Workforce and job planning
The number of gastroenterologists and hepatologists recorded in the 2018–19 census of consultants and higher specialty trainees in the UK is:
Proportion working less than full time (LTFT)
Higher specialty trainee
*HST LTFT percentages are calculated from JRCPTB data to give overall figures which may differ from those in the census
There is significant regional variation in consultant gastroenterologist provision in the UK. North East England and London have exceeded the RCP recommended number per population. South East Coast/South Central England, East Midlands and East of England have the lowest number of consultant gastroenterologists per population.
There is also regional variation in the number of trainees per population. There is a higher than average density of trainees to population in London, the North East and the West Midlands, whereas Wales, Yorkshire and Humber, and the South West have the lowest number of trainees per population. Redistributing national training number (NTN) posts to areas of consultant under-provision or those that have difficulty recruiting could help recruitment in these areas.
The range of activities for the specialty are described below. This is included as guidance rather than intended to be prescriptive. Activities will vary according to population served, demographics and location. For further information, see the BMA/NHS Employers guidance from 2011.
Programmed activities (PAs)
- Number of direct clinical care sessions (DCCs) per week: 7.5 including admin. Admin is usually 1/6th PA per timetabled session. The number of administration PAs should be determined by the time actually spent by the consultant doing administration. This will vary from job plan to job plan and will be determined by nature of the clinical work undertaken. Typically it is appropriate there are 0.5–1 Admin PAs for ward work, 0.25–0.5 PAs for each 4-hour outpatient clinic, 0.125–0.25 PAs for each endoscopy list and 0.5–1 PAs for general administration. When there is uncertainty about the time spent on administration generated by clinical sessions a detailed diary should be kept.
- Number of SPAs, usually 2.5 including 1.5 CPD for activities related to revalidation.
On-call commitment: A British Society of Gastroenterology position paper on out-of-hours (OOH) gastroenterology from 2007 states that there should be a minimum of 8 consultant staff to cover a rota for an OOH service.
In larger gastrointestinal units consultants often rotate periods of inpatient care responsibility with periods of more intense outpatient and endoscopy responsibilities without inpatient responsibilities. Consultants undertaking ward work should have 1 PA per week for ward administration within their job plans.
Within their job plans, consultants should have 1.5 PAs for CPD and revalidation and in addition PAs for clinical and educational supervision of trainees and medical students. Additional PAs are also required for consultants leading specialist services such as IBD and hepatology.
The number of endoscopies done on a list is calculated using a point system. A point is a unit of time and typically one point is equivalent to 20 minutes. For training, an increase of 50% in the points allocated for a procedure in early training seems appropriate. Many units allocate 12 points to a morning list and 10 to an afternoon list.
Diagnostic and therapeutic upper gastrointestinal (GI) endoscopy
A typical consultant diagnostic gastroscopy list allows 20 minutes per procedure (ie 1 point): a maximum of 12 points should be carried out in a session, equivalent to 1 PA.
Therapeutic upper GI endoscopy takes two to three times as long as routine upper GI endoscopy and requires 40–60 minutes per procedure (ie 2–3 points).
Diagnostic and therapeutic flexible sigmoidoscopy
Diagnostic flexible sigmoidoscopy (equivalent to 1 point) is the examination of the distal colon. It is appropriate to carry out up to 12 points in a session.
Therapeutic flexible sigmoidoscopy in which polypectomy is performed takes twice as long as routine flexible sigmoidoscopy; equivalent to 2 points.
Diagnostic and therapeutic colonoscopy
In this procedure the entire colon and often the terminal ileum is examined (2 points). Typical therapeutic procedures are polypectomy, argon plasma coagulation for the treatment of colonic bleeding and dilation of colonic strictures. There should be a maximum of six colonoscopies per session.
Endoscopic retrograde cholangiopancreatography (ERCP)
This is equivalent to 3 points and therefore a maximum of four procedures should be carried out in one session. Units should have at least two consultants able to undertake ERCP to provide full cover. Comprehensive quality standards are also laid out by the British Society of Gastroenterology.
Hepatology has developed as a subspecialty such that most gastroenterology units will require one or two hepatologists, while transplant hepatology is delivered in tertiary supra-regional units.
- Outpatient clinic sizes: The consultant staff, junior medical staff in training and specialty practice nurses provide outpatient services. A consultant physician in gastroenterology working alone in a new patient clinic may see 6–8 new patients in a session (usually equivalent to 1 PA). The exact number of patients seen will be dependent on experience and the complexity of the problem. Each new patient should be given approximately 30–40 minutes.
- A consultant physician working alone in a follow-up clinic for selected patients after acute medical or gastroenterological admission may see 12–15 patients in a session (usually equivalent to 1 PA). Each follow-up consultation should be given about 16–20 minutes. A physician working alone in a specialist follow-up clinic for chronic GI and liver disease may see 10–12 patients in one session. In practice, most gastroenterologists will run clinics that involve a mixture of new and old patients.