Following graduation from undergraduate medical school, there are a number of points along the ‘pipeline’ for psychiatrists where potential supply can be lost:
• Not enough newly qualified doctors choosing/able to train in psychiatry. In 2016, only
349 of the advertised 417 Core Psychiatry Training places were filled by a trainee (83%). The percentage of unfilled training posts in psychiatry is consistently higher than any other specialty. Doctors in postgraduate training programmes contribute significantly to the service by delivering care, as well as getting trained. The impact of poorly filled training programmes therefore directly affects care today as well as risking care tomorrow if too few consultants are produced.
• Low direct transition rates from Core to Higher Specialty Training. Historically, for every 100 psychiatrists recruited into core psychiatry, 60 will complete core training and then proceed directly to complete higher psychiatry training. For UK medical graduates, the figure is significantly higher than overseas medical graduates. Trainees may temporarily or permanently step out of training at this transition point to work as locum or nonconsultant, non-training grade doctors.
• Recruitment into higher psychiatry is therefore reliant on non-UK doctors in training
and augmentation from beyond the pool of former core trainees. As many as 48% of
higher specialty trainees in psychiatry have non-UK Primary Medical Qualifications. 67% of our medical staff in mental health services are British (10% EU, 17% non-EU) compared to 75% of all medical staff (9% EU, 16% non-EU). The contribution of overseas doctors to the NHS is highly valued and it is essential that we retain their skills whilst also ensuring we have a sustainable ’homegrown‘ future workforce.
• A quarter of recently qualified consultant psychiatrists do not go on to be employed
substantively by the NHS (although they may be providing NHS-funded services in other settings or working as a locum for the NHS). This figure rises to a third within five years of registering. The GMC annual report2 shows over 8000 psychiatrists on the Specialist Register (across the whole of the UK), but the NHS in England employs fewer than 5000
• The psychiatric workforce also relies heavily on non-consultant, non-training grade
(SASG) doctors (24% of the psychiatric workforce). This staff group is unplanned and
therefore does not have a secure supply pipeline, but are a vital and valued part of
specialist medical care. The Five Year Forward View for Mental Health and this Workforce Plan identify the need for significant additional psychiatrists to be employed, if these services are delivered using current service models. This is in addition to filling the high levels of vacancies in current services.