leaving, potentially leading to a retention problem the struggling workforce can ill-afford.

Key findings from the census include:

· More than half (56%) of the UK surgical workforce faces challenges accessing operating theatres.

· 61% of surgical trainees specifically highlight this issue, which impacts their training time.

· 50% of respondents have considered leaving the workforce in the past year.

· Burnout and stress, primarily because of excessive workloads, are cited by 61% as the key challenges.

· 64% of consultant surgeons aged 55-64 plan to retire in the next four years.

· 47% believe 'system challenges' affect their ability to deliver work.

· 67% of consultants work beyond contracted hours.

· 42% did not take their annual leave entitlements in the past year.

The impact of these challenges is broader than the detrimental impact on the surgical workforce. Waiting lists in the UK remain at a record high, and it is no surprise that lack of access to operating theatres is a key factor. Recommendations released by the Royal College of Surgeons of England include addressing theatre capacity by increasing the number of surgical hubs; ring fencing beds for elective surgery; increasing consultant surgeon workforce year-on-year; adjusting working practices; and increasing theatre staff capacity, including anaesthetists.

A second recommendation, that of ensuring a sustainable surgical workforce, calls for flexible and Less Than Full Time (LTFT) working; the tackling of bullying and harassment and sexual misconduct in the workplace; and improvements to the working environment itself, which includes the provision of places of rest and study, and availability of hot meals. The College has outlined these factors as part of a holistic approach in which they will work with NHS trust organisations and health boards to overhaul policies and implement guidance with a focus on surgeons’ wellbeing.

A happy and fulfilled workforce is not the product of a few tweaks. The census shows us we must challenge multiple factors to make even the smallest impact. We must view this as a long game; an improved and stable surgical environment for the benefit of all, including the public. This report is a first step, a catalyst for change, and these changes are a matter of priority.

CBS President, Mark Henley, says:

“In the current environment it’s shocking yet not surprising that the majority of experienced consultants are choosing to retire early as there is a very real risk of burnout and a chronic perception of feeling undervalued – and this is a concern spanning all stages of training and experience.

“Moreover, past reorganisations within the Health Service meant to produce efficiencies for administration have resulted in transfer of that workload onto clinicians. Surgeons are desperate to operate; it’s fundamental to what we do! We would love to be focused on this provision, rather than fulfilling administrative needs.

“The importance of the surgical team as a whole needs to be recognised in maintaining and further developing best practice, and therefore patient safety as well as satisfaction. This support system is key to the training of the next generation of surgeons.

“It is testament to how hardworking professionals in surgery have been through these pressurised periods; with such a high proportion of them working beyond their hours and forgoing their allocated leave. This, however, is clearly untenable in the long term.

“At the Confederation of British Surgery, we aim to provide independent support to the entire surgical team and their families.”

CBS offers help and guidance to all members of the surgical team on medico-legal matters, issues relating to terms and conditions, as well as bullying and harassment via its independent and confidential advisory line – the Surgical Advisory Service.

CBS members also have exclusive access to a comprehensive Member Assistance Programme which offers confidential counselling, legal support, bereavement assistance, medical guidance, and online Cognitive Behavioural Therapy (CBT), along with the Wisdom app and additional resources for a holistic approach to wellbeing.

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