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Our latest report, Rheumatology Workforce: A crisis in numbers, has revealed chronic workforce shortages and high levels of vacancies. This means the specialty lacks sufficient staff to provide the level of care recommended by NICE guidance.


We spoke to Dr Alan MacDonald, a consultant rheumatologist in the north of Scotland. Covering a wide geographical area, Dr MacDonald talks about staff shortages, what impact it’s having and how working across health board boundaries is supporting service provision.


What’s the situation like in the north of Scotland?

By some considerable distance, workforce is the biggest challenge we face. My perspective is a specific one from the north of Scotland, which encompasses both urban and remote rural communities. We cover an enormous geographical area and like most areas away from the large population centres, the problems of recruitment and retention are that much greater.


How many consultant roles are you short?

We currently have less than six full-time equivalent consultants covering the whole of the north of Scotland, which is nearly a million people widely scattered. We’re two consultants short in my health board, with the same number short in the neighbouring one, so we’re well below target figures. One of the posts has been vacant for around three years. When there are so few senior clinicians, trying to do more than just keep afloat becomes a challenge.


Is that reflected in the rest of the MDT?

In my board area, service has traditionally been largely delivered by consultants and because of the vacancies we haven’t been able to do as much MDT development like other centres have. In trying to deal with the shortage of consultants, finding new funding to develop MDT becomes really difficult. But we’ve always recognised the need to expand and support the entire rheumatology team and this is more important than ever.


What impact is that having?

Workforce shortage is long-standing and coupled with the backlog of care built up over the period of the pandemic means that the full impact has probably not yet been fully seen. Waiting times for new patients are running at many months. Without adequate staffing, many of the improvements in patient care that have been achieved over the last 20 years will be put at risk.


What are some of the issues?

Problems with recruitment and retention goes back a long way and the reasons are complicated. Planning in health services has always been incredibly difficult and we’re not producing enough trained specialists. I also think that long term conditions such as arthritis have simply never had the priority they deserve. As the NHS faces up to the enormous challenges of recovering from this pandemic, we can’t allow the needs of our patients to again be sidelined.


What do you think needs to be done?

The solutions needed here to provide better care might not be the same as elsewhere, but training is certainly an area that would help everywhere. The issue also needs high-level engagement and getting people to take services seriously. Beyond the cost of biologics, we’re not an expensive specialty so money isn’t the biggest issue we face, in my view it’s priority and engagement.


Tell us about the work you’re doing to strategically plan services in your area?

Whilst we continue to push for more adequate resource, we have to look at ways by which we can use existing resource more effectively and we have sought to work more collaboratively across health board areas. I am currently providing clinical sessions across three health board areas in an attempt to support this process and share best working practices.


The use of remote technology, of course, has expanded greatly and whilst no panacea, it has been of benefit particularly to those living in our most remote mainland and island communities. If we can ensure that this is driven by the needs of our patients it will at least mitigate the worst harms of our current manpower crisis whilst we continue to highlight the need for improved staffing.


Read the report