PLASTIC SURGERY MEDICAL SPECIALTY WORKFORCE FACTSHEET
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MEDICAL SPECIALTY WORKFORCE FACTSHEET
PLASTIC SURGERY
This document sets out factors that will be considered when assessing the supply and requirement of the future medical workforce. The first
section of the fact sheet focuses on the future requirement of the specialty; the second section focuses on the current supply. This information
will form part of the body of evidence used to advise recommendations of future medical training numbers. At this stage it does not present
conclusions or recommendations. This is a live document that represents work in progress; it will be updated on an ongoing basis as information is
located and made available to the CfWI. The CfWI will welcome relevant contributions to the content or interpretation of information within the
medical specialty workforce fact sheets.
As a guide, the document is set out in the following divisions. Some of the themes that have been identified may overlap several divisions.
Considerations for future requirements
Current Status of Specialty’s Requirement
Demographics
Health and Lifestyle
Prevalence and estimated future incidence of factors that affect requirement
Changes in practice which may affect level of service
Finished Consultant Episodes (FCEs) and Outpatient Attendances
Weighted Capitation
Historical and forecast supply
Existing Workforce
Consultant projections
Geographic distribution
Recruitment to further medical training
Related healthcare workforce
CfWI | August 2010 1
Medical Specialty Workforce Factsheet
Plastic Surgery
CONSIDERATIONS FOR FUTURE REQUIREMENTS
Current Status of Specialty’s Requirement
Developing a Modern Surgical Workforce, the report from the Royal College of Surgeons of England (RCSeng, 2005) recommends a ratio of one full
time equivalent (FTE) consultant per 100,000 population. Based on subnational population projections by the Office of National Statistics (ONS) for
2010, this gives an estimated requirement of 522 FTE trained specialists for England. The Information Centre (IC) Census reports that there are 308
(291 FTE) Plastic Surgery consultants employed in England as of September 2009.
Vacancies and Locum Staff
The most recent data available (extracted via iView from ESR, March 2010) records that 1.5% of the practising consultant workforce are locums (5
locums out of a total of 320 consultants).
The IC vacancy survey (2008) records a 3-month vacancy rate of 2.2% for Plastic Surgery consultants in England. This is highest in London SHA at
11.5%. The remaining SHAs have vacancies rates of 0%.
CfWI | August 2010 2Medical Specialty Workforce Factsheet
Plastic Surgery
Demographics
Figure 1: 2031 population estimate and indication of age and gender of the population which relies most heavily on Plastic Surgery
Figure 1 represents the population of England as of 2010 and highlights
85+
80-84 2010 Females the age and proportion of males and females that typically present for
most heavily reliant
75-79
70-74
care in Plastic Surgery. The areas highlighted in blue and pink show the
65-69 ages that require the most significant portion of Plastic Surgery services
60-64 2010 Females
for males and females respectively. A grey area illustrates the population
Age Group
55-59 less heavily reliant
50-54
45-49 2010 Males most
distribution where neither males nor females in the age range are
40-44
35-39
heavily reliant typically treated or have interventions delivered by this speciality. The
30-34
25-29
2010 Males less bold lines show the level of the population in 2031 by age band as
heavily reliant
20-24 predicted by the Office of National Statistics (ONS).
15-19
Black outline -
10-14
2031 population
5-9
0-4
estimate It indicates that the population aged between 0-54 is most reliant on
5% 4% 3% 2% 1% 0% 1% 2% 3% 4% 5%
Plastic Surgery and will drive the requirement for those services.
Figure 2 displays the relative population percentage growth per year broken down by age groups highlighting the variable rates over time and age.
Figure 2: Demographic Summary
2010 2017 2019 2025 2031
In Plastic Surgery the age group which accounts for the most significant
proportion of care required is generally the young and adult groups. The
0-19 0.53%
majority of the population served by Plastic Surgery is expected to grow
20-39 0.79% -0.01%
0.43% 0.01% 0.5%
at an average rate of approximately 0.5% per year up to 2031.
40-59
60+ 2.03%
all ages 0.74%
Time/years
CfWI | August 2010 3Medical Specialty Workforce Factsheet
Plastic Surgery
Health and Lifestyle
Lifestyle Influences
The information presented here is meant to aid in identifying possible influences to future requirements of consultants in Plastic Surgery. These
indicators have not been quantified but rather present intelligence from which future trends on the impact of requirements to the specialty may
be ascertained. The information presented here does not constitute a complete list.
Common procedures and interventions performed by Plastic Surgeons are reconstruction as a result of trauma to the upper and lower limbs, or
cancers of the head and neck, and breast.
Traumas
Typical behaviours and lifestyle choices that can lead to trauma incidents that require intervention by a plastic surgeon are:
• Violence
• Taking risks when driving, leading to road traffic accidents
• Participation in sport –leading to injuries
• General risk taking attitudes that lead to accidents such as burns
The incidence of road traffic accident may change as a result of the withdrawal of speed cameras in parts of England.
Cancers
The National Cancer Intelligence Network report, Cancer Incidence by Deprivation, England, 1995-2004, states that head and neck cancer
incidence has particularly strong associations with social deprivation. In the most deprived quintile of the population head and neck cancers had a
ratio of 2.1 to 1 comparing the incidence rates in the most deprived with the most affluent (males and females combined). Therefore a swing in
social deprivation levels could lead to a change in requirement for plastic surgeons.
CfWI | August 2010 4Medical Specialty Workforce Factsheet
Plastic Surgery
Prevalence and estimated future incidence of factors that affect requirement
The Oxford Cancer Intelligence Unit report, Profile of Head and Neck Cancers in England: Incidence, Mortality and Survival, summarises the
incidence of head and neck cancers as follows:
‘The incidence of several Head and Neck cancers has risen between 1990 and 2006:
• Oral cavity cancer incidence has risen by more than 30%; immigration from the Indian subcontinent may have contributed to this trend,
since chewing of betel quid is an important risk factor. This finding supports the further development of oral cancer risk awareness
programmes.
• Salivary gland cancer incidence has increased by around 37%, though the numbers remain small. The reasons for this rise are unclear, but
analysis of trends in different pathological subtypes might be informative.
• Oropharyngeal cancer incidence has more than doubled – the biggest rise in any head and neck cancer. Recent research suggests a
change in patterns of causation, with human papilloma virus (rather than smoking and alcohol) being the primary risk factor in a younger
subpopulation.
• The incidence of palate cancer has increased by 66%. The reasons for this are unclear; further work is needed to establish whether the rise
is primarily in soft palate cancer (matching the rise in oropharyngeal cancer) or hard palate cancer.
• The incidence of thyroid cancer has doubled. This may be due in part to increased detection of small papillary carcinomas through the
imaging of goitres.
Laryngeal cancer has declined in incidence by 20% since 1990, but incidence has levelled off in the last five years. Laryngeal cancer is strongly
associated with smoking and its falling incidence may reflect a reduction in smoking rates.
The incidence of nasopharyngeal and hypopharyngeal cancers has not changed significantly during the study period.
Incidence rates for all types of cancer (averaged over the last four years of the study period) vary significantly between the Strategic Health
Authorities and Cancer Networks with the lowest and highest incidence, but the geographical pattern of distribution varies from cancer to cancer.
This may reflect the distribution of different risk factors, including those that predominantly affect certain ethnic groups. A general pattern of
higher incidence in the north and west of the country is common but not universal; London often has high rates too, and the highest rates of oral
CfWI | August 2010 5Medical Specialty Workforce Factsheet
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cancer, nasopharyngeal cancer and palate cancer are found in parts of London.
The average national incidence rates vary from 0.39 per 100,000 population for nasopharyngeal cancer (an average of 208 cases per year across
England) to 3.01 for laryngeal cancer and 3.02 for oral cancer (an average of 1729 and 1767 cases per year respectively).’
Changes in practice which may affect level of service
Procedures in Plastic Surgery are becoming more complex and therefore more labour intensive. This may increase the level of service required in
the future.
The Royal College of Surgeons of England (2007) made the following statement in the Future of the Medical Workforce: College Response:
‘Historically the basis for calculating the requirement for surgical consultants was the ability to sustain an emergency and elective service in a
system comprising teaching and district general hospitals. That mould has now been broken and going forward, workforce planning will need to
take into account recent policy developments including the introduction of a range of different providers to the health system, making further
economies in the use of specialist surgeons more likely. The workforce required to deliver a safe and efficient service will need to be planned
against the locations in which that service will be delivered. For example, there is evidence to suggest that 96% of elective care by volume requires
a critical care stay in fewer than 4% of cases. This gives some indication of the volume of work that could be safely undertaken in a separate
environment regardless of proximity to critical care and will be important in discussions relating to workforce planning and the reconfiguration of
services.’
Cancer
The coalition government has asked Prof. Sir Michael Richards to review the Cancer Reform Strategy (CRS) of 2007. The consultation ends in
September 2010, the outcome from this may have an effect on the requirement of Plastic Surgeons if there are changes in practice for cancer
treatment as a result of the review.
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Skin cancer
The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) has made the following statement in 2010:
‘A high proportion of UK plastic surgeons' non-emergency work-load is spent treating and reconstructing patients with skin cancer. BAPRAS is
concerned that young people in particular don't fully understand the dangers and long term health risks associated with skin cancer and feel that
restricting use of sun beds will help prevent a further increase in levels of skin cancer in the UK.
Research from BAPRAS in 2009 showed that 28% of 18-24 year olds say the risk of skin cancer won't make them spend less time sunbathing. Of
these, 43% said this was because the threat of skin cancer didn't occur to them, while 19% didn't realise they were at risk of developing it. In
addition, 16% of 18-24 saying they would be too busy to get a mole checked and one in ten saying getting it looked at wouldn't even occur to
them.’
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Finished Consultant Episodes (FCEs) and Outpatient Attendances
Figure 3: FCE per year for Plastic Surgery
Finished Consultant Episodes for Plastic Surgery
300000
Finished Consultant Episodes (FCEs)
It is assumed that the recording and definition of FCEs in this speciality
250000 has not changed significantly over this time period, and therefore the
rise in FCEs from 2005 onwards indicates an increase in activity in the
200000
speciality. Figure 4 shows the trend in outpatient FCEs from 2003-
150000 2008; it indicates a similar trend of an increase in activity.
100000
50000
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year starting
Source: The NHS Information Centre, Hospital Episode Statistics for England. Inpatient statistics, 1998-2008.
CfWI | August 2010 8Medical Specialty Workforce Factsheet
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Figure 4: All outpatient attendances per year for Plastic Surgery
Outpatient attendances per year for Plastic Surgery Figure 4 shows outpatient data for Plastic Surgery. Note: The main
1000000
specialty reflects the specialty under which the consultant with prime
All outpatient attendances (Main
900000 responsibility for the patient is registered. This is in contrast to
800000 treatment outpatient attendances data which is also available, and is
700000 described as: ‘Treatment specialty reflects the specialty under which
Specialty)
600000 the consultant with prime responsibility for the patient is working’.
500000
400000 Advice for interpretation of outpatient data is given as follows: ‘The
300000
outpatients’ dataset contains individual records for all outpatient
200000
appointments occurring in England, such as the type of attendance, ie
100000
0
whether it was a first or follow-up attendance, or the main specialty, ie
2003 2004 2005 2006 2007 2008 the specialty under which the consultant with prime responsibility for
Year starting
Source: The NHS Information Centre Hospital Episode Statistics, Main specialty Outpatient attendances for England, 2003 – 2008
the patient is registered. The latest HES data is available from the freely available data section of the HESonline website
[http://www.hesonline.nhs.uk]. For data breakdowns beyond the scope of the tables available, such as a count of appointments split by source of
referral (ie whether or not the outpatient appointment was initiated by the consultant responsible for the outpatient attendance or not), please see
the Request a tailor made report section of the HESonline website. Great care must be exercised when comparing HES figures for different years.
Fluctuations in the data can occur for a number of reasons, eg organisational changes, reviews of best practice within the medical community, the
adoption of new coding schemes and data quality problems that are often year specific. These variations can lead to false assumptions about
trends. We advise users of time series data to carefully explore the relevant issues before drawing any conclusions about the reasons for year-on-
year changes.’
CfWI | August 2010 9Medical Specialty Workforce Factsheet
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Weighted Capitation
Table 1: Table of six scenarios for each SHA based on weighted capitation for the possible requirements of junior doctors – Plastic Surgery
Strategic Health Ratio of Actual: Weighted Move all to average Move all to median Move all to Move all to 2nd Move all to 2nd Move all to
Authority capitation value value min min Max Max
0.99 1.04 0.01 0.51 1.40 1.63
North East 1.63 max max max max max max
North West 0.99 0 2 -39 -19 16 25
Yorkshire & The Humber 1.10 -3 -2 -31 -17 8 15
East Midlands 0.45 min min min min min min
West Midlands 0.83 5 6 -24 -9 17 23
East of England 1.40 -11 -9 -37 -24 0 6
London 1.23 -9 -7 -45 -26 6 15
South East Coast 0.51 10 11 -10 0 18 22
South Central 1.13 -2 -1 -19 -11 5 9
South West 0.76 6 7 -19 -7 16 22
Total -4 7 -223 -112 86 137
% change -1.4% 2.2% -69.8% -35.2% 27.0% 43.0%
The table above displays six scenarios based on weighted capitation (WCAP) alone for the possible requirements of junior doctors in Plastic Surgery.
CfWI | August 2010 10Medical Specialty Workforce Factsheet
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Column 2 is the ratio of the actual capitation to the calculated theoretical capitation. Columns 3-8 are the scenarios where all except the most
under capitated and the most over-capitated are moved to the mean, median, least, 2nd least, 2nd most and most capitated levels respectively. The
values in the 2nd row are the mean, median, least capitated, 2nd least capitated, the 2nd most and most capitated respectively.
This analysis reveals that change in requirements range from an increase of 27% (2nd most capitated) to a decrease of 35.2% (2nd least capitated)
on average when only WCAP is considered for Plastic Surgery junior doctors.
CfWI | August 2010 11Medical Specialty Workforce Factsheet
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HISTORICAL AND FORECAST SUPPLY
The supply of Plastic Surgeons is shown in Figures 5a-b. The figures are based upon the latest data available (SAS data only dates back to 2005).
Figures 5a-b: (a) Workforce supply (FTE) and, (b) Workforce supply (HC) – Plastic Surgery
Cumulative historical workforce supply (FTE) and future consultant Cumulative historical workforce supply (HC) and future consultant
projections - Plastic Surgery projections - Plastic Surgery
1000 1000
900 900
800 SAS 800 SAS
700 700
All Trainees All Trainees
600 600
FTE
HC
500 500
Consultants Consultants
400 FTE (historic) 400 HC (historic)
300 300
Consultants Consultants
200 FTE (forecast) 200 HC (forecast)
100 100
0 0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Year Year
The charts above show that the consultant workforce expanded by 5.0% during the past five years based upon the Information Centre (IC) census.
The trend is reflected by middle grade medical staff together with trainees. The supply of plastic surgery staff over the next ten years is forecast to
increase to 464FTE in 2018 (546 headcount), an average increase of 6% annually, based on the following assumptions:
CfWI | August 2010 12Medical Specialty Workforce Factsheet
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• retirement occurs at 60 years of age
• 5% of current trainees are delayed in completing their training by one year, 5% are delayed by two years, 5% by three years and 5% by four
years
• (there are nine international recruits per annum, however no young leavers (non-retirements) or returners per annum,
• there is no conversion from staff grade or associate specialist posts to consultant posts
• there is a wastage rate amongst registrars of 1%.
In the past, the accuracy of WRT’s projections in this specialty have been true to within 1.12%, based upon records published by the IC from 2005
to 2008.
Existing Workforce
Supply
According to the 2009 IC census there are 291 FTE (308 headcount) consultants, while ESR records from September 2009 record 295 FTE (305
headcount). This is a difference of 1% in comparison to census records. The latest available data records 305 FTE consultants (320 headcount)
(extracted via iView from Electronic Staff Records, March 2010).
The age profile of the current consultant workforce as at September 2009 is shown in Figure 6.
CfWI | August 2010 13Medical Specialty Workforce Factsheet
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Figures 6a-b: (a) age profile (FTE) and, (b) age profile (Headcount) – Plastic Surgery
Consultant age profile (FTE) - Plastic Surgery Consultant age profile (Headcount) - Plastic Surgery
160 160
140 140
120 120
100 100
FTE
Headcount
80 80
60 60
40 40
20 20
0 0
Under 30
Under 30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
Age bracket (years) Age bracket (years)
The chart shows a plentiful supply of younger staff and that a number of staff are working beyond typical retirement age - suggesting a possible
impending retirement spike.
The IC three-month vacancy rate for all surgical consultants is 0.7% as of March 2008 (the latest available data); the three-month vacancy rate for
Plastic Surgery consultants is marginally higher at 0.9%.
Geographic Distribution
Figures 2a and 2b below show the geographic distribution of doctors and trainees in absolute values and in relation to the weighted capitation of
each Strategic Health Authority (SHA) (a definition of weighted capitation is given below*).
CfWI | August 2010 14Medical Specialty Workforce Factsheet
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Tables 2a-b: (a) Number of Plastic Surgeons minus the weighted capitation value for each area, and (b) Actual number of medics in each area, across ten SHAs for Plastic Surgery
Number of doctors minus the weighted capitation, shown for Actual number of doctors by grade and SHA, shown for
Plastic Surgery by SHA - Based on latest data available as at Plastic Surgery - Based on latest data available as at April
April 2010 2010
Table (a) Table (b)
SHA Weighted Junior Staff Specialty Associate Consultant Junior Staff Specialty Associate Consultant
Capitation Doctors Grade Doctor Specialist Doctors Grade Doctor Specialist
North East 5.9% 10 -1 1 1 2 25 0 2 3 19
North West 15.2% 0 -1 1 0 -10 39 1 2 4 35
Yorkshire & The Humber 10.8% 3 0 -1 -2 -1 31 1 0 1 31
East Midlands 8.6% -12 -1 -1 1 -10 10 0 0 3 15
West Midlands 11.2% -5 2 -1 4 2 24 3 0 7 34
East of England 10.2% 11 1 -1 -3 8 37 2 0 0 38
London 14.1% 8 -1 1 -2 16 45 1 2 2 57
South East Coast 7.6% -10 0 -1 0 -5 10 1 0 2 17
South Central 6.6% 2 0 1 -1 -4 20 1 2 1 15
South West 9.8% -6 0 0 2 3 20 1 1 5 32
Total 100% 260 11 9 28 291
CfWI | August 2010 15Medical Specialty Workforce Factsheet
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The tables suggest that London, East of England and the North East SHAs have a higher proportion of both consultants and junior doctors than if
provision were to follow weighted capitation. East Midlands SHA has a lower proportion of both consultants and junior doctors than if provision
were to follow weighted capitation.
*The Department of Health uses a weighted capitation formula (WCAP) to distribute resources to primary care trusts (PCTS) based on the relative
health needs of each PCT’s catchment area. If qualified doctors and trainees were equitably distributed according to the formula, all other columns
in Table 8a would be zero. Values greater than zero indicate that the SHA has more doctors and trainees than would be included by WCAP; values
less than zero indicate evidenced room for growth of the workforce.
CfWI | August 2010 16Medical Specialty Workforce Factsheet
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Recruitment 2009
The level of recruitment to further medical training is shown in table 3. The table illustrates the entry point situation for 2009. The data correspond
to posts openly advertised but not those training posts secured by ‘run-through’ trainees:
Table 3: 2009 specialty recruitment for Plastic Surgery at ST3
Deanery Available Posts Accepted Posts Fill Rate
East Midlands 0 0 -
East of England 0 0 -
Kent, Surrey and Sussex 0 0 -
London 23 10 43%
Mersey 0 0 -
North West 3 4 133%
Northern 0 0 -
Oxford 0 0 -
Peninsular 0 0 -
Severn 0 0 -
West Midlands 0 0 -
Wessex 0 0 -
Yorkshire and the Humber 0 0 -
Total 26 14 54%
CfWI | August 2010 17Medical Specialty Workforce Factsheet
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The table shows that there is an uneven distribution geographically, with the North West exhibiting a fill rate of 133% while London has a fill rate of
43%. In CfWI’s view, the degree to which the current numbers of available posts are filled together with the geographic distribution are essential
factors in evaluating the requirement for additional posts.
Related Healthcare Workforce
Plastic surgeons work alongside all surgical specialties, plus surgical nurses and anaesthetists.
CfWI | August 2010 18Medical Specialty Workforce Factsheet
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REFERENCES
• British Association of Plastic Reconstructive and Aesthetic Surgeons, 2010. Plastic surgeons welcome support to stop under 18s accessing
sunbeds. Available at http://www.bapras.org.uk/news.asp?id=580
• Cancer Incidence by Deprivation, England, 1995-2004. National Cancer Intelligence Network. Available at
http://library.ncin.org.uk/docs/081202-NCIN-Incidence_by_Deprivation_95_04.pdf
• Oxford Cancer Intelligence Unit, Profile of head and neck cancers in England: Incidence, mortality and survival. Available at
http://www.ociu.nhs.uk/sph-ociu/sph-documents/Final_Head_-_Neck_Profiles_04May2010.pdf
• Royal College of Surgeons, 2005. Developing a modern workforce. Available at
http://www.rcseng.ac.uk/publications/docs/modern_surgical_workforce.html
• Royal College of Surgeons, 2007. Future of the medical workforce: College response. Available at
http://www.rcseng.ac.uk/rcseng/content/publications/docs/futuremedworkforce.html
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