• POLICY
• PUBLIC HEALTH
• CLINICAL STI CARE

The genitourinary medicine consultant and trainee workforce is reviewed annually by Health Education England and the Royal College of Physicians (RCP) to make recommendations for specialty training numbers. In a simple model, knowing the demographics of existing consultants and their retirement plans coupled with the predicted trainee throughput should result in a balanced workforce.

The information used to inform the review come from a variety of sources in an attempt to make it as accurate as possible including:

• The electronic staff record for all trusts in England: this relies on an individual consultant's job title. It provides information on the total number of contracted sessions, but does not capture if sessions are not undertaken in genitourinary medicine, for example management or deanery roles.

• The annual RCP consultant survey: this only has a 40% completion rate. The methodology used applies the information gathered to non-responders which may be invalid. It is possible that non-responders are not equivalent to responders: they may be on maternity leave and include more part-time workers. In the last 2 years the data have shown a 20% increase in Scottish consultant numbers and on investigation has been due to the inclusion of Sexual and Reproductive Health colleagues.

• These shortcomings mean that while the consultant headcount is reasonably accurate, the whole-time equivalent (WTE) is unknown. BASHH has attempted to collect workforce information via the regional chairs and membership record, but this is of limited success due to low completion rates and lack of details on non-members.

• The 2014 RCP survey gave a UK headcount of 420 (approximately 350 WTE). There were 230 female and 190 male consultants in 2014 compared with 212 and 197, respectively in 2012 and of those under 40 and 35 years of age, 80% and 90%, respectively were females. From available data, 51% of female consultants work less than 10 programmed activities compared with 7.3% of men. Despite an apparent expansion in headcount, more posts are now advertised as part-time and consultants appointed to full-time posts may drop sessions so it is thought that there been a contraction in consultant sessions in the last 5 years. In the next 10 years 120 (28.8%) consultants will reach age 65 but their retirement plans are not known, and may alter depending on changes to the consultant contract. Eleven consultants (all male) are currently aged over 65.

• The number of trainees gaining their certificate of completion of training and the locum and substantive consultant posts advertised on National Health Service jobs website are monitored by the specialty advisory committee (SAC) and workforce group.

• The SAC undertakes an annual review of trainees, identifying numbers at each grade, those working part-time and those on training breaks for any reason. This enables prediction of trainee throughput. In the last 2 years there has been a drop in the number of applicants to training posts, which together with the abolition of locum for training posts, has resulted in a number of vacancies in the system. There is likely to be a future reduction in numbers of higher trainees as part of cost savings, irrespective of workforce planning.

Predictions in genitourinary medicine are particularly challenging at present. STIs and incident HIV infection have increased significantly over the past 15 years and is likely to continue. The reduction in public health funding to local authorities, with tendering of services has resulted in delays in appointing to consultant vacancies and in some areas, redundancies. This is further complicated by integration with contraception services, increased nurse delivered services and remote testing. With modernisation of service delivery and the need to contain costs, robust arguments will be needed for expansion. Trusts may resist replacing retiring consultants like for like. However, there are additional factors that must be considered where greater consultant numbers may be required: demographic mix, numerical population, HIV cohort, deprived areas, risk groups such as asylum seekers, ethnic minority groups, young people, university or other training establishments. The role of consultants encompasses the provision supervision of healthcare professionals, providing the clinical governance framework and leadership across a locality that may involve primary, secondary care and private providers. These needs, along with the additional expectations of revalidation and training, require maintaining consultant numbers despite the specialty being committed to modernisation and alternative service models. With present uncertainties, a reduction in proposed number of consultants from 1 WTE per 84 000 to 2 WTE per 250 000 is suggested. In the UK, this would equate to 480 WTE.

Using data from Public Health England, it may become possible to develop more sophisticated workforce models, based on deprivation indexes, infection and complications rates, men having sex with men, and unplanned conceptions to reflect local need. This modelling will only be effective if data continue to be captured in all sexual health services, and where services are discontinued due to financial cuts this is acknowledged, rather than misidentified as an actual reduction in infections or unplanned pregnancy.