Workforce and job planning

Physician workforce

The number of geriatricians recorded in the 2018–19 census of UK consultants and higher specialty trainees is:

Role

Total

Proportion working less than full time (LTFT)

Consultant

1,626

22%

Higher specialty trainee

777

22%*

*HST LTFT percentages are calculated from JRCPTB data to give overall figures which may differ from those in the census 
These figures relate to physicians who work substantively for the NHS.

Regional variance

The highest concentration of consultants per head of population aged over 75 is in London, and the lowest is in the East and West Midlands. 


Job planning

The examples below are included as guidance and not 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.

If a consultant has responsibility for acute ward patients, they will need a minimum of 3 programmed activities (PAs) per week (for 15–20 patients) to provide the appropriate clinical and MDT review, and allow time for liaison with relatives and other professionals. For acute patients, best practice indicates daily consultant review of new patient admissions to a ward and a daily, senior-led MDT. For this to take place, patients will often have their care overseen by consultants working closely together as part of a ward team. This model of working is beneficial for consultants who work LTFT. A consultant looking after rehabilitation patients could be expected to have responsibility for 25–30 patients in the same time allowance, and again consideration should be given to facilitate LTFT job plans. If a consultant has responsibility for patients undergoing rehabilitation on remote sites, travel time must also be recognised in the job plan.

Many subspecialty areas such as front door geriatrics, POPS or orthogeriatrics often take place on a sessional basis. Employers should consider employing more than one consultant in these roles, in order to provide cover when leave is required.

As per BMA/NHS Employers job planning guidance, a standard 10 PA post should consist of 7.5 direct clinical care (DCC) sessions including patient administration, and 2.5 supporting professional activities (SPAs) including 1.5 continuing professional development (CPD) for activities relating to revalidation.

The majority of geriatricians see GIM as a key part of their workload, and the specialty is second only to acute internal medicine in the proportion of consultants who take part in unselected on calls. Around one-third partake in specialty on call only, with one-fifth providing on-call work to both geriatric and GIM rotas.


Clinics

Geriatric medicine clinics may follow a traditional outpatient model. However, they are increasingly likely to be multidisciplinary, focusing on a subspecialty area such as Parkinson’s disease, or taking place in a community setting or day hospital, contributing towards intermediate care and appropriate hospital admission or avoidance thereof.

A new patient in a geriatric medicine clinic could require an appointment ranging from 30 minutes to over 2 hours, depending on the degree of comprehensive geriatric assessment (CGA) that occurs, where the clinic takes place, and the involvement of the multidisciplinary team.

Follow-up appointments should range from 15 to 30 minutes, again depending on the clinic environment and MDT involvement. Where a clinic involves multiple healthcare professionals, time must be built in for interdisciplinary discussions and care planning.

30/06/2017