On 11 September 2014, we published Securing the future workforce supply: trauma and orthopaedic surgery stocktake. This review, commissioned by Health Education England (HEE) and the Department of Health (DH), is designed to inform decisions on the number of trauma and orthopaedic surgeons likely to be required to meet patient demand up until 2028.
The review assesses the key drivers of workforce demand and supply for T&O surgery and estimates the future number of Certificate of Completion of Training (CCT) holders that would enable current levels of T&O services per patient to be maintained to 2028. It also estimates how many T&O trainees need to enter higher specialty training level three (ST3) to ensure workforce supply is broadly in balance with expected demand to 2028.
Findings contained in the stocktake of the T&O workforce in England include the following:
- Our principal demand projection for T&O surgery forecasts growth of around 50 per cent by 2028, as a result of a growing and ageing population, greater average individual patient need and decreasing surgeon productivity.
- Our principal supply projection forecasts that if ST3 intake is maintained at recent levels (about 122 trainees per year) from 2014 onwards there is a risk of workforce oversupply until around 2022 followed by a risk of undersupply until 2028.
- However, if ST3 intake from 2014 onwards reflects the maximum commissions currently possible (about 173 trainees per year), there may be a significant risk of continuous oversupply over the projection period.
These key findings have led the CfWI to suggest that HEE considers what action may be required to bringing supply and demand into balance in the medium term, for example by capping ST3 recruitment at 122 trainees per year for the 2013-14, 2014-15, and 2015-16 recruitment rounds inclusive. The CfWI also suggests that a further specialty review is undertaken before the end of 2016 to confirm whether any change in ST3 recruitment may be required for the 2016-17 recruitment round and onwards to balance future retirements and other leavers.
Following discussions with stakeholders, the CfWI acknowledges that future uncertainties (such as changes to service commissions, future service delivery models, the impact of productivity, and new ways of working) are difficult to estimate. Particular considerations for further analysis in future are the potential impact of seven-day services (including the affordability) on the T&O workforce and growth in the amount of activity private centres perform on behalf of the NHS.