1

British Association of Urological Surgeons

and

The Specialist Advisory Committee in Urology

Workforce Report

November 2017

Michael Palmer, Charlotte Taylor

2

Overall UK Consultant and Trainee Numbers

2013 2014 2015 2016 2017 Consultant 886 963 989 1048 1083 Trainee 326 277* 322 310 319

UK Consultant Distribution 2017 (2016)

Total 2017 (2016) Substantive 2017 (2016) Locums 2017 (2016)

England 922 (889) 866 (848) 56 (41)

Wales 50 (50) 46 (46) 4 (4)

Scotland 86(85) 83 (81) 3 (5)

Northern Ireland 25 (24) 24 (23) 1 (1)

UK 1083 (1048) 1019 (997) 64 (51)

Republic of Ireland 44 39 5

3

Consultant Numbers by BAUS Region

Region Regional Rep Substantive Locum Cons 2017(2016)

England North East David Thomas 46(47)

0

North West Max Mokete 124(124) 8

Yorks/Humberside Tony Browning 88 (90) 5

West Midlands Hemant Ohja 78(78) 7

East Midlands Simon Williams 49 (49) 3

East of England Bill Turner 101(92) 14

South East Coast Sri Sriprasad 71(63) 1

London North Giles Hellawell 104 (102) 9

London South Nick Watkin 53(53) 4

South Central Matt Hayes 75 (77) 4

South West Mark Stott 77 (73) 1

Wales Neil Fenn 46 (46) 4

Scotland

Scotland West Mary Brown 45 (43) 1 Scotland East Ben Thomas 38 (37) 2

Northern Ireland John McKnight 24 (23) 1

UK Total 1019 (997)

64 (51)

Republic of Ireland Tom Lynch 33 4

4

UK SUBSTANTIVE Consultant Urologist: Population Ratios 2007-17

UK England Wales Scotland N Ireland 2007 1:88,000 1:91,000 1:90,000 1:83,000 1:110.000 2008 1:84,000 1:85,000 1:83,000 1:72,000 1:103,000 2009 1:80,000 1:81,000 1:78,000 1:71,000 1:93,000 2010 1:77,000 1:78,000 1:70,000 1:70,000 1:89,000 2011 1:74,121 1:74,301 1:71,581 1:69,613 1:89,970 2012 1:72,189 1:72,306 1:70,455 1:69,142 1:82,309 2013 1:71,312 1:71,349 1:68,076 1:68,771 1:86,232 2014 1:70,330 1:69,909 1:75,610 1:68,831 1:85,714 2015 1:69,457 1:69,095 1:74,171 1:66,512 1:84,286 2016 1:65,769 1:65,116 1:67,826 1:67,250 1:81,000 2017 1:64,376 1:63,810 1:67,608 1:65,060 1:77,500

Total Consultant Numbers 2006-17

There has been a 3.3% increase in total consultant numbers over the last 12 months and a 2.2% increase in substantive numbers. Increase in locum consultant numbers was 25%

Chronological Rate of Annual Total Consultant Expansion (%)

0

200

400

600

800

1000

1200

2006 2008 2010 2012 2013 2014 2015 2016 2017

5

The average annual rate of total consultant expansion over the last 16 years has been 4.6%

Substantive UK Consultant: Population Ratios 2017

UK 1: 64,376 ↓ (relative to 2016) 65.6 million England 1: 63,810 ↓ 55.26 million Wales 1: 67,608 no change 3.11 million Scotland 1: 65,060 ↓ 5.40 million Northern Ireland 1: 77,500 ↓ 1.86 million

Republic Ireland 1: 127,027 2016 data 4.7 million

Comparison with Other Countries

8.9

5.9

3.33

3.7

0.5

5.5

6.9

5.45

4.2

1.30

8.7

2.7

6

3.3

0

1

2

3

4

5

6

7

8

9

10

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17

6

Country Population Number of Urologists Pop ratio

United Kingdom 65,648,100 1017 1: 64,550 Australia 24,168,303 380 1: 63,500 France 64,811,043 1350 1:48,008 New Zealand 4,565,185 120 1: 38,043 Denmark 5,690,750 253 (est) 1: 22,493 Sweden 9,851,852 480 1: 20,524 Spain 47,737,941 2400 1: 19,890

Much of the data available online from sources such as EAU/ESRU is out of date. The above information was obtained directly from USANZ, Association Française de Urologie, Spanish Association of Urology, Danish Urological Society and the National Board of Health and Welfare Office (Sweden). The presence of office urologists in some countries makes comparisons difficult.

Non-Membership of BAUS

There has been a slight reduction in the number of consultants in substantive posts who are not members of BAUS.

“Unfilled” posts

0

10

20

30

40

50

60

70

80

2014 2015 2016 2017

Non-members in substantive posts

7

There has been an apparent reduction by 53% in the number of “unfilled” posts over the last twelve months.

2016 2017

Total posts (inc unfilled) Unfilled posts Total posts (inc unfilled) Unfilled posts

North East 53 5 47 1 North West 137 4 134 2 York / Humber 102 9 100 7

West Midlands 95 14 89 4 East Midlands 59 7 52 0 East of England 112 14 117 2 South East Coast 76 12 78 7

London North 120 8 120 7 London South 65 10 61 3 South Central 87 9 84 4

South West 79 4 85 7 Wales 55 5 53 3 Scotland West 49 6 48 3 Scotland East 48 6 42 2 Northern Ireland 28 4 28 3

Totals 1165 117 1138 55

The reduction in “unfilled posts” cannot be explained simply by recruitment into them or replacement by locums. Overall, 27 less posts have been declared compared with last year, when filled and unfilled posts are added together. It is possible that posts which have not been filled have been withdrawn, but inaccurate returns are also an explanation.

Gender Ratios 2017

0

20

40

60

80

100

120

140

2014 2015 2016 2017

8

Current consultant workforce (inc. locums) comprises 92 females and 991 males (8.5% female). Female trainee numbers are 106 of 319 (33%) a slight reduction compared to 2016.

Consultant Gender Ratio by Age

Age range Male Female % Female

< 40 66 15 19%

40 - 49 330 54 14% Over 50 447 16 3%

Analysis of 928 consultants for whom date of birth is known

Percentage of Female Consultants by Region

Consultant Retirements

0%

20%

40%

60%

80%

100%

Consultant Trainee

Female

Male

13

8

5 56

9

4

10

18

5

13

6

11

13

4

0

2

4

6

8

10

12

14

16

18

20

9

Region Projected Retirements 2018 - 2022 North East 8 North West 30 York/Humber 18 West Midlands 19 East Midlands 13 East of England 19 South East Coast 22 London North 26 London South 10 South Central 12 South West 15 Wales 11 Scotland West 6 Scotland East 7 Northern Ireland 4

Based on number of consultants aged 62 or over during 2018 – 2022

Projected Retirements as % of Workforce by Region 2018 - 2022

Trainee Numbers

17

24

20

24

27

19

31

25

19

16

19

24

13

1817

0

5

10

15

20

25

30

35

10

Deanery No of Trainees Northern 19 North West 18 Mersey 17 Yorkshire and Humber 30 West Midlands 25 East Midlands 16 East of England 20 Thames Valley 14 Wessex 11 South West 18 London/KSS 84 Wales 13 Scotland East 14 Scotland West 14 Northern Ireland 6

Total 319

Republic of Ireland 20 (not included in total) Recording the exact number of trainees remains difficult. Calculation was made more difficult this year due to JCST declining to release data to allow cross checking. The apparent increase from last year’s total of 310 is mainly due to an increase in the return from London/KSS of 6 trainees. This appears to be due to inaccuracy in previous returns. There will always be variation due to trainees on OOP and in periods of grace, some of whom will have already been replaced at the time of the return, resulting in double counting.

Number of Trainees (2007-17)

Trainee numbers remain static (2014 figures almost certainly incorrect)

Percentage of Female Trainees by Programme

100

150

200

250

300

350

2007 2009 2011 2013 2014 2015 2016 2017

11

Certification Statistics

GMC CCT Statistics 2010-16

Year No of Trainees obtaining CCT (or CESR CP)

2010 51 2011 44 2012 60 2013 46 2014 54 2015 2016

51 54

Average annual number of trainees completing training over the last 7 years is 51

6

61

18

34

12

44

20

5045

50

30

4643 43

50

0

10

20

30

40

50

60

70

12

Workforce Predictions – do we have enough trainees?

Number of projected Trainees awarded CCT against Consultant retirements 2018 - 2022 Assuming 4.5%, 2% and 0% expansion

(Includes SAS Grade retirements)

Year CCT Additional Posts (4.5%)

Retirements Expansion 4.5%

Expansion 2%

No expansion

2018 59 49 27 -17 +10 +32

2019 64 51 28 -15 +14 +36

2020 58 53 39 -34 -4 +19

2021 67 56 32 -21 +12 +35

2022 71 58 47 -34 +1 +24

Projections are based on the number of consultants reaching 62 in each year. The consultants already over 62 at the time of compilation are excluded as it is assumed that they will be offset by some consultants retiring before age 62. CCT numbers are estimates based on all trainees completing training at their current expected CCT date. Due to lack of JCST figures for cross checking purposes, some data has extrapolated from 2016 data. As in previous years, the figures demonstrate the importance of consultant expansion in the calculations. If the expansion continues at the same rate as the last 15 years we do not have enough trainees. A smaller expansion could be accommodated.

Number of projected Trainees awarded CCT against Consultant retirements 2018 - 2022

using historical average CCT award numbers (Includes SAS Grade retirements)

Year CCT Additional Posts (4.5%)

Retirements Expansion 4.5%

Expansion 2%

No expansion

2018 51 49 27 -25 +2 +24

2019 51 51 28 -28 +1 +23

2020 51 53 39 -41 -11 +12

2021 51 56 32 -37 -4 +19

2022 51 58 47 -54 -19 +4 Using a more realistic number of CCT awards based on historical averages, these predictions show that even a very small expansion of 2% is not achievable in the medium term. The number of trainees required to expand at 2% over the next 5 years would be 288, based on these figures, but we are unlikely to produce more than 255 new CCT holders during that period. If the expansion continues at the same rate as the last 15 years there will be a significant shortfall.

Longer Term Projections

13

An additional approach to estimating trainee numbers is to look at longer term trends. Using the following data a number of projections can be developed. Of 928 consultants whose date of birth is known, there are 463 aged over 50 years (50%). This number can be expected to retire over the next 12 years. The expected number of SAS retirements is not known but has been estimated in the past to be approximately 7 per year. There are a total of 319 Urology trainees on a 5 year training programme. If all trainees achieve CCT (or CESR CP) within the minimum time then the maximum average number of new consultants per annum we can achieve is 64. This will not be achieved due to periods of OOP, delayed progression, post CCT fellowships and some trainees not taking up UK consultant posts. Over the last 7 years the average number has been 51 per annum. “Unfilled posts” have not been included in this analysis. Historical consultant grade expansion has been 4.6% over the last 15 years. We do not know what it will be going forward, but it is highly unlikely to be 0%

Scenario 1 – Minimum requirement

Assumptions Number over next 12 years Replacement of retired

Urologists Known consultants only SAS grades not included

463

Expansion 2% 289

New consultants available Maximum possible 744

Outcome -8

Scenario 2 – “Realistic” requirement

Assumptions Number over next 12 years

Replacement of retired Urologists

Known consultants only, SAS grades not included

463

Expansion 2% 289 New consultants available Historical average (51 per

annum) 612

Outcome -140

Scenario 3 – Maximum requirement

14

Assumptions Number over next 12 years Replacement of retired

Urologists SAS grades included at rate

of 7 per annum 547

Expansion Historical average (4.6%) 772

New consultants available Historical average (51 per annum)

612

Outcome -707

These scenarios continue to provide evidence that we do not have enough trainees. The training programme can only deliver Scenario 1. This scenario uses an expansion rate that is half the historical average, ignores SAS retirements and has an unrealistic number of new consultants becoming available. The other scenarios are short by large margins. Although Scenario 3 might seem extreme, it uses the historical averages over the last few years. Using Scenario 2 as a guide we would need to produce 63 new consultants per year. Based on the recent CCT awards, the average is 82% of the maximum number. To produce 63 CCTs per annum we would therefore need 384 trainees – 65 more than we have at present. This number is lower than quoted last year because “unfilled posts” have not been included in the analysis.

Workload Data

15

Outpatient HES Data (England only)

Outpatient attendance 2015/16 – Main Specialty

Procedures (HES – England only)

466,908 498,432548,852 588,326 582,623 596,279 627,022

712,559 741,440 749,891

1,125,9741,128,3531,201,521

1,256,2771,265,2101,275,0831,340,953

1,446,5551,507,6551,533,491

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

New Patients Follow Up

749,891938,228

2,012,413

482,088

1,579,3601,533,491

1,990,091

2,527,215

891,174

2,021,224

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Urology General Medicine General Surgery Gastroenterology Gynaecology

New Patients Follow Up

16

35,33535,13734,16633,48535,70135,53536,434

39,15239,33139,71241,070

39,69140,45140,20639,373

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

TURBT

2,582 2,7983,107 3,321 3,552 3,436

3,8514,133

4,704

5,716

6,4596,987

7,9008,518

9,561

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Flexi URS / PCNL

17

384446

514579 598 630

721783 800

972

1,160

1,327

1,5161,579

1,713

200

400

600

800

1,000

1,200

1,400

1,600

1,800

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Partial Nephrectomy

4,8825,144 5,034

5,3595,676 5,730

6,154 6,264 6,316 6,2816,600

6,7996,999

7,344 7,299

3,000

3,500

4,000

4,500

5,000

5,500

6,000

6,500

7,000

7,500

8,000

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Nephrectomy

1,396

1,489 1,475 1,479 1,5011,564 1,588

1,654 1,670

1,801

1,890 1,889 1,920 1,922 1,927

1,000

1,100

1,200

1,300

1,400

1,500

1,600

1,700

1,800

1,900

2,000

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Cystectomy

18

Acknowledgements. My thanks to:

• Charlotte Taylor who has collated and provided updates of the data tables

• Encarna Manzano, JCST/ SAC Urology for providing JCST data to help with verification.

• BAUS regional representatives for timely and accurate data submission. • TPDs for updating the trainee information

2,5032,916 2,984

3,413 3,537 3,487 3,5824,026

4,8465,052

5,5765,318

6,1226,554

7,527

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Open Excision of Prostate

2,890

3,082 3,049 3,090 3,1423,224 3,255

3,4313,534

3,300

3,488 3,436 3,4663,370

3,269

2,000

2,200

2,400

2,600

2,800

3,000

3,200

3,400

3,600

3,800

01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Repair of Urethra