Conversion of agency and non-permanent consultant posts to permanent jobs urged
A new collaborative workforce plan for psychiatry identifies a need for almost 630 extra consultant psychiatrists in the next 10 years.
A key finding of the latest medical workforce planning report from the National Doctors Training and Planning (NDTP) unit was that the number of consultant psychiatrists required to 2030 to target the staffing deficit and to deliver a fit-for-purpose mental health service was 825.
An analysis of the gap between the plan’s estimated requirement of 825 consultants, and the current 581 consultants working today, indicated that a total of 628 additional consultants would be required in the next 10 years, when those who leave the service for retirement and other reasons were accounted for.
A second key finding was that approximately 71 to 72 trainees would need to complete Higher Specialist Training (HST) each year and take up consultant posts between the years 2024 and 2030, if consultant demand were to be met by training alone.
Between 2021 and 2023, 22 to 46 trainees in HST programmes were expected to complete the training programme and to become eligible to take up consultant posts.
There was a large deficit between the current level of consultant staffing across mental health services in Ireland today and the recommended appropriate level of consultant staffing required to deliver a fit-for-purpose mental health service, as outlined in national policy documents based on international good practice, underscored the report.
Severe recruitment and retention challenges in both the consultant and trainee psychiatrist workforce had presented delays in service delivery, with associated patient safety concerns.
These issues had been a catalyst in the development of the collaborative workforce plan for the specialty of psychiatry.
The up-to-date status of the psychiatry workforce consisted of 526 consultants working in the public healthcare systems, with a proportion working in private practice also.
In addition, there were 55 consultants working exclusively in the private mental healthcare system.
The report identified that there were 263 trainee psychiatrists at Basic Specialist Training (BST) level and 142 at HST level at present. In addition, 231 non-training non consultant hospital doctors (NCHDs) worked across psychiatry services in Ireland.
Many factors driving the demand for consultant and trainee doctors in psychiatry across Ireland were identified in the report, including population and epidemiological projections, high levels of consultants working in non-permanent, locum posts – representing a significant unmet demand for consultant psychiatrists in Ireland.
Furthermore, unsustainable levels of vacant consultant posts and doctors not on the specialist register occupying temporary consultant posts, highlighted the very real under-supply of consultant psychiatrists across the country.
Other drivers of future demand included a high level of reliance on non-training NCHDs to deliver services that should otherwise be delivered by trainees and consultants.
The plan also looked to the full development and implementation of National Clinical Programmes, currently five, and related models of care across mental health services; the full implementation of mental health service improvement projects; increasing demand for mental health services in response to the Covid-19 pandemic, and changes in the model of care for mental health service delivery as a result of telehealth initiatives introduced in response to the Covid-19 pandemic.
As the next steps, it was recommended that an analysis of the non-training NCHD posts across mental health services be carried out to identify where it may be possible to convert non-training posts to training posts, in order to increase the number of training posts in a cost-effective manner.
A significant proportion of consultant psychiatrists contributing to publicly funded service provision hold non-permanent contracts i.e. 22 per cent. Urgent consideration should be given to converting agency, locum and non-permanent consultant posts to permanent consultant posts, recommended the plan.
Further to this, it was estimated that 67 consultant psychiatrists working in HSE-funded services occupied locum and agency posts. This represented 13 per cent of all consultant psychiatrists working in the public sector. “Taken together, consultants in non-permanent, locum posts represent a significant unmet demand for consultant psychiatrists in Ireland,” stated the report.
A review of the implementation of the findings and recommendations of the report should be carried out within the next five years and should inform the implementation of Sharing the Vision and Sláintecare.
The ‘expert stakeholder informed review’ represented a collaboration across stakeholders involved in the delivery of psychiatry services across Ireland including HSE National Doctors Training and Planning (NDTP), HSE Mental Health Services, the College of Psychiatrists of Ireland, HSE National HR and the Department of Health.