Physician workforce

The number of palliative medicine physicians recorded in the 2016–17 census of consultants and higher specialty trainees in the UK is:

Role

Total

Proportion working less than full time (LTFT)

Consultant

628

53%

Higher specialty trainee

224

32%*

*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.

The Association for Palliative Medicine (APM) in collaboration with the National Council for Palliative Care and other organisations recommended the following minimum requirements per population of 500,000 in its 2012 commissioning guidance for specialist palliative care:

  • consultants in palliative medicine – 4 full-time equivalent (FTE) for community and hospice services and additionally 1 WTE for 250 hospital beds
  • additional supporting doctors (eg trainee/specialty doctor) – 4 FTE
  • community specialist palliative care nurses – 10 FTE
  • inpatient specialist palliative care beds – 20–25 beds with 1:2 nurse to bed ratio

In 2015, the APM recommended (opens PDF, 620.09KB) that population-based requirements should be increased to five FTE consultants per 500,000. In addition, the following should be noted:

  • hospitals with cancer centres and tertiary referrals for other conditions will require more than the above minimum requirements
  • following the NICE Supportive and Palliative Care Guidance 2004, services in both acute trust and community should provide at least working day (9am to 5pm) direct clinical assessment and 24/7 access to palliative care advice.

There is a predominantly female workforce (76% of consultants) with many choosing to train less than full time and also to work flexibly in their first years as a consultant (53% of consultants). 

Trend in the number of consultants  


Job planning

The guidance below is an example 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.

Palliative medicine services

Hospital palliative care support teams (HSPCTs)

The HPCST is a consultant-led multiprofessional team, including palliative care nurse specialists, allied health professionals, and representatives of the chaplaincy team.

Current minimum requirements are one WTE consultant and one WTE nurse specialist per 250 beds as recommended in commissioning guidance for specialist palliative care.

There are 230 specialist hospital teams in the UK. On average, each team care for over 700 patients per year, with 27% referrals non-cancer. The mean length of contact was 14 days (see NCPC Minimum Data Set 2014–15 ).

The HPSCT service should be provided on site 7 days a week. At weekends, palliative care nurse specialists are supported by palliative care physicians through on-call. There are insufficient WTE to provide 7-day medical services on each site.

Palliative medicine outpatient clinic

Typically a new consultation will take 45–60 minutes; a follow-up 30 minutes, with up to seven patients booked in a 4-hour clinic.

Specialist palliative care inpatient unit

For a population of 250,000 there should be provision of a minimum of 20–25 beds with a 1:2 nurse to bed ratio as recommended in commissioning guidance for specialist palliative care.

Activity UK hospice units: mean inpatient admissions/year/unit 283; mean bed occupancy 78.6% and mean length of stay 14.1 days (see NCPC Minimum Data Set 2014–15).

Community services

Per population of 250,000 the minimum requirement is for 2 WTE consultants and 5 WTE community specialist palliative care nurses as recommended in commissioning guidance for specialist palliative care.

Joint working between hospital and community is an essential element of good community services for patients and posts should be integrated across settings.

31/12/2018