The state of the older people’s healthcare workforce: A report from the BGS membership survey

Report
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Authors
British Geriatrics Society
Dr Amit Arora
Professor Adam Gordon
Sally Greenbrook
Topics
Allied Healthcare Professionals
Education, Training and Careers
Health and social care policy
Nursing
Workforce
Mental Health
Wellbeing
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This report summarises the findings of a survey of the BGS membership undertaken in the second half of 2023. It provides a snapshot into how our members are feeling about their work and the services they work in. 

Foreword

We last surveyed the BGS membership in the midst of the COVID-19 pandemic. The survey was designed to gather intelligence specifically about our members’ experiences during the pandemic – the challenges they faced and how the services they worked in were meeting these challenges. While COVID is very much still present in our healthcare systems, the emergency posed by the virus has passed. We are aware, however, that the situation faced by our members daily is still incredibly tough.

In 2023 there was industrial action across a number of professional groups, including the first time ever that consultants have walked out. At the time of writing, these industrial disputes remain unresolved for several disciplines. The workforce continues to be under immense pressure with high vacancy rates across the system and patients facing long waits for care. Winter 2022-23 was extremely challenging for BGS members and the older people they care for and, even as we wait for formal statistics, the indications are that winter 2023-24 has been every bit as challenging.
 
This report gives us an insight into how our members are feeling about their work and the services they work in. For the most part, it paints a bleak picture. It tells of a workforce who are frustrated and exhausted by the system that they are working in and the desperation they feel at not being able to provide the high quality care they aspire to. Too often we talk about healthcare being a vocation, which is an unhelpful narrative; people who work in healthcare roles are professionals who deserve to be paid fairly for their time and expertise. However, it is noteworthy that very few of our respondents mentioned pay when asked what would make the biggest difference to their mental and emotional wellbeing. Far more respondents simply said that having more staff would improve their wellbeing. Healthcare professionals should receive fair pay for the crucial work that they do but they are generally not motivated by money. Rather, they want a resolution to workforce shortages so that, with their colleagues, they can achieve more for their patients.
 
There is however some cause for optimism. Members told us that their services have implemented innovative solutions to the workforce crisis locally, ensuring that older people can still access the care they need. While more staff are plainly needed, we applaud those services that have managed to find creative ways of working to make the most of the staff they do have. Here at BGS, we would like to be able to share those stories so that colleagues can learn from each other.
 

Healthcare professionals should receive fair pay for the crucial work that they do but they are generally not motivated by money."

We publish this report at the beginning of what will almost certainly be an election year. Older people use the NHS and social care more than any other population group. It is imperative that political parties consider the needs of this age group, and the views of the healthcare professionals who care for them, when planning their health policies. This is vital in solving current pressures on the healthcare system but also fundamental to planning for our ageing society.
 

Professor Adam Gordon

Dr Amit Arora

BGS President

BGS Vice President for Workforce

Introduction 

During summer and autumn 2023, the British Geriatrics Society (BGS) surveyed members via SurveyMonkey. Our aim in doing this was twofold. Firstly, we wanted to gather workforce information from across our multidisciplinary membership. We knew that through the annual census conducted by the Royal College of Physicians1 we had access to rich quantitative data about our physician members. We understand from this census how many geriatricians there are across the country, where they are and some information about how they feel about their work. This is useful data and we used this in our Case for More Geriatricians2 report. However, we do not have equivalent data for our multidisciplinary members and this survey was, in part, an attempt to gather some of this data. 

Our second reason for surveying the membership was to understand more about what is happening in their services around the country. While we will not claim that this survey gave us as much data on the multidisciplinary team as we were hoping for, it did give us an insight into how our members are feeling about the services they work in and the care they are currently providing for their patients. 

The survey was open from 31 July 2023 until 9 October 2023 and was promoted to members through email and posts on X (formerly Twitter). At the time of the survey, BGS had 4,600 members across the multidisciplinary team; 359 people responded to the survey, representing around 8% of the total membership.

We regularly analyse data from the RCP census from the perspective of geriatric medicine and publish this analysis.3 Our latest analysis of the RCP data will be published shortly after this report is published. We have cross-referenced some of the findings from the census into this report where relevant.

Who responded

Demographics
Approximately two thirds (66%) of those who responded identified as female, 33% identified as male and 1% preferred not to say. This matches closely with the gender make-up of our membership. More than 60% of respondents were aged between 40 and 59.
 
When asking about ethnicity, we used categories used by the Government for the census4 which break down common ethnic groupings into more specific ethnicities. The majority of respondents told us they were white (English, Welsh, Scottish, Northern Irish or British) with 68% of respondents placing themselves in this category. In total, 77% of respondents told us that they were from white ethnic groups. The second largest ethnic group was Asian or Asian British (Indian) with 7% of respondents identifying with this ethnicity. When added together, those from all Asian and Asian British ethnicities comprised 16% of respondents. Only 2% of respondents told us they were from Black ethnicities, making this the smallest ethnic group. We do not hold full ethnicity data on all our members. However, from what we do hold, it appears that members from white ethnic groups are slightly overrepresented in our survey responses when compared to members from other ethnic groups.
 
Just over 70% of respondents were based in England with 13% in Scotland, 8% in Wales, 6% in Northern Ireland and 3% outside of the UK. When compared to our membership distribution, it appears that members in England are slightly underrepresented in this survey as 78% of our membership is based in England. The devolved nations are each slightly overrepresented when compared to their share of the BGS membership.
 
Responses were received from each of the English regions of membership. The fewest responses were received from Mersey with 1.2% of responses, while the region with the most responses was the South East with 11.8% of responses.
 
Work
More than half (60%) of respondents are in Category A of BGS membership which includes senior doctors – post CCTi or CESR CP.ii Category B members (pre CCT or CESR CP doctors) represent 16% of respondents. Just under a quarter (23%) were in Category C which includes healthcare professionals such as nurses and allied health professionals and 1% were in Category D which is the free membership category available to students. With the exception of category C members, the distribution of responses does not closely match our distribution of our membership. Category A members are over-represented in the survey response as they comprise 45% of our membership. Category B members are underrepresented as they comprise 25% of our membership. As mentioned, category C members almost match as they comprise 24% of our membership. Category D members are underrepresented as they comprise 6% of our membership.iii The vast majority of those responding from category A were consultants in geriatric medicine with 80% of category A respondents giving this as their job title. The second largest profession within this category were GPs who comprised 6% of respondents from category A.
 
More than half (56%) of those from category B said they were Specialty Registrars followed by 26% who told us they were Associate Specialists or SAS grade doctors.
 
Within category C, the largest group was Advanced Clinical Practitioner (ACP) at 30% followed by Consultant Practitioner (CP) and physiotherapist, both at 19%. Within the ACP and CP groups, we asked respondents to specify their profession by registration, and nurses were the most represented profession in both categories.
 
The people who responded in category D were undergraduate medical students and foundation year doctors. However, the numbers responding in this category were very low and because of this, we have avoided making generalisations about this group in the analysis.
 
The majority of respondents (60%) work in an acute hospital setting. Nine per cent told us they work in blended working roles and 8% said they work in a community including hospital at home and virtual wards (excluding community hospitals which were a separate category). Six per cent told us they work in primary care and 5% said they work in community hospital.
 
Almost two thirds (62%) of respondents work full time with 28% working less than full time. Analysis of the RCP census shows that 31% of consultant geriatricians work flexibly or less than full time. Of those within the BGS membership who work less than full time, 83% told us that they identify as female. The vast majority (93%) of respondents work in a role that is clinical at least part of the time.
 

i. Certificate of Completion of Training
ii. Certificate of Eligibility for Specialist Registration via the Combined Programme
iii. Membership data correct as of 31 December 2023.
iv. We were advised by members of our Trainees Council to use this terminology instead of ‘junior doctors’.

Results and analysis

To read the results and analysis of the survey, including direct quotes supplied by members and a call to action from BGS, please download the PDF of the report here.