Paediatric Neurology Manpower Report: 2012

1. Introduction

This is the seventh Manpower Report since the publication of Matching Manpower and Training in Paediatric Neurology (BPNA 2002), which was prepared by the

Neurology Specialist Advisory Committee of the RCPCH in January 2002. It updates previous reports and is informed by the results of the most recent annual

manpower survey which reports on the position in January 2012.

The purposes of the current report are:

(i) To monitor changes in the number of Consultant in Paediatric Neurology posts.

(ii) To monitor expected retirements in Consultant Paediatric Neurology posts and planned changes in such posts over the next few years.

(iii) To monitor the numbers of trainees expected to complete their training in paediatric neurology over the next few years.

(iv) To assist in determining the number of candidates that should be appointed through the National Training Grid in Paediatric Neurology for the years 2012 and

2013.

(v) To monitor the development of Outreach Clinics and Managed Clinical Networks.

(vi) To review the distribution of Consultant in Paediatric Neurology posts throughout the UK in relation to population numbers.

2. Methodology

The report is based on the Annual Manpower Survey conducted by the BPNA in January 2012. Each of the 15 Deanery Advisors in Paediatric Neurology was asked to

provide data concerning funded senior and non-training posts contributing to provision of the NHS paediatric neurology service, academic posts in paediatric

neurology, anticipated new consultant posts, vacant consultant posts and posts expected to becoming available following retirement. Information was also

collected on numbers of trainees in paediatric neurology, and the appointment of trainees to consultant posts following completion of their training. The population

served by each Deanery was requested, as were details of outreach clinics and clinical networks.

Additionally, although not strictly the remit of a manpower survey, but in response to several requests, data was also collected on various aspects of the paediatric

neurology service including specialist clinics and services, out-patient tariffs, and out-patient appointment durations.

Table 1a: Consultant Paediatric Neurology Staffing

Region *Whole time NHS Consultants: ≥ 7 NHS PAs

*Part time NHS Consultants: ≤ 6 NHS PAs

Academic posts (not necessarily whole time)

No. of posts funded but unfilled

No. of PAs contributed to NHS by academic posts

No. of PAs provided to Paediatric Neurology by General/ Community/ND

Unfunded NHS PAs

2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012

E. Anglia 2 3 4 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 - 2 1

Mersey 4 4 5 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 - 10 10

N.East 3 3 3 1 0 1 4 5 4 0 0 0 12.5 19 13.5 2 0 0 - 6.5 6.5

N. London

14 14 16 2 4 2 5 4 5 0 0 0 11 12 15 10 10 0 - 22 14

N. West 6 5 7 0 2 1 0 0 0 0 0 0 0 5 0 0 0 0 - Y Y

S. London 10 10 13 2 2 0 0 1 1 0 0 0 0 5 7 2 2 2 - 9.2 19

S. West 5 5 4 2 1 2 0 1 1 0 0 1 0 5 6 0 0 2 - 4 10

Trent 7 7 7 0 0 0 1 1 1 0 0 1 6 0 0 0 2.5 0 - 5 9

Oxford 3 3 4 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 - 6 0

Yorkshire 4 3 6 2 3 0 0 1 1 0 0 0 0 10 4 0 0 0 - - 0

Wessex 1 0 3 2 3 0 2 2 3 0 0 0 10 0 17 0 0 0 - 6 0

W. Midlands

4 5 6 4 3 0 0 0 0 0 0 0 0 0 8.5 8.5 5.5 - 5 0

N. Ireland 1 3 4 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - 0 0

Scotland 8 10 9 1 0 0 1 0 0 0 0 0 5 0 0 9 4 4 - 20 18

Wales 3 3 5 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 - 2 2

Totals 75 78 96 20 22 7 13 15 16 1 0 2 44.5 60 62.5 31.5 27 13.5 - 97 89.5

*Whole time and part time defined in this manner for the first time in 2012.

Table 1b: Summary of manpower changes since 2002

Year Whole time consultants

Part time consultants

No. of academic posts contributing to NHS (No. of PAs)

Total No. of Consultant Paediatric Neurology posts “funded and filled”

No. of PAs provided to Paediatric Neurology by non-neurologists

Total whole time equivalents (assuming part timers contribute an average of 5 PAs)

2002 50 4 13 (66) 67 20.5 61

2003 56 9 11 (56) 76 8 68

2004 60 9 12 (61) 81 12 72

2005 74 9 12 (57.5) 95 26 88

2008 75 20 13 (44.5) 108 31.5 90

2010 78 22 15 (60) 115 27 95

2012 96* 7* 16 (incomplete data)

119* 13.5 106**

*Whole time (≥ 7 NHS PAs) and part time (≤ 6 NHS PAs) defined in this manner for the first time in 2012.

** 106 = (96 + 7/2 + 62.5 PA/10)

Table 2: Retirements and expected new posts as Consultant in Paediatric Neurology

Region Retirements No. of expected new posts Reappointments following retirement and new posts

2008 2009 2010 2011 2012 2013 2014 2015 2008 2009 2010 2011 2012 2013 2014 2015

E. Anglia 0 0 0 0 1 0 2 0

Mersey 0 0 0 0 0 0 0 0

N.East 0 0 0 0 0 0 0 0

N. London

1 0 0 0 1 0 0 <1 0 1 Academic

1 Replaced

N. West 0 0 0 0 1 0 0 0 0

S. London 0 0 0 0 0 0 0 0 1 PN/ND

1 Replaced

S. West 1 0 0 0.3 0 0 1 0 2

Trent 0 0 0 0 ?1 0 0 1 (0.5) 1 Replaced

?1

Oxford 0 0 0 0 1 ?time

0 0 1 0 ?1

Yorkshire 0 0 0 0 1 0 1 1(0.8) 0 1 Ass. Spec PN/Neurophysiol

1 Replaced

Wessex 0 0 0 0 1 +1 ?time

0.4 0 0.2 0 ?1 Replaced

W. Midlands

0 0 0 0 0.5 rehab

1 0 0 0

N. Ireland 0 0 0 0 2 0 1 0 1 Staff Grade PN

Scotland 0 0 0 1 2 0 0 0 2

Wales 1 0 0 0 0 0 0 0

Totals 3 0 0 1.3 7.5 retirements expected by end 2015 6.4 1 ~6.5 1 14 posts expected by end 2015, 12 at Consultant in Paediatric Neurology level

Table 3: The number of trainees expected to gain CCT in Paediatrics (Neurology)

Region Number of CCT expected Special interest

2009 2010 2011 2012 2013 2014 2015 2016

E. Anglia 1 2 0 0 1 (ND) 1 (ND)

Mersey 1 0 0 1

N.East 0 0 0 1 1 (Academic)

N. London

2 1 2 2 2 1 1 Vascular, metabolic, ND, epilepsy

N. West 1 1 1 2

S. London 1 0 0 1 2 1 Epilepsy, Motor Dx, NMD

S. West 0 2 0 1 2 (Academic)

Trent 0 1 0 1 1 Epilepsy

Oxford 1 0 0 1

Yorkshire 0 1 1 2 1 Spasticity/ND

Wessex 0 0 0 1 Epilepsy

W. Midlands 1 0 1 1 (Academic)

Immunology/Epilepsy

N. Ireland 0 0 0

Scotland 0 2 0 1 Motor Dx

Wales 0 0 1

Totals 8 10 6 10 7 4 4 4 25 trainees expected to gain CCT by end 2015, 29 by end of 2016

Table 3a: Paediatric Neurology trainees from each region appointed to substantive consultant posts

Region 2004-2007 2007-2010 January 2010 - Years following CCT to consultant appointment

Where appointed (January 2010 - )

E. Anglia 0 2 3 0.5, 0.5, 0.25 Cambridge

Mersey 0 0

N.East 3 -

N. London

3 6 4 <1, 1.5, 0.5, 2 London, Edinburgh, Cambridge, Cork

N. West 2 1 3 0, 0.25, 1.5 NW, NW, Glasgow

S. London 3 2 3 0, 0, ? London, Sheffield, Greece

S. West 1 0 1 0 India

Trent 3 1 2 <1, 1-2 Oxford, London

Oxford 1 1 2* (? Not PN) 0, 0 Oxford, India

Yorkshire 2 1 1.5 LTH

Wessex 1 1 1 0.5 India

W. Midlands 2 2 3 0, >2, >3 London, Birmingham, Birmingham

N. Ireland 0 0

Scotland 1 0 1* (Comm. Paeds) 0

Wales - 1 2 2, 0.25 Bridgend, Bristol

Totals 22 18

Table 4: Population served and data on outreach clinics

Region No. of paediatric neurology consultants (Whole & P/T NHS + Academic)

Total PAs Population ( millions)

No. of districts served

No. of districts with outreach clinics

Outreach clinics with local consultant present in clinic

Outreach clinics without local consultant present in clinic

No. of funded outreach clinics

No. of districts with lead consultants for epilepsy

No. of districts with lead consultants for neurodisabiility

Comments

E. Anglia 5 38 4 13 13 10 1 15 7 2

Mersey 5 53 ? 11 11 11 0 ? 11 6

N.East 8 55.5 3.1 16 13 3 0 16 12 16

N. London

23 169.5* 15 1 1 1 0 ? ? ? Neurology/ Neonatal PA

N. West 8 77 4.5 23 20 18 2 20 21 23

S. London 14 121 ? 17 17 9 8 ? 6 5

S. West 7 61 5 11 10 10 0 10 11 7

Trent 8 88.25 9.2 16 13 10 3 11 12 4

Oxford 4 44.8 2.7 9 ? ? ? 8 3 4

Yorkshire 7 61.5 4 13 13 6 7 ? 8 8

Wessex 6 44 3 10 8 5 3 8 2 3

W. Midlands

6 69.5 6 15 10 6 4 ?10 ? ?

N. Ireland 4 40 1.75 5 3 1 2 ? 3 1

Scotland 9 119 5.5 9 7 7 0 7 7 3

Wales 5 43* 3 7 7* 7 0 0 3 2 *Several DGH’s in some districts , so some not served, Bridgend issue

Table 5: Networks

Region Clinical forum Teaching session

P.E.T. Courses Shared protocols

Patient pathways

Is network activity funded

Estimate (PA/week)

Other networks

E. Anglia Y Y 1 & 2 Y Y N 0.25 Medical 0.25 Nursing

Mersey Y Y 1 & 2 Y Y (Planned) N - ND

N.East Y Y 1 & 2 Y (Planned) Y (Planned) N -

N. London

Y Y Y Y Y N - NMD: Northstar, MD SIG, Stroke SIG, N. Thames Neurology Group

N. West Y Y Y N N N - NMD: Northstar

S. London Y Y 1 & 2 Y Y N 6 Medical 6 Nursing

S. West Y Y 1 & 2 Y (Planned) Y (Planned) N 0.5 Medical 0.5 Nursing

NMD, ABI

Trent Y Y Y Y Y N -

Oxford Y Y 1 & 2 N N N -

Yorkshire Y Y Y Y Y N 0.25-0.5

Wessex Y Y 1 & 2 Y (Planned) Y (CP) Y (Planned Epilepsy)

N - ND, NMD

W. Midlands Y Y 1 & 2 Y Y N -

N. Ireland Y Y 1 & 2 Y (Planned) Y (Planned) N 0.5 Medical

Scotland Y Y 1 & 2 Y Y Y 2 Medical 8 Nursing

Full-time manager & Part-time Administrator

Wales y y 1 & 2 Y Y (Ep Transition)

N -

Table 6: Specialist nursing staff

Region W.T.E Type Band Level Nurse led clinics

E. Anglia 1.4 Epilepsy 7 Y Transition

Mersey 2+ Epilepsy, NMD 7 Y Epilepsy

N.East 1.8 Epilepsy, Neurology 7 Y VNS

N. London

4 Epilepsy, NMD, ketogenic diet, vascular, headache, neurology 7,8 N

N. West 6 Epilepsy, NMD, ABI ? Y DMD

S. London 3 Epilepsy, complex motor, neurology ? N

S. West 3.5 Epilepsy, epilepsy Surgery, discharge planning 6,7 Y Epilepsy, VNS

Trent 4.9 Epilepsy, neurology, ITB, Homecare, 6, 7, 8 Y Epilepsy, ITB

Oxford <1 Epilepsy ? Y VNS

Yorkshire 2.5 Epilepsy, spasticity 7 Y VNS

Wessex 3.2 Epilepsy, NMD, neuro-oncology, neurology, spasticity 6, 7 Y Epilepsy, general

W. Midlands 1.5 Epilepsy, metabolic 8 Y Epilepsy, ketogenic diet

N. Ireland 2 Neurology 6, 7 N

Scotland ?17.6 Epilepsy, NMD, neurology, vein of Galen 7, 8, Nurse Consultant

Y Epilepsy, teenage, transition, VNS

Wales ?7 Epilepsy 6, 7 N

Paediatric Neurology Manpower Report: 2012

Table 7a: Some specialist clinics, the remainder are listed in table 7b

Region Epilepsy Spasticity Movement disorder

Neuro-ophthalmology

Metabolic Ketogenic diet

Vagus Nerve Stimulator

Demyelination /Inflammation

Neuromuscular

E. Anglia Y Y Y

Mersey Y Y Y Y

N.East Y Y Y Y

N. London

Y Y Y Y Y Y

N. West Y

S. London Y Y Y Y

S. West Y Y Y Y Y Y

Trent Y Y Y Y Y Y Y Y

Oxford Y Y

Yorkshire Y Y Y

Wessex Y Y Y Y

W. Midlands Y Y Y Y Y Y Y Y

N. Ireland Y Y Y Y Y Y

Scotland Y Y Y

Wales Y Y Y Y Y Y

Paediatric Neurology Manpower Report: 2012

Table 7b: Some specialist clinics, others are listed in table 7a

Region Neuro-oncology Neuro-respiratory

Neuro-genetic Headache Teenage epilepsy Transitional Neuro- psychiatry

E. Anglia

Mersey Y Y Y

N.East Y Y Y

N. London

Y Y Y Y (NMD)

N. West

S. London

S. West Y Y Y

Trent Y Y Y

Oxford Y Y

Yorkshire Y Y Y (NMD)

Wessex Y Y

W. Midlands

N. Ireland

Scotland Y Y Y

Wales Y Y Y

Paediatric Neurology Manpower Report: 2012

Table 8: Specialist paediatric neurology services offered

Region Epilepsy surgery

Ketogenic diet

Intrathecal baclofen

Deep brain stimulation

Epilepsy genetics

Vagus nerve stimulator implantation

Botulinum toxin injection

Dorsal root rhizotomy

Miscellaneous

E. Anglia Y Y Microcephaly, TS, Neonatal neurology

Mersey Y Y Y Y Vascular

N.East Y Y Y Y Post ABI, Mitochondrial, Congenital myasthenia, Arthrogryphosis, Hereditary neuropathy, Immunology

N. London

Y Y Y Congenital myasthenia, SMA, DMD, Neuropathy, Myopathy, Connective tissue, Orthopaedic

N. West Y Y ABI, NF

S. London Y Y Y Y Y Y Tourette, Tic, Wilson, Vascular

S. West Y Y Y Y Y Y Y TS, ABI, Dorsal rhizotomy

Trent Y Y Y Y Y Syncope, Orthopaedic,

ND, AT

Oxford Y Y Y Y Congenital myasthenia, Tourette, NF2

Yorkshire Y Y Y Y (starting) Spinal dysraphism, ABI, ND

Wessex Y Y Y Y

W. Midlands Y Y Y Ataxia, Sleep

N. Ireland Y Y

Scotland Y Y Y Y Sleep

Wales Y Neurosurgery (joint)

Paediatric Neurology Manpower Report: 2012

Table 9: Outpatient tariff for paediatric neurology

Region New patient (£) Follow up (£)

E. Anglia 375 195

Mersey 370 270

N.East ? ?

N. London

190 190

N. West ? ?

S. London ? ?

S. West 150-300 95-150

Trent 480, ?, ? 440,?, ?

Oxford ? ?

Yorkshire ? ?

Wessex ? ?

W. Midlands ?350 ?250

N. Ireland ? ?

Scotland ? ?

Wales ? ?

? = Tariff under negotiation or not provided

Paediatric Neurology Manpower Report: 2012

Table 10: SPA within NHS sessions for paediatric neurology consultants?

Region Total No. of NHS PAs for all consultants

Total No. of SPA for all consultants

DCC: SPA ratio Comments

E. Anglia

Mersey

N.East

N. London

N. West

S. London

S. West

Trent

Oxford

Yorkshire

Wessex

W. Midlands

N. Ireland

Scotland

Wales

Information about SPA was not provided by most of the Deanery Advisers. These data are therefore not provided. Subsequent discussions indicate that WTE posts

appointed to a few years ago had contracts with 2.5 SPA/week, and more recent posts 1.5-2 SPA/week. Clinical work in many posts did not allow 2.5 SPA/week to

be set aside during normal working hours, although the majority undertook >2.5 SPA/week.

Paediatric Neurology Manpower Report: 2012

Table 11: Provision of secondary and tertiary level neurological services, outpatient durations, and telephone clinics

Region Secondary level services

Duration secondary level new outpatient appointment (minutes)

Duration secondary level follow-up outpatient appointment (minutes)

Tertiary level new outpatient appointment (minutes)

Tertiary level follow-up outpatient appointment (minutes)

Telephone clinics Tariff for telephone clinics (£)

E. Anglia Y 45 30 60 30

Mersey ? ? ? ?

N.East N ? ? 60 30

N. London

N ? ? 60 30 Y 12

N. West Y 35 15 45 20

S. London N ? ? 45 40

S. West Y 40 20 40 20

Trent Y, Y, N 40, 60, ? 20, 30, ? 40, 60, ? 20, 30, ?

Oxford Y 40 20 40 30

Yorkshire Y 40 20 50 25 Y ?

Wessex Y 40 20 50 25

W. Midlands Y 30 15 40 20

N. Ireland N ? ? ? ?

Scotland Y 30 15 30 15

Wales Y (S), N (C) ? ? 40 20

? = data not provided

Paediatric Neurology Manpower Repot 2102

Table 12: Training requirements and suggestions for overcoming any problems

Region Difficulties with meeting training requirements in paediatric neurology because of general paediatric commitments.

Suggestions for improving situation

There is a general agreement that this is a problem, but it was felt that the manpower survey was the wrong place for this question and was ignored by

almost all respondents.

Suggested questions to consider with next BPNA Manpower survey:

There were no suggestions made.

For future surveys the latest Manpower Report could be modified with additional columns for the new information requested. The data for the Trent Region

is currently collected from three centers by the single Regional Advisor. Likewise the data from the two Welsh centers are also amalgamated by the Regional

Advisor for Wales. In the future it may be more appropriate to nominate a clinician at each center in these regions to provide individualised data.

It would also be helpful to define whole time and part time posts before the next survey.

Summary of BPNA Manpower Survey performed in January 2012 1 There are 96 whole time NHS consultant paediatric neurologists in the UK (defined as ≥ 7 NHS PAs), 7 part time NHS consultant paediatric

neurologists (defined as ≤ 6 NHS PAs), and 16 academic posts at consultant level in paediatric neurology. The latter contribute 62.5 PAs per week to the NHS (equivalent of 6 whole time consultant posts). Assuming that each part time post is equivalent to a 0.5 whole time post, there are approximately 106 whole time equivalent NHS consultant paediatric neurologists in the UK.

2 There are fewer part time NHS posts in this survey than in the past, but this is likely to be secondary to a more explicit definition of part time

working in this survey. 3 The total number of whole time NHS Consultants has increased over time from 61 in 2002, to 95 in 2010, and to 106 in 2012. 4 The total number of consultant in paediatric neurology posts, which includes whole and part time NHS and academic posts has increased from

67 in 2002, to 115 in 2010, and to 119 in 2012. 5 Consultants in general and community paediatrics or neurodisability provide 13.5 PAs of paediatric neurology activity. 6 It was estimated that nearly 90 PA of NHS activity, equivalent to the activity of 9 whole time consultants, was being performed without funding

in 2012. 7 There were 2 consultant paediatric neurology posts funded but unfilled in 2012. 8 It is anticipated that 7.5 consultants will be retiring by the end of 2015. Over the same time period it is anticipated that 14 posts will become

available (appointment to posts following retirement and new posts), 12 at consultant level in paediatric neurology. This indicates an average of 3 new appointments per year in paediatric neurology at consultant level over the next 4 years.

9 25 trainees are expected to gain CCT in paediatric neurology by end of 2015, an average of 6 per year. This indicates a surplus of 3 trainees with

CCT each year for the number of consultant paediatric neurology posts becoming available each year over the same time period.

10 A slight surplus of trainees over available posts is desirable to develop a flexible workforce allowing part time working/job sharing arrangements, appointment to posts that may not be filled because CCT holders are unable to relocate for personal reasons, and because CCT holders may choose to take up permanent positions outside the UK (4 since January 2010).

11 It is likely that the creation of new consultant posts over the next few years will be hampered by the current need for savings within the NHS.

In the longer term there is a growing move towards consideration of a consultant provided service and restricting the number of training posts (RCPCH), which for small specialities may warrant an initial increase in the number of training posts.