We must address the oncologist shortage
As the NHS now turns to the growing backlog of cancer treatment that lies before it, concerning figures suggest that it does not have the numbers of specialists to resume ‘normal’ service.
Last month The Royal College of Radiologists (RCR) released figures revealing that the NHS has only five more full-time clinical oncologists than it did in 2018, and needs at least 200 more to meet expected levels of patient demand.
“By any metric you take, there are simply not enough of us doing the job,” says Dr Tom Roques, the college’s Medical Director of Professional Practice for Clinical Oncology, and Lead Author of the report. “NHS cancer teams were working flat out before coronavirus hit and have continued to provide services during the pandemic. We just do not have the capacity to provide the same level of care as before when we are faced with a new peak of cancer referrals and given the added pressures of coronavirus.”
RCR figures show that at the end of 2019 there were 938 clinical oncology consultants working across the UK’s 62 cancer centres. Factoring in retirements and part-time working, this equates to 868 full-time doctors – an increase of just five extra full-time consultants from 2018. Meanwhile, the number of new cancer patients needing non-surgical treatment is rising by an estimated 165,000 each year. The cancer community is also anticipating a surge of new patients whose diagnosis and treatment has been delayed because of the virus, likely to hit in the autumn.
A cocktail of factors, with Covid thrown on top
The census confirms that before the outbreak, the NHS was not able to recruit oncologists to keep up with the pace of patient demand. With the UK’s ageing population, more and more people will be diagnosed with cancer. While the increased sophistication of treatment pathways is a positive development, allowing for more targeted treatment of specific cancers, these treatments require an ever more specialised workforce to administer them.
Tom says that a lack of investment in the supply of oncologists combined with earlier and earlier retirement are compounding shortages. In recent years, the median age of retirement for an oncologist has dropped from 64 to 59. Tom attributes this partly due to the increasing stress of the job.
“Undoubtedly, people are more stressed and are feeling burnout,” says Tom, “but other issues such as the pensions dispute have not helped either.” The real worry for Tom and the RCR is how the pressures of the pandemic and the future mountain of backlogged procedures could further exacerbate staff burnout.
Over the years shortages of oncologists have ebbed and flowed between sub-specialties, and Tom outlines that swings are often seen after new treatments are developed and streamlined. He says that when he first became a consultant there was an acute shortage of head and neck cancer specialists, but changes to radiotherapy treatments have since made this a more interesting option for trainees. Currently, Tom says, there is an acute shortage of breast cancer specialists, despite it still being one of the most common forms of cancer.
While stressing that more centrally-driven support for workforce expansion is crucial, Tom explains that individual trusts must also be responsible for ensuring their cancer services are modelled to mitigate consultant shortages. “Individual trusts and hospitals will need to design their workforce and fill gaps appropriately,” he says. “There are two responses to shortages: one is to ask for more staff, but the other is to ask ourselves how we can work differently and streamline to maximise efficiency.”
New ways of working
The pandemic has highlighted the need to search for streaming opportunities across healthcare delivery, and nowhere is this more pertinent than in cancer treatment. Covid-19 has forced the hands of clinicians looking to reform and is igniting positive change. As with many parts of the sector, we are seeing changes that would have taken years happening in a matter of weeks.
A major breast cancer study, published at the start of the pandemic, demonstrated that five fractions of radiotherapy could be as effective as 15 – and once the pandemic began to take hold oncology departments across the UK began adopting the new recommendations. “This is practically an instantaneous change,” says Tom, who stresses that something like this would have taken years to implement pre-Covid. Additionally, the latest radiotherapy operational delivery networks, set up in April 2019, have seen increased activity in response to the pandemic.
“Suddenly we have embraced this joined-up approach like never before,” says Tom. While addressing issues of recruitment will take years to improve, it is streamlining and joining up approaches, he says, that will help see NHS cancer services through this turbulent period. “Part of this is about adding value to the ways we work, seeing if there are things that another specialist can perform to free up time for an oncologist to maximise patient benefit.”
Naturally, digital technology is now playing an increasing role for oncologists and the added flexibility that tools such as virtual team meetings bring have freed up time for oncologists and will help alleviate staff pressures in the months and years ahead – if we can maintain this uptake. However, while he still uses a computer that runs Outlook 2010 – Tom advises caution against pinning all hopes on digital.
Tough days ahead
While oncology departments have worked tirelessly to maintain treatments such as chemotherapy and radiotherapy (with some service alterations or delays necessary in certain areas), this has been in the context of considerably fewer referrals due to lockdown. In Tom’s mind, this is very much the calm before the storm, and the real fear is when these people manifest themselves that it could overwhelm oncology departments.
Tom says, “our system was just about coping before the pandemic, but we may suddenly be asked to deal with up to 20-30 per cent increased demand.” While highlighting the need to implement new ways of working, Tom and the RCR will still be keeping the pressure on sector leaders and government to continue recruiting medical specialists. As he says, cancer is not going anywhere.