Junior doctor contract is making paediatric rotas more difficult to fill, finds survey

Authors: Zosia Kmietowicz 

Publication date:  18 Jul 2017

Two thirds (67%) of directors responsible for paediatric staffing in the UK have said that the new contract for junior doctors has had a negative effect on filling rotas, a survey has found.

One respondent to the survey from the Royal College of Paediatrics and Child Health said, “The impact of the contract is to make working hours and conditions less attractive and therefore likely to deter doctors from wanting to enter the specialty of paediatrics.”

Of the 211 inpatient paediatric and neonatal units in the UK, clinical directors or workforce leads from 132 responded to the college’s seventh survey on rota gaps and vacancies (response rate 63%). The survey was carried out between January and April 2017.

It found that the overall proportion of vacant posts was almost one in five (18.6%), up from 14.9% in January 2016. Vacancies for rotas requiring middle grade doctors were even higher, with nearly a quarter (23.4%) unfilled. The highest overall vacancy rate was in Northern Ireland (32.3%).

Of the vacant posts, 41% were filled by locums, down from 47% in 2016. And more consultants seem to be taking on juniors’ shifts. In the latest survey 54 paediatric units (45%) said that some of their consultants permanently worked resident shifts, up from 2015-16, when 23 (32%) of units reported this.

Four fifths (83%) of respondents said that the cap imposed by the government on how much trusts could pay locums had had a negative or moderately negative effect on staffing levels. One service lead said, “As a unit a long way from most locums . . . the cap means we can’t offer a rate that is attractive to locums. They were difficult to attract without a cap and almost impossible with.” Another commented, “Caps have resulted in unfilled shifts, consultants stepping down, and clinics cancelled the next day. Overall poor experience for patients.”

Almost 90% of children’s units expressed concern over how they would cope over the coming six months.

Simon Clark, officer for workforce planning at the Royal College of Paediatrics and Child Health, said, “In an NHS already stretched by budget cuts, the new figures shed further light on the pressures facing junior doctors. With more than 40% of positions filled by expensive locum temporary staff, this can only add more pressure to strained hospital budgets. While recognising the need to curtail costs, the pay cap was a simplistic, short term approach to a complex problem. It does not go to the root of the problem, and as such is working for nobody.”

The college called for a “strategic approach” from the government to fix the crisis in the paediatric trainee workforce. This included identifying a body to integrate national and regional workforce planning, increasing the number of paediatric trainee places to 465 posts a year (there were 437 in 2016, with 400 filled); funding integrated primary and secondary care training in child health; and putting paediatrics on the shortage occupation list, which means that employers could recruit from outside the European Economic Area without needing to carry out a resident labour market test.[1]


  1. Rimmer A. Five facts about the paediatrician workforce. BMJ Careers May 2017. [Link] .

Zosia Kmietowicz The BMJ

Cite this as BMJ Careers ; doi: