Workforce and job planning

Physician workforce

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

Role

Total

Proportion working less than full time (LTFT)

Consultant

754

12%

Higher specialty trainee

417

17%*

*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. 


Job planning

The job planning guidance below is 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.  

It is difficult to outline a typical nephrology job plan, as there are many different types of nephrologist (general nephrologists, transplant nephrologists, academic nephrologists, interventional nephrologists, haemodialysis and peritoneal dialysis nephrologists etc). Individuals often combine these roles, may have differing commitments to general internal medicine (GIM) within their trust, and differing roles when on call for the wards/admissions and at other times.

Typically, nephrologists work in teams, sharing responsibilities with each other, and with multiprofessional colleagues.  

There are some important principles that should be considered when drafting job plans for nephrologists:

  • Nephrologists usually have an ongoing commitment to patients on renal replacement therapy (RRT patients), including patients receiving haemodialysis, peritoneal dialysis and those with functioning renal transplants. These patients present 7 days a week, and require specialist input. A renal service is therefore unlikely to be tenable with fewer than 4 WTE consultants. It is also recommended (British Renal Society workforce planning document (opens PDF, 494.73KB) from 2002) that there is one whole-time equivalent (WTE) nephrologist for every 100 RRT patients.
  • The profile of AKI (acute kidney injury) has increased significantly in recent years (and continues to grow), along with referrals for specialist nephrological opinion. This includes requests for telephone or written advice, which has historically not been recognised in tariff or workload.
  • The increasing number of patients who need treatment for kidney disease underlines the importance of nephrologists’ role in planning, with commissioners, the expansion and development of services and evaluating innovative approaches to service delivery. This includes the participation of renal physicians in regional and national work. Email and virtual advice clinics for older patients who could be managed remotely in partnership with GPs are currently disincentivised, because there is no tariff, nor recognition of this work.
  • Given the large number of clinic referrals, in order to prioritise those who will benefit from specialist referral, nephrologists have a guidance and triage role. New referrals are managed efficiently with prompt referral back to primary care, with advice and guidance systems in place. This takes time, and should be factored into job plans.
  • Given the complexity and morbidity of patients with renal disease, dedicated renal wards with nursing experience and expertise are essential. There are often nearly as many ‘outliers’– patients with AKI, renal complications of other medical conditions and renal patients under the care of other clinicians, including in intensive care. A ward round session of 25–30 renal patients would be reasonable. In excess of these numbers usually requires the ward round to be split into two direct clinical care (DCC) sessions (for example between renal ward patients, and outliers). Inpatient workload is now very ‘consultant heavy’ and requires a significant commitment. In weeks when a consultant is on call for the wards, other commitments, including clinics, must be significantly reduced.
  • A WTE consultant renal physician should expect to work in a number of clinics per week, which are likely to reflect a mixture of general nephrology, predialysis, haemodialysis, continuous ambulatory peritoneal dialysis (CAPD), renal transplant and specialty clinics. The number of patients seen will vary considerably according to the clinic and the support staff available. For example, a new patient with established kidney failure may require 1 hour of a consultant’s time if seen in a clinic without support staff but might spend half an hour with the consultant and half an hour with other staff, including a specialist nurse and a dietitian, in a dedicated low clearance clinic. Similarly, a follow-up patient with established renal failure may need to spend 10–30 minutes with a consultant, depending on the availability of specialist support staff, who might advise on management of anaemia, vascular access for dialysis and diet.
  • Most nephrologists travel to outlying dialysis units and hospitals to facilitate care closer to the patient – this travel must be factored into job plans.
  • In large renal units, further specialist clinics (often shared with other disciplines) may focus on specific clinical issues for people with kidney disease – eg clinics for people with diabetes, pregnancy, lupus and vasculitis, and transition clinics for young adults transferring from paediatric clinics.
  • The need for ongoing specialist input into many long-term renal conditions, rare renal disorders, or specialised conditions such as vasculitis, means that there is a high ratio of follow-up appointments to new patient appointments. 

30/06/2017